Mark Russell

Lichenoid dermatitis after consumption of gold-containing liquor

Medicinal gold has a well-known side effect profile that includes mucocutaneous eruptions. We describe three patients with a pruritic dermatitis that began after consumption of a gold-containing alcoholic beverage. Blood and urine gold levels, chemistry panels, hepatitis screens, skin biopsies, and patch tests were performed. The gold-containing liquor was analyzed for the presence and quantity of gold. The liquor consumed by all of the patients was a cinnamon schnapps with free-floating gold-colored flakes. Gold is present in the liquid portion of this liquor and in the solid flakes. Elevated levels of gold in the urine and blood were present in one patient 3 months after last drinking this beverage. Another patient had a positive patch test to gold sodium thiosulfate. All patients experienced improvement of their dermatitis after they stopped drinking the gold-containing liquor.

Suggested Excisional Margins for Cutaneous Malignant Lesions Based on Mohs Micrographic Surgery

IMPORTANCE Surgical excision of skin cancer is a common treatment, yet the proper surgical margin remains unclear. This study reviews data on lesions and their margins as defined by Mohs micrographic surgery. OBJECTIVE To review margins as defined by Mohs micrographic surgery. DESIGN Retrospective review of data from patients with skin cancer. SETTING Academic medical center. PARTICIPANTS All patients with nonmelanoma skin cancer. MAIN OUTCOME AND MEASURE Size and final defect size were compared to calculate the margins needed. All lesions were categorized based on histologic characteristics. RESULTS A total of 495 lesions were reviewed. All tumors and defects had precise measurements. The mean margins for low-risk basal cell carcinomas, high-risk basal cell carcinomas, low-risk squamous cell carcinomas, and high-risk squamous cell carcinomas were 2.4 mm, 3.7 mm, 2.6 mm, and 5.3 mm, respectively. Statistical differences in surgical margins were found between all low- and high-risk cancer types. Established high-risk zones (H-zone) for basal cell carcinoma and squamous cell carcinoma were not associated with larger margins. Margins required to excise completely 95% of all the low-risk basal cell carcinomas, high-risk basal cell carcinomas, low-risk squamous cell carcinomas, and high-risk squamous cell carcinomas, were 4.75 mm, 8 mm, 5 mm, and 13.25 mm, respectively. CONCLUSIONS AND RELEVANCE Differences are noted between low- and high-risk cutaneous lesions. When primary excision instead of Mohs micrographic surgery is the only option, the aforementioned margins may be considered guidelines. The relevance of this study is to guide future management and margins for primary excision. LEVEL OF EVIDENCE 3.

Lichen planus after consumption of a gold-containing liquor.

To the Editor: Idiopathic lichen planus is a pruritic papulosquamous eruption that typically occurs in middle-aged persons. The estimated prevalence of this disorder is less than 1 percent, and its...

The Cadaveric Skin Biopsy Project: Description and student evaluation of an innovative approach to dermatology instruction in the preclerkship medical school curriculum

BACKGROUND Dermatology can develop creative ways of participating in the preclerkship medical school curriculum. OBJECTIVE We sought to describe and report student survey results of a novel collaborative learning activity for medical students, directed by dermatology, histology, and gross anatomy faculty, which used cadavers to replicate the process of skin lesion biopsy and provided a realistic setting in which to learn normal-appearing and abnormal skin histology. METHODS First-year medical students were surveyed regarding the impact of this activity on their understanding of skin histology and their appreciation of dermatology and dermatologic procedures. RESULTS Students were appreciative of the opportunity to perform biopsies and discover the link between the clinical presentation of a lesion and its underlying histopathology. They were less impressed with the ability of the activity to improve their understanding of the characteristics of benign versus malignant lesions. LIMITATIONS This is an early feasibility trial at 1 institution. CONCLUSIONS This project represents one approach to introducing students to dermatology and dermatologic procedures and achieves institutional, Liaison Committee on Medical Education, and Association of American Medical Colleges educational goals. Overall, students highly valued the opportunities to practice clinical procedures and found it aided their understanding and appreciation of dermatology.