Molly Hinshaw

Hidradenomas and a Hidradenocarcinoma of the Scalp Managed Using Mohs Micrographic Surgery and a Multidisciplinary Approach: Case Reports and Review of the Literature

&NA; The authors have indicated no significant interest with commercial supporters.

Cutaneous Adenoid Cystic Carcinoma with Perineural Invasion Treated by Mohs Micrographic Surgery—A Case Report with Literature Review

We report a 58-year-old woman with cutaneous adenoid cystic carcinoma arising on the chest treated with Mohs micrographic surgery. The patient remained tumor-free at 24-month follow-up. To date, only six other cases of cutaneous adenoid cystic carcinoma were reportedly managed by Mohs surgery. Cutaneous adenoid cystic carcinoma has low potential for distant metastasis but is notorious for its aggressive infiltrative growth pattern, frequent perineural invasion, and high risk of local recurrence after excision. We propose that Mohs surgery is an ideal method to achieve margin-free removal of cutaneous adenoid cystic carcinoma. A brief literature review is provided.

Lipoatrophic Panniculitis: Case Report and Review of the Literature

BACKGROUND Lipoatrophic panniculitis (LP) is a rare disease of childhood characterized by eruption of tender erythematous nodules and plaques followed by circumferential bands of lipoatrophy often seen on the arms and legs. This condition has also been known as lipophagic panniculitis of childhood, annular atrophy of the ankles, and partial lipodystrophy. OBSERVATIONS A previously healthy 8-year-old boy was evaluated for tender, raised plaques on the ankles, which progressed to circumferential atrophy of the distal lower extremities. Biopsy specimen analysis revealed a dense mixed infiltrate extending into the subcutaneous tissue as well as lipophages within the fatty lobules. A diagnosis of LP was made, and the patient began treatment with prednisone and hydroxychloroquine. Methotrexate was added later to the regimen as a steroid-sparing agent, and the dose was increased over the course of 3 months, by which time the cutaneous disease progression was nearly halted. However, the patient continued to have lower leg pain with bone changes demonstrated on magnetic resonance imaging. CONCLUSIONS We report this case and review of the literature to call attention to the clinical features of LP and its association with skeletal changes. Our patients response to combination therapy is of interest and contributes to the limited literature about management of this disease.

The current state of dermatopathology education: a survey of the association of professors of dermatology

Background:  Dermatology training programs develop program‐specific dermatopathology (DP) curricula. We summarize the current state of DP education in dermatology residency programs and identify opportunities for DP education resource development.

Chronic disseminated cutaneous blastomycosis in an 11-year old, with a brief review of the literature.

Abstract:  Chronic disseminated cutaneous blastomycosis is rare in children. We discuss an 11‐year‐old immunocompetent boy who presented with a history of persistent and multiple skin lesions of >1 years duration. These lesions proved to be secondary to chronic Blastomyces dermatitidis infection. Complete resolution of clinical disease occurred after a 6‐month course of oral itraconazole. We also present a brief review of the literature focusing on the epidemiology, manifestations, diagnosis, and treatment of pediatric blastomycosis.

Core competencies in dermatopathology

Abstract:  Medical education has traditionally focused on imparting medical knowledge, delivering quality patient care, and teaching research methodology. Various measures of success, including standardized testing, have been developed to assess the achievement of those goals. These measures then served as documentation of the effectiveness of individual training programs. However, in 1999, the Accreditation Council for Graduate Medical Education (ACGME) changed the way we measure the success of medical education. They developed six core competencies for medical education and assigned the task of enforcing them to the individual Residency Review Committees. By July 2006, all accredited programs, including dermatopathology fellowships, must use measurable, competency‐based objectives, and assess achievement of those objectives. Programs should also be documenting ways they are improving the evaluation process. They must be in full compliance with implementation, measurement, and assessment of the six core competencies for accreditation. The next phase required by the ACGME involves developing curriculum based on competencies as well as using resident, fellow, or graduate competency performance to assess success in preparing trainees for the practice of medicine. This manuscript discusses measurable objectives to address the core competencies for dermatopathology fellowship training as well as dermatopathology rotations in dermatology and pathology residency training.

Multiple painful vaginal ulcerations

A 58-year-old man presented with a 7-year history of a lump on the plantar aspect of his left foot. The lesion had slowly enlarged within the preceding 2 years. The patient described intense pain of the left foot during walking or exercise. Dermatological examination revealed a round, rubbery, flesh-colored, 1.5-cm palpable nodule on the volar aspect of the left foot, corresponding with the area of the third metatarsophalangeal joint (Figure 1). The lesion was slightly tender when squeezed between the thumb and index finger. Figure 2 and Figure 3 show a 4-mm punch biopsy specimen obtained from the nodule. What is your diagnosis?

Mohs surgical excision of a granular cell tumor with plexiform features on the arm of a 7-year-old child.

Granular cell tumors (GCTs) are uncommon neoplasms of neural origin. Traditionally, the treatment of choice for GCTs has been routine surgical excision. All reported cases of GCTs treated with Mohs micrographic surgery (MMS) are reviewed. Only five cases of GCT treated with MMS have been reported in the English literature. Furthermore, none of these cases displayed plexiform features, and only one of these cases involved MMS treatment of a GCT in a child. Although GCTs have been reported in almost every location throughout the body, the most common location is the oral cavity, particularly the tongue. GCTs present most commonly during the third to sixth decades of life and are more common in women and African Americans.

Use of Genetic Tools to Control Tumor Margins in Melanoma

Primary melanoma can recur at the excision site if not excised with a safety margin of surrounding uninvolved skin. To characterize the nature of residual melanoma in the skin surrounding primary tumors targeted by safety margins, we used array comparative genomic hybridization and fluorescent in situ hybridization to detect and spatially map aberrations in the skin adjacent to acral melanomas. Melanocytic cells with genetic amplifications in histopathologically normal skin (field cells) were detected exclusively in the epidermis in 84% of 19 cases, with a mean extension of 6.1 mm (in situ melanomas) and 4.5 mm (invasive melanomas) beyond the histopathological margin. Genetic profiling of these field cells indicated that they represent an early phase of disease preceding melanoma in situ. The extent of field cells did not correlate with tumor depth or diameter, indicating that tumor depth is not suited to predict the extent of field cells. These results demonstrate that, on acral sites, melanoma field cells extend significantly into seemingly normal skin. These field cells provide a plausible explanation for the tendency of certain melanoma types to recur locally despite apparently having undergone complete excision.

Dermatopathology Education: An Update

Dermatopathology (DP) education is critical to the comprehensive training of dermatology and pathology residents and to the accurate diagnosis and management of cutaneous disease. DP has seen tremendous growth, and its success depends on our ability to effectively educate future leaders, teachers, and researchers who will continue to advance the field. This article focuses on DP education in the United States, although specific components, such as assessment of medical education and the future of DP education, are relevant to the larger DP community. It is hoped that this review will aid in discussions of direction and collaboration.