Rebecca Körner

Improved patient-centered care with effective use of Integra® in dermatologic reconstructive surgery

The incidence of skin tumors is increasing among elderly patients, and the multi‐morbidities which occur in the elderly are a great challenge for dermatologic surgeons. The currently required safety margins for different types of melanomas and non‐melanoma skin cancers lead to extensive and profound wounds.

Histopathology of body art revisited - analysis and discussion of 19 cases.

With the number of tattoos increasing, a rising number of complications have also been reported, such as allergic and foreign body reactions or the development of malignant tumors. We discuss 19 patients with alterations in skin tattoos, define clinicopathologic characteristics and give a brief review of the literature.

Metastatic breast carcinoma mimicking a sebaceous gland neoplasm: a case report

IntroductionBreast cancer is common in women and its metastases involve the skin in approximately one quarter of patients. Accordingly, metastatic breast cancer shown to be cutaneous through histology must be distinguished from a wide variety of other neoplasms as well as the diverse morphologic variants of breast cancer itself.Case presentationWe report the case of a 61-year-old Caucasian woman with cutaneous metastases of a bilateral ductal breast carcinoma that in histopathological examination mimicked an adnexal neoplasm with sebaceous differentiation.ConclusionAgainst the background of metastatic breast carcinoma, dermatopathological considerations of sebaceous differentiation of skin lesions are presented and discussed focusing on the rare differential diagnosis of sebaceous carcinoma of the breast.

Primary cutaneous carcinosarcomas: a morphological histogenetic concept revisited.

Abstract:To present and define diagnostic criteria for primary cutaneous carcinosarcomas (CSs). Neoplasms of 6 patients with primary cutaneous CSs were retrospectively analyzed. A panel of histopathologic parameters and immunophenotypic expression of distinct markers of differentiation were investigated. All cases had medium-to-poorly differentiated squamous cell carcinoma representing the epithelial component intermingled with a variable amount of malignant sarcomatous tissue proliferation. The authors identified 3 distinct morphological criteria for the diagnosis of primary cutaneous CSs with features of (1) a clearly defined dual neoplasm with explicit morphological characterization using histology and immunohistochemistry with distinct marker panels while, (2) metastases from distant sites and true collision neoplasms must be excluded, and (3) recognition of the neoplasm as a solid coherent proliferation with careful exclusion of sarcomatous stromal changes in the surrounding neoplasm stroma has to be assured. The low incidence of this entity and a plethora of different synonymous terms in the dermatopathologic literature often cause diagnostic problems and hamper the accurate comparative analysis of cases published previously. Herein, the authors propose defining criteria and a clearly defined morphological approach to contribute to more accurate dermatopathologic diagnoses and provide an unprecedented summary on this neoplastic entity.

Occupational allergic contact dermatitis of the ears caused by thiurams in a headset

A 56-year-old female was referred with a 6-month history of recurrent eczema of the auditory canal and adjacent auricle (Fig. 1a). She had been working as a secretary for more than 30 years, and her principal duty was typing dictated letters. In this function, she wore a headset with white or black rubber ear olives for more than 6-hrs a day. The eczema healed spontaneously during holidays, but relapsed within several days after she returned to work. She reported some episodes of contact dermatitis after wearing costume jewellery and perfume as a teenager, but now avoided those items. Patch testing with a Deutsche Kontaktallergie-Gruppe baseline series, rubber allergens (Allmirall Hermal, Reinbek, Germany) and her worn ear olives was performed. For patch testing, the ear olives were shaved and moistened with tap water. Allergens were applied on the upper back with Finn Chambers® on Scanpor® tape (Epitest, Tuusula, Finland) and Fixomull® stretch tape (BSN Medical, Hamburg, Germany), which were removed after 24 hr. Readings were taken on days 2, 3 and 4, according to International Contact Dermatitis Research Group guidelines. Positive reactions

Verbesserte patientenorientierte Versorgung durch den effizienten Einsatz von Integra® in der rekonstruktiven Dermatochirurgie

Zusammenfassung Hintergrund: Die ansteigende Inzidenz von Hauttumoren bei älteren Patienten und die bei älteren Menschen auftretende Multimorbidität ist eine große Herausforderung für Dermatochirurgen. Die gegenwärtig geforderten Sicherheitsabstände für die verschiedenen Arten von Melanomen und Nicht-Melanom-Hautkrebs (NMSC) führen zu umfangreichen und tiefen Wunden. Studienziel: Untersuchung der Nützlichkeit eines Hautersatzes (Integra®) für den routinemäßigen Einsatz in der täglichen dermatologischen Tumorchirurgie. Patienten und Methodik: Retrospektive Studie mit 20 Patienten, die aufgrund von Hautkrebs sequenziell operiert wurden. Die Wundverschlüsse erfolgten unter Verwendung von Integra® (single layer) mit einer unmittelbar sich anschließenden Spalthautdeckung. Ergebnisse: 22 Tumoren (6 maligne Melanome, 10 Plattenepithelkarzinome, 2 pleomorphe Sarkome, 1 Basalzellkarzinom, 2 Merkelzellkarzinome und 1 trichoblastisches Karzinom) wurden reseziert. Die mittlere Defektgröße betrug 41,4 cm2. Alle Transplantate waren vital (65–100 %); Defekte im Mittelgesicht (Wange und infraorbitaler Bereich) verheilten jedoch oft mit ästhetisch störenden, kissenartigen Narben. Schlussfolgerungen: Durch den Einsatz von Integra® konnte die Dauer der Hospitalisierung verkürzt werden, auch multimorbide Patienten erfuhren eine effektive Behandlung, und es wurden funktionell und ästhetisch befriedigende Ergebnisse erzielt.

Maspin expression in the invasive margin of primary melanomas may reflect an aggressive tumor phenotype

The role of maspin has been discussed controversially in different tumors. In the majority of malignant tumors, maspin seems to act as a tumor suppressor. However, data about maspin expression as well as its function in melanoma are very inconsistent.

Contact allergic gastritis: an underdiagnosed entity?

Only a few cases of contact allergic gastritis in patients with nickel allergy have been reported. We report a case of probable contact-allergic gastritis in a 46-year-old woman. Clinical examination revealed lichenoid mucosal lesions of the gums adjacent to bridges and crowns that had been implanted several weeks back. Since implantation, the patient had suffered from gastrointestinal complaints (including stomach pain). Gastroscopy showed eosinophilic gastritis. Patch testing done under the diagnosis of contact allergic stomatitis showed positive reactions to: gold sodium thiosulphate; manganese (II) chloride; nickel (II) sulphate; palladium chloride; vanadium (III) chloride and zirconium (IV) chloride. The crowns and bridge contained gold, palladium and zirconium chloride, hence they were replaced by titan-based dentition. Shortly after replacing the artificial dentition, all gastrointestinal symptoms resolved spontaneously without further treatment. Delayed-type allergy against the components of artificial dentition seemed to be the cause of gastritis.

Tinea incognita due to Trichophyton mentagrophytes

Production of melanin as a virulence factor in pathogenetic fungi especially in Cryptococcus neoformans is well known in literature [1, 2]. Conidial melanization is likely to protect this stage in life cycle from various environmental insults, such as UV radiation and extremes of temperature [3, 4, 5] and may reduce susceptibilities to antimicrobial treatment [2]. It may also have anti-oxidative, anti-radioactive, paramagnetic and metal-binding properties [6]. A 33-year old Portuguese woman presented with pigmented macules on the plantar skin which finally were diagnosed as Tinea pedum caused by pigment-producing Trichophyton mentagrophytes. She had a six-month history of multiple hyperpigmented plantar macules (Figure 1a and 1b). There were no subjective symptoms, especially no itching or scaling and no history of other skin diseases. Dermoscopy did not reveal any specific pattern. Clinical differential diagnoses included hyperpigmentation due to cultural background, acquired acromelanosis, atypical acropigmentation or acquired syphilis. Hematoxylin-eosin staining of a punch biopsy showed an acanthotic epidermis with slight hyperkeratosis due to acral skin. PAS-staining revealed countless wiry hyphae within stratum corneum (Figure 1c). Basal and suprabasal keratinocytes displayed a dot-shaped hyperpigmentation, best seen in Fontana-Masson-melanin staining (Figure 1d). Pigmentation was furthermore mostly seen in stratum corneum. No increase in melanocytes could be detected immunohistochemically (HMB45, S100 and Melan A). Direct microscopy was positive for fungal hyphae (Figure 1e). Fungal culture on Sabouraud’s agar grew T. mentagrophytes (Figure 1f ). An infection due to treponema pallidum could be excluded serologically. Thus, the diagnoTinea incognita due to Trichophyton mentagrophytes

Socio-epidemiologic aspects and cutaneous side effects of permanent tattoos in Germany – Tattoos are not restricted to a specific social phenotype

ABSTRACT Background: More and more people of all age classes have a tattoo. Intriguingly, there are multiple prejudices in the general population and published data that concern tattooed persons, such as being criminals, having a low education, being alcohol or drug abusers, or more risky in their life style. Objective: To obtain and to evaluate sociodemographic data on tattooed persons, to investigate the incidence of tattoo-related cutaneous complications and to define personal risk factors and course of the persons after being tattooed concerning behavior of personal environment. Patients and Methods: We interviewed 426 participants with already existing tattoos and 20 participants just before getting a new tattoo by using an online questionnaire. The participators were asked about socio-epidemiologic aspects of tattoos in general and special aspects of their own tattoo(s) in particular. There were no exclusion criteria. Results: Tattoos are interesting for people seeking popular body art, esp. university graduates and financially-secure individuals. 446 persons participated in this study. Most of the persons were female with a mean age of 35. Local pruritus around the tattooed area was the most common cutaneous side effect among the participants. 93.5% of the participants did not want a tattoo removal. Intriguingly, most of the participants experienced no career problems related to the tattoo(s). Limitations: The study population is not representative as we included only persons being tattooed prior to or getting newly tattooed. Furthermore, there is a potential selection bias as the participation in this study was voluntary. Only persons that felt involved by the flyer did answer the questionnaire. Conclusion: The present data shows that common tattooed persons are not low educated criminals with any drug or alcohol abuse or with risky life style. Nowadays being tattooed encompasses a kind of body art and displays a certain kind of lifestyle habit.