1
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Orloff J, Patel DD, Powers CM, Piontkowski AJ, Phelps RG, Richter J, Gulati N. Pityriasis lichenoides et varioliformis acuta in a patient treated with cevostamab. JAAD Case Rep 2024; 47:23-25. [PMID: 38576898 PMCID: PMC10993135 DOI: 10.1016/j.jdcr.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Affiliation(s)
- Jeremy Orloff
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dev D. Patel
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Camille M. Powers
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Austin J. Piontkowski
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert G. Phelps
- Departments of Dermatology and Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joshua Richter
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicholas Gulati
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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2
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Pagan AD, Obi A, McKinley J, Oladunjoye E, Kasago I, Gulati N, Phelps RG, Svidzinski C. Birt-Hogg-Dubé syndrome in skin of color: Literature review. J Am Acad Dermatol 2024; 90:412-414. [PMID: 37838258 DOI: 10.1016/j.jaad.2023.09.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/16/2023]
Affiliation(s)
- Angel D Pagan
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, Ponce Health Sciences University, School of Medicine, Ponce, Puerto Rico
| | - Ashley Obi
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, Meharry Medical College, Nashville, Tennessee
| | - Jayvon McKinley
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Esther Oladunjoye
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Israel Kasago
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicholas Gulati
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert G Phelps
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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3
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Poplausky D, Piontkowski AJ, Phelps RG, Gulati N. Microcystic lymphatic malformation following a double mastectomy. JAAD Case Rep 2024; 44:74-76. [PMID: 38304102 PMCID: PMC10831273 DOI: 10.1016/j.jdcr.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Affiliation(s)
- Dina Poplausky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Austin J. Piontkowski
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert G. Phelps
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicholas Gulati
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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4
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Anvekar A, Phelps RG. Cutaneous Aspergilloma Caused by Aspergillus niger in an Immunocompetent Patient. Skinmed 2023; 21:373-374. [PMID: 37945369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
An 82-year-old man presented with a growth on his scalp for 7 months. It was increasing in size despite treatment with a variety of shampoos and systemic plus topical antibiotics. It was pruritic with a burning sensation. Lately, the patient had a body weight loss of 35 pounds. Extensive work-ups for malignancy included computerized axial tomography (CAT) and examinations of the gastrointestinal and respiratory tracts; however, no etiology for this weight loss was established. This was not thought to be directly related to the scalp lesion. Work-ups for any infectious etiology, including blood cultures, were proven to be noncontributory. His past medical included chronic obstructive pulmonary disease and gastritis. He also patient had a long history of tobacco use.
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Affiliation(s)
- Anika Anvekar
- Departments of Dermatology and Pathology, Icahn School of Medicine at Mount Sinai, New York, NYAQ5
| | - Robert G Phelps
- Departments of Dermatology and Pathology, Icahn School of Medicine at Mount Sinai, New York, NYAQ5;
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5
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Pagan AD, Obi A, Cices A, Mubasher A, Phelps RG, Dautriche Svidzinski CN. Cutaneous IgG4-related disease associated with lymphocytic colitis. JAAD Case Rep 2023; 36:99-101. [PMID: 37274144 PMCID: PMC10238804 DOI: 10.1016/j.jdcr.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
- Angel D. Pagan
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
- Ponce Health Sciences University School of Medicine, Ponce, Puerto Rico
| | - Ashley Obi
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
- Meharry Medical College, Nashville, Tennessee
| | - Ahuva Cices
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adnan Mubasher
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert G. Phelps
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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6
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Marks E, Jarell A, Ludzik J, Farberg AS, Rabinovitz HS, Phelps RG, Cockerell CJ, Witkowski A. A Physician's Guide to the Use of Gene Expression Profile Ancillary Diagnostic Testing for Cutaneous Melanocytic Neoplasms. J Clin Aesthet Dermatol 2023; 16:12-20. [PMID: 37077930 PMCID: PMC10110288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Objectives Some melanocytic neoplasms suspicious for melanoma require additional workup to arrive at a final diagnosis. Within the last eight years, gene expression profiling (GEP) has become an important ancillary tool to aid in the diagnosis of melanocytic neoplasms with uncertain malignant potential. As the usage of two commercially available tests (23-GEP and 35-GEP) evolves, it is important to answer key questions about optimal utilization and their impact on patient care. Methods Recent and relevant articles answering the following questions were included in the review. First, how do dermatopathologists synthesize the available literature, the latest guidelines, and their clinical experience to determine which cases would be most likely to benefit from GEP testing? Second, how best can a dermatologist convey to their dermatopathologist that the use of GEP in the diagnostic process could provide a more clearly defined result and thereby help empower the dermatologist to provide higher-quality patient care when making specific patient management decisions for otherwise pathologically ambiguous lesions? Results When interpreted in the context of the clinical, pathologic, and laboratory information, GEP results can facilitate the rendering of timely, accurate, and definitive diagnoses for melanocytic lesions with otherwise uncertain malignant potential to inform personalized treatment and management plans. Limitations This was a narrative review focused on clinical use of GEP compared to other ancillary diagnostic tests performed postbiopsy. Conclusion Open communication between dermatopathologists and dermatologists, especially regarding GEP testing, can be a vital component to achieve appropriate clinicopathologic correlation for otherwise ambiguous melanocytic lesions.
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Affiliation(s)
- Etan Marks
- Dr. Marks is with Dermatopathology, Kansas City University-Graduate Medical Education Consortium in Oviedo, Florida, and Advanced Dermatology and Cosmetic Surgery in Oviedo, Florida
| | - Abel Jarell
- Dr. Jarell is with Granite State Dermatology, PC in Portsmouth, New Hampshire
| | - Joanna Ludzik
- Drs. Ludzik and Witkowski are with the Department of Dermatology, Oregon Health & Science University in Portland, Oregon
- Dr. Ludzik is also with the Department of Telemedicine and Bioinformatics, Jagiellonian University Medical College in Krakow, Poland
| | - Aaron S. Farberg
- Dr. Farberg is with Baylor Scott & White Health System in Dallas, Texas
| | - Harold S. Rabinovitz
- Dr. Rabinovitz is with the Department of Dermatology, Medical College of Georgia in Augusta, Georgia
| | - Robert G. Phelps
- Dr. Phelps is with Mount Sinai Hospital in New York City, New York
| | - Clay J. Cockerell
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas and the Departments of Dermatology and Pathology, UT Southwestern Medical Center in Dallas, Texas
| | - Alexander Witkowski
- Drs. Ludzik and Witkowski are with the Department of Dermatology, Oregon Health & Science University in Portland, Oregon
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7
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Abstract
Verrucous psoriasis is a variant of psoriasis that presents with wartlike clinical features and overlapping histologic features of verruca and psoriasis. The disease typically arises in patients with established psoriasis but can occur de novo. We report the case of an 80-year-old man with a history of hypertension and coronary artery disease who presented with a rash characterized by multiple asymptomatic plaques with overlying verrucous nodules on the left side of the body. The lesions appeared shortly after coronary artery bypass surgery with a saphenous vein graft.
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Affiliation(s)
- Riana D Sanyal
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nikki S Vyas
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Allen N Sapadin
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert G Phelps
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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8
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Lenskaya V, Panji P, de Moll EH, Christian K, Phelps RG. Oral lymphangiectasia and gastrointestinal Crohn disease. J Cutan Pathol 2020; 47:1080-1084. [PMID: 32761835 DOI: 10.1111/cup.13834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 12/27/2022]
Abstract
Lip edema with non-caseating granulomas or lymphangiectasia pose a clinical and pathological challenge. These findings can be attributed to cheilitis granulomatosa (CG), Melkersson-Rosenthal syndrome (MRS), or Crohn disease (CD) depending on the appropriate clinical context. Lymphangiectasis, in particular, is a common pathological finding in CD due to lymphatic obstruction by granulomas and intralymphatic granulomas. Because oral symptoms can precede gastrointestinal symptoms of CD or be seen in patients with asymptomatic gastrointestinal disease, the identification of lymphangiectasia should raise the possibility of underlying CD. We present a case of a young woman with several years of lip swelling, with notable lymphangiectasia and subtle granulomas on pathological evaluation. The patient was diagnosed with MRS at an outside institution and treated with systemic steroids, without further systemic evaluation. We believe that early recognition of lymphangiectasia and consideration of CD early in the work-up are critical for early diagnosis and appropriate management. Neither clinical nor histopathological findings should be used in isolation to diagnose GC, MRS, or CD as there is significant debate as to the etiology and overlapping findings of these conditions. We highlight the importance of lymphangiectasia in diagnosing underlying CD in the appropriate clinical context.
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Affiliation(s)
- Volha Lenskaya
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Parin Panji
- Department of Dermatopathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ellen H de Moll
- Department of Dermatopathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Robert G Phelps
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Dermatopathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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9
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Del Duca E, Ruano Ruiz J, Pavel AB, Sanyal RD, Song T, Gay-Mimbrera J, Zhang N, Estrada YD, Peng X, Renert-Yuval Y, Phelps RG, Paus R, Krueger JG, Guttman-Yassky E. Frontal fibrosing alopecia shows robust T helper 1 and Janus kinase 3 skewing. Br J Dermatol 2020; 183:1083-1093. [PMID: 32215911 DOI: 10.1111/bjd.19040] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) is a scarring alopecia with unclear pathogenesis and a progressive course. The disease has a major impact on patients' quality of life and there is a lack of effective treatment to halt disease progression. METHODS We profiled lesional and nonlesional scalp biopsies collected in 2017 from patients with FFA (n = 12) compared with scalp biopsies from patients with alopecia areata (AA) (n = 8) and controls (n = 8) to evaluate gene and protein expression, including the primary outcome (CXCL9). We determined significant differences between biomarkers using a two-sided Student's t-test adjusting P-values by false discovery rate. RESULTS Significant increases were seen in CD8+ cytotoxic T cells, CD11c+ dendritic cells, CD103+ and CD69+ tissue-resident memory T cells in FFA and AA vs. control scalp (P < 0·05), with corresponding significantly upregulated granzyme B mRNA, particularly in FFA (P < 0·01). In AA, cellular infiltrates were primarily concentrated at the bulb, while in FFA these were mainly localized at the bulge. FFA demonstrated significant upregulation of T helper 1/intereferon (IFN) (IFN-γ, CXCL9/CXCL10), the Janus kinase/signal transducers and activators of transcription (JAK-STAT) pathway (STAT1, JAK3) and fibrosis-related products (vimentin, fibronectin; P < 0·05), with no concomitant downregulation of hair keratins and the T-regulatory marker, forkhead box P3, which were decreased in AA. The stem cell markers CD200 and K15 demonstrated significantly reduced expression only in FFA (P < 0·05). CONCLUSIONS These data suggest that follicular damage and loss of stem cells in FFA may be mediated through immune attack in the bulge region, with secondary fibrosis and reduced but still detectable stem cells. JAK/STAT-targeting treatments may be able to prevent permanent follicular destruction and fibrosis in early disease stages.
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Affiliation(s)
- E Del Duca
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - J Ruano Ruiz
- Department of Dermatology, University of Córdoba, Córdoba, Spain.,Immune-Mediated Inflammatory Skin Diseases Research Group, IMIBIC/Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
| | - A B Pavel
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R D Sanyal
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T Song
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Gay-Mimbrera
- Department of Dermatology, University of Córdoba, Córdoba, Spain.,Immune-Mediated Inflammatory Skin Diseases Research Group, IMIBIC/Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
| | - N Zhang
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Y D Estrada
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - X Peng
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Y Renert-Yuval
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - R G Phelps
- Department of Pathology, Division of Dermatopathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R Paus
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Centre for Dermatology Research, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - J G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - E Guttman-Yassky
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
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10
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Vyas NS, Shieh WJ, Phelps RG. Investigating the histopathological findings and immunolocalization of rickettsialpox infection in skin biopsies: A case series and review of the literature. J Cutan Pathol 2020; 47:451-458. [PMID: 31955452 DOI: 10.1111/cup.13649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 01/09/2020] [Accepted: 01/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recognition of rickettsialpox infection on skin biopsy can be challenging. The histopathology is non-specific and inconsistently described. We assess classic histopathologic features in confirmed cases and review the literature. METHODS We searched for cases of "rickettsialpox" diagnosed between 2006 and 2018 with positive immunostaining for Spotted Fever Group Rickettsia species. Original slides were evaluated for vacuolar alterations, granulomatous inflammation, vasculitis, necrosis, fibrin thrombi, microvesiculation, papillary dermal edema, and extravasated red blood cells. All biopsies were stained for CD3, CD20, CD68, and myeloperoxidase. RESULTS Six biopsy specimens were compiled, three of which were sampled from vesiculopapules, one from a maculopapule, and two from eschars. Vacuolar alterations and vasculitis were present in all specimens (6/6; 100%). Granulomatous inflammation was present in five specimens (5/6; 83.3%). Fibrin thrombi and red blood cells were seen in 3/6 (50%) of specimens. The eschars showed necrosis of the epidermis and superficial dermis (2/6, 33.3%). Only one specimen showed intraepidermal vesiculation and papillary dermal edema (1/6; 16.7%). All six specimens showed perivascular infiltration with CD3+ T-cells, and low amounts of CD20+ B-cells and neutrophils. Five of the six specimens (83.3%) showed significant levels of CD68+ histiocytes. CONCLUSION The histopathology of rickettsialpox infection is septic lymphocytic and granulomatous vasculitis.
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Affiliation(s)
- Nikki S Vyas
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Wun-Ju Shieh
- Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert G Phelps
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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11
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Huang A, Vyas NS, Mercer SE, Phelps RG. Histological findings and pathologic diagnosis of spiradenocarcinoma: A case series and review of the literature. J Cutan Pathol 2019; 46:243-250. [DOI: 10.1111/cup.13408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/07/2018] [Accepted: 12/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Amy Huang
- Department of DermatologyState University of New York Downstate Medical Center Brooklyn New York
| | - Nikki S. Vyas
- Department of PathologyIcahn School of Medicine at Mount Sinai New York New York
| | | | - Robert G. Phelps
- Department of PathologyIcahn School of Medicine at Mount Sinai New York New York
- Department of DermatologyIcahn School of Medicine at Mount Sinai New York New York
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12
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Yao JL, Goldenberg G, Phelps RG. Ripple-Pattern Sebaceous Trichoblastoma. Skinmed 2018; 16:276-279. [PMID: 30207534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 28-year-old man of Middle-Eastern descent presented with a raised, pearly, slightly pigmented lesion on the right nasal ala. The lesion had been present for approximately 4 months. An excisional biopsy was taken, and the lesion measured 1.0 cm × 0.9 cm in dimension. The cut surface revealed a firm, white to tan nodule located within the dermis. The patient had no other significant medical history. After the initial excision, the lesion did not recur.
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Affiliation(s)
- Jonathan L Yao
- From the Department of Dermatopathology, Mount Sinai Medical Center, New York, NY;
| | - Gary Goldenberg
- From the Department of Dermatopathology, Mount Sinai Medical Center, New York, NY
| | - Robert G Phelps
- From the Department of Dermatopathology, Mount Sinai Medical Center, New York, NY
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13
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Yao JL, Cellura P, Phelps RG. Syringocystadenocarcinoma Papilliferum: A Rare Malignant Sweat Gland Tumor. Skinmed 2018; 16:195-197. [PMID: 29989541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 73-year-old Hispanic woman presented to the clinic with an erythematous, friable 3.0 cm × 2.7 cm × 0.7 cm mass located on the posterior vertex of the scalp (Figure 1). The lesion had been present since birth but had recently begun to bleed intermittently, prompting evaluation. A biopsy was obtained, revealing a tumor with irregular, complex papillomatous invaginations lined by a two-layered epithelium. Atypical and crowded columnar cells lined the luminal aspect, while cuboidal cells lined the epithelium adjacent to the stroma (Figure 2). Decapitation secretion was noted in several areas on the luminal surface.
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Affiliation(s)
- Jonathan L Yao
- Department of Dermatopathology, Mount Sinai Medical Center, New York, NY;
| | - Paul Cellura
- Department of Dermatopathology, Mount Sinai Medical Center, New York, NY
| | - Robert G Phelps
- Sidney Kimmel Medical College at, Thomas Jefferson University, Philadelphia, PA
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14
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Abstract
A 60-year-old female presented with a one-year history of multiple enlarging tender subcutaneous nodules. Initial biopsy demonstrated a poorly differentiated adenocarcinoma. Mammography showed multiple nodular breast lesions. After the patient failed to respond to tamoxifen, a second biopsy demonstrated a metastatic carcinoid tumor. Further search revealed a single small pulmonary nodule, which on aspiration biopsy proved to be a carcinoid tumor. The patient failed to respond to treatment with streptozotocin and 5'-fluorouracil. Therapy with leucovorin calcium and 5'-fluorouracil then produced a partial response.
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Affiliation(s)
- L Oleksowicz
- Mount Sinai School of Medicine, Department of Neoplastic Diseases, New York, N.Y. 10029
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15
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Dong J, Phelps RG, Levitt J. Isotretinoin and Surgical Extraction for Adult-Onset Nevus Comedonicus. Skinmed 2017; 15:309-310. [PMID: 28859748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We present a case of postmenopausal-onset nevus comedonicus in a 58-year-old white woman with no relevant medical history. Two years before presentation, the patient had had a solitary red nodule, measuring 3.8 cm wide, on the mid lateral region of her left thigh. This progressed to a large area, 11.4 cm wide and 14 cm long, of multiple pruritic and painful red nodules, cysts, and deep open comedones extending across the lateral part of the left thigh, with less severe segmental extension to the lateral aspect of the left leg.
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Affiliation(s)
- Joanna Dong
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert G Phelps
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacob Levitt
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY;
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16
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Ventarola DJ, Contard PC, Phelps RG. Widespread poikilodermatous dermatomyositis associated with chronic lymphocytic leukemia. Cutis 2017; 99:E9-E10. [PMID: 28319632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | - Paul C Contard
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert G Phelps
- Division of Dermatopathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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17
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Abstract
Background: We report a patient with chronic lymphocytic leukemia (CLL) that developed recurrent vesicobullous lesions that histologically demonstrated features of an exaggerated response to an arthropod bite. Objective: Patients with CLL can present with many cutaneous manifestations, including specific and nonspecific lesions. Although rare, patients with CLL can develop an exaggerated response to an arthropod bite. Conclusion: Emphasis needs to be placed on the clinical recognition of arthropod bites as an unusual cutaneous manifestation of CLL, as they provide the physician with both a diagnostic and a therapeutic challenge. Patients often deny being bitten and, thus, the biopsy results conflict with the patient's history. Additionally, as there is no specific treatment, both the patient and physician are faced with a similar dilemma. Although our patient initially responded well to corticosteroids, his lesions significantly improved while being treated with dapsone.
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Affiliation(s)
- Robin R. Blum
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York, USA
| | - Robert G. Phelps
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York, USA
- Department of Pathology, Mount Sinai School of Medicine, New York, New York, USA
| | - Huachen Wei
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York, USA
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Lanoue J, Jacobson KB, Ooka K, Singh C, Camacho-Vanegas O, Martignetti JA, Levitt J, Phelps RG. Porokeratotic Adnexal Ostial Nevus-Report of a Case With Unusual Clinical and Histologic Features. Skinmed 2016; 14:221-224. [PMID: 27502264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
An 11-year-old Tanzanian girl presented with diffuse verrucous lesions of varying morphology, scarring alopecia, and keloid scars over the face with a predilection for the ears. Physical examination revealed dark keratoderma and patches of hypopigmentation near the midline of the dorsal trunk (Figure 1a). Her forearms were densely covered by verrucous lesions with the exception of a clear linear patch on the dorsal aspect of the left forearm (Figure 1b). The perioral area was notable for white spires projecting from verrucous papules (Figure 1c) while the oral mucosa and teeth appeared normal on visual examination. The rest of her body, including the palms and soles, was covered by patchy, scaly lesions of varying severity.
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Affiliation(s)
- Julien Lanoue
- Departments of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Karen B Jacobson
- Departments of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kohtaro Ooka
- Departments of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Chanpreet Singh
- Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Olga Camacho-Vanegas
- Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John A Martignetti
- Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacob Levitt
- Departments of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert G Phelps
- Departments of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY;
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de Moll EH, Fu Y, Qian Y, Perkins SH, Wieder S, Gnjatic S, Remark R, Bernardo SG, Moskalenko M, Yao J, Ferringer T, Chang R, Chipuk J, Horst BA, Birge MB, Phelps RG, Saenger YM. Immune biomarkers are more accurate in prediction of survival in ulcerated than in non-ulcerated primary melanomas. Cancer Immunol Immunother 2015; 64:1193-203. [PMID: 26076664 PMCID: PMC4581435 DOI: 10.1007/s00262-015-1726-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 05/27/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Ulcerated melanomas may have a unique biology and microenvironment. We test whether markers of immune infiltration correlate with clinical outcome in ulcerated compared to non-ulcerated primary melanoma tumors. METHODS Sixty-two stage II-III cutaneous melanomas, 32 ulcerated and 30 non-ulcerated, were analyzed for tumor-infiltrating lymphocytes (TILs). Immunohistochemistry (IHC) was performed for CD2, a marker previously shown to correlate with overall survival (OS) and recurrence-free survival (RFS) in this patient population. IHC using antibody, VE1, to BRAF V600E was also performed on a subset of 41 tumors to assess the relationship of BRAF mutation to immune markers. RESULTS We found, using Cox regression models, that the presence of TILs was associated with improved OS (p = 0.034) and RFS (p = 0.002) in ulcerated melanoma tumors, but not in non-ulcerated melanoma (p = 0.632, 0.416). CD2 expression also was correlated with improved OS (p = 0.021) and RFS (p = 0.001) in ulcerated melanoma, but no relationship was seen in non-ulcerated melanoma (p = 0.427, 0.682). In this small population, BRAF status did not correlate with TILs or CD2+ count. CONCLUSION Our data show that immune markers including TILs and CD2 count correlate more closely with survival in ulcerated melanomas than that in non-ulcerated melanomas. We propose that immune biomarkers may be particularly relevant to ulcerated, as compared to non-ulcerated, melanomas and that this merits study in larger populations.
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Affiliation(s)
- Ellen H. de Moll
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yichun Fu
- Department of Medicine, Columbia University College of Physicians and Surgeons, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - Yingzhi Qian
- Department of Medicine, Columbia University College of Physicians and Surgeons, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - Sara H. Perkins
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shira Wieder
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sacha Gnjatic
- Hematology Oncology Division, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Romain Remark
- Hematology Oncology Division, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sebastian G. Bernardo
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marina Moskalenko
- Hematology Oncology Division, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan Yao
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Rui Chang
- Department of Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jerry Chipuk
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Basil A. Horst
- Department of Pathology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Miriam B. Birge
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Hematology Oncology Division, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert G. Phelps
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Hematology Oncology Division, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yvonne M. Saenger
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Columbia University College of Physicians and Surgeons, 177 Fort Washington Avenue, New York, NY 10032, USA
- Hematology Oncology Division, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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20
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Harcharik S, Bernardo S, Moskalenko M, Pan M, Sivendran M, Bell H, Hall LD, Castillo-Martín M, Fox K, Cordon-Cardo C, Chang R, Sivendran S, Phelps RG, Saenger Y. Defining the role of CD2 in disease progression and overall survival among patients with completely resected stage-II to -III cutaneous melanoma. J Am Acad Dermatol 2014; 70:1036-44. [PMID: 24698703 DOI: 10.1016/j.jaad.2014.01.914] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 12/23/2013] [Accepted: 01/16/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Accurate assessment of prognosis remains clinically challenging in stage II to III cutaneous melanoma. Studies have implicated CD2 in immune surveillance, T-cell activation, and antitumor immunity, but its role in melanoma progression warrants further investigation. OBJECTIVE We sought to investigate the prognostic role of CD2 in primary cutaneous melanoma. METHODS Patients with American Joint Committee on Cancer stage II and III cutaneous melanoma were identified by retrospective review of dermatopathology databases from 2001 to 2010 at Mount Sinai Medical Center and Geisinger Medical Center. Additional patients were provided by New York University Medical Center based on retrospective review and tissue availability. Immunohistochemistry was performed on tumors from 90 patients with known recurrence status and documented follow-up. RESULTS Primary tumors from patients who developed recurrent disease had fewer CD2(+) cells (P = .0003). In multivariable analyses including standard clinicopathologic predictors, CD2 was an independent predictor of disease recurrence (P = .008) and overall survival (P = .007). CD2 count correlated with characterization of tumor-infiltrating lymphocytes (P = .0004). Among the intermediate prognosis group of patients with nonbrisk tumor-infiltrating lymphocytes, CD2 count was predictive of disease recurrence (P = .0006) and overall survival (P = .0318). LIMITATIONS Our retrospective design may have resulted in incomplete representation of patients lacking documented follow-up. CONCLUSIONS CD2 may be an independent predictor of disease recurrence and overall survival among patients with primary cutaneous melanoma.
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Affiliation(s)
- Sara Harcharik
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York; Department of Hematology and Medical Oncology, Mount Sinai School of Medicine, New York, New York
| | - Sebastian Bernardo
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York; Department of Hematology and Medical Oncology, Mount Sinai School of Medicine, New York, New York
| | - Marina Moskalenko
- Department of Hematology and Medical Oncology, Mount Sinai School of Medicine, New York, New York
| | - Michael Pan
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York; Department of Hematology and Medical Oncology, Mount Sinai School of Medicine, New York, New York
| | - Meera Sivendran
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania
| | - Heather Bell
- Department of Pathology, Mount Sinai School of Medicine, New York, New York
| | - Lawrence D Hall
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania
| | | | - Kelly Fox
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York; Department of Hematology and Medical Oncology, Mount Sinai School of Medicine, New York, New York
| | | | - Rui Chang
- Department of Genetics and Genomic Sciences, Mount Sinai School of Medicine, New York, New York
| | - Shanthi Sivendran
- Hematology/Oncology Medical Specialists, Lancaster General Health, Lancaster, Pennsylvania
| | - Robert G Phelps
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York; Department of Pathology, Mount Sinai School of Medicine, New York, New York
| | - Yvonne Saenger
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York; Department of Hematology and Medical Oncology, Mount Sinai School of Medicine, New York, New York.
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21
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Affiliation(s)
- Robert G Phelps
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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22
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Sivendran S, Chang R, Pham L, Phelps RG, Harcharik ST, Hall LD, Bernardo SG, Moskalenko MM, Sivendran M, Fu Y, de Moll EH, Pan M, Moon JY, Arora S, Cohain A, DiFeo A, Ferringer TC, Tismenetsky M, Tsui CL, Friedlander PA, Parides MK, Banchereau J, Chaussabel D, Lebwohl MG, Wolchok JD, Bhardwaj N, Burakoff SJ, Oh WK, Palucka K, Merad M, Schadt EE, Saenger YM. Dissection of immune gene networks in primary melanoma tumors critical for antitumor surveillance of patients with stage II-III resectable disease. J Invest Dermatol 2014; 134:2202-2211. [PMID: 24522433 DOI: 10.1038/jid.2014.85] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 01/14/2014] [Accepted: 01/15/2014] [Indexed: 01/18/2023]
Abstract
Patients with resected stage II-III cutaneous melanomas remain at high risk for metastasis and death. Biomarker development has been limited by the challenge of isolating high-quality RNA for transcriptome-wide profiling from formalin-fixed and paraffin-embedded (FFPE) primary tumor specimens. Using NanoString technology, RNA from 40 stage II-III FFPE primary melanomas was analyzed and a 53-immune-gene panel predictive of non-progression (area under the curve (AUC)=0.920) was defined. The signature predicted disease-specific survival (DSS P<0.001) and recurrence-free survival (RFS P<0.001). CD2, the most differentially expressed gene in the training set, also predicted non-progression (P<0.001). Using publicly available microarray data from 46 primary human melanomas (GSE15605), a coexpression module enriched for the 53-gene panel was then identified using unbiased methods. A Bayesian network of signaling pathways based on this data identified driver genes. Finally, the proposed 53-gene panel was confirmed in an independent test population of 48 patients (AUC=0.787). The gene signature was an independent predictor of non-progression (P<0.001), RFS (P<0.001), and DSS (P=0.024) in the test population. The identified driver genes are potential therapeutic targets, and the 53-gene panel should be tested for clinical application using a larger data set annotated on the basis of prospectively gathered data.
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Affiliation(s)
- Shanthi Sivendran
- Division of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Hematology/Oncology Medical Specialists, Lancaster General Health, Lancaster, Pennsylvania, USA
| | - Rui Chang
- Department of Genetics and Genomic Science, Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Lisa Pham
- Department of Genetics and Genomic Science, Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert G Phelps
- Department of Dermatology, Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sara T Harcharik
- Department of Dermatology, Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lawrence D Hall
- Department of Dermatology, Geisinger Health Systems, Dermatology Woodbine Danville, Danville, Pennsylvania, USA
| | - Sebastian G Bernardo
- Department of Dermatology, Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marina M Moskalenko
- Division of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Meera Sivendran
- Department of Dermatology, Geisinger Health Systems, Dermatology Woodbine Danville, Danville, Pennsylvania, USA
| | - Yichun Fu
- Division of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ellen H de Moll
- Division of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Pan
- Division of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jee Young Moon
- Department of Genetics and Genomic Science, Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sonali Arora
- Department of Genetics and Genomic Science, Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ariella Cohain
- Department of Genetics and Genomic Science, Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Analisa DiFeo
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Tammie C Ferringer
- Department of Pathology, Geisinger Health Systems, Danville, Pennsylvania, USA
| | - Mikhail Tismenetsky
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Pathology, Englewood Hospital and Medical Center, Englewood, New Jersey, USA
| | - Cindy L Tsui
- Department of Dermatology, Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Philip A Friedlander
- Division of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael K Parides
- Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacques Banchereau
- Department of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Damien Chaussabel
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | - Mark G Lebwohl
- Department of Dermatology, Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jedd D Wolchok
- Ludwig Center for Cancer Immunotherapy, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Nina Bhardwaj
- Division of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Pathology, New York University, New York, New York, USA; Department of Dermatology, New York University, New York, New York, USA
| | - Steven J Burakoff
- Division of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William K Oh
- Division of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Karolina Palucka
- Division of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Baylor Institute for Immunology Research, Dallas, Texas, USA
| | - Miriam Merad
- Division of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric E Schadt
- Department of Genetics and Genomic Science, Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yvonne M Saenger
- Division of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Dermatology, Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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23
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Levitt JO, Keeley BR, Phelps RG. Treatment of porokeratosis of Mibelli with cantharidin. J Am Acad Dermatol 2013; 69:e254-e255. [DOI: 10.1016/j.jaad.2013.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/10/2013] [Accepted: 06/15/2013] [Indexed: 11/26/2022]
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Singh R, Chen C, Phelps RG, Elston DM. Stem cells in the skin and their role in oncogenesis. J Eur Acad Dermatol Venereol 2013; 28:542-9. [PMID: 24118325 DOI: 10.1111/jdv.12248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 07/22/2013] [Indexed: 12/18/2022]
Abstract
Stem cells generate great interest because they hold the promise for treatment of various incurable diseases. Several distinct stem cell populations have been identified in each organ, including the skin. As the skin is the largest organ in the body and is easily accessible, cutaneous stem cells have raised significant hopes for being a rich source of easily available multipotent stem cells. Genetic alterations and mutations in stem cells are being proposed as initiation step in multiple cancers. Small populations of oncogenic stem cells termed as cancer stem cells or tumour-initiating cells have been identified in multiple tumours, including squamous cell carcinomas, and melanomas that can sustain tumour growth, underlie its malignant behaviour and initiate distant metastases. These cells are controlled and regulated by the same pathways that are also responsible for maintenance and differentiation of normal stem cells. Developing a targeted therapy against the oncogenic stem cells and dysregulated members of the signalling pathways may be the key to understanding and treating skin cancers like melanomas, for which we still do not have an effective treatment.
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Affiliation(s)
- R Singh
- Department of Dermatology and Pathology, Mount Sinai School of Medicine, New York, NY, USA
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25
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26
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Dembitzer FR, Kinoshita Y, Burstein D, Phelps RG, Beasley MB, Garcia R, Harpaz N, Jaffer S, Thung SN, Unger PD, Ghebrehiwet B, Peerschke EI. gC1qR expression in normal and pathologic human tissues: differential expression in tissues of epithelial and mesenchymal origin. J Histochem Cytochem 2012; 60:467-74. [PMID: 22638269 DOI: 10.1369/0022155412440882] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The gC1qR (i.e., gC1q receptor, gC1q binding protein, p32, p33) is a multifunctional cellular protein that interacts with components of the complement, kinin, and coagulation cascades and select microbial pathogens. Enhanced gC1qR expression has been reported in adenocarcinomas arising in a variety of organs. The present study compared gC1qR expression in normal, inflammatory, dysplastic, and malignant tissue of epithelial and mesenchymal origin. gC1qR expression was visualized in tissue sections by immunohistochemistry using the 60.11 monoclonal antibody (i.e., IgG(1) mouse monoclonal antibody directed against gC1qR) and the UltraVision LP Detection System. Sections were counterstained with hematoxylin and examined by light microscopy. Strongest gC1qR expression was noted in epithelial tumors of breast, prostate, liver, lung, and colon, as well as in squamous and basal cell carcinoma of the skin. However, increased gC1qR staining was appreciated also in inflammatory and proliferative lesions of the same cell types, as well as in normal continuously dividing cells. In contrast, tumors of mesenchymal origin generally stained weakly, with the exception of osteoblasts, which stained in both benign and malignant tissues. The data suggest that increased gC1qR expression may be a marker of benign and pathologic cell proliferation, particularly in cells of epithelial origin, with potential diagnostic and therapeutic applications.
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Abstract
Melanonychia is a black, tan, or brown streak within the nail plate subsequent to activation of melanocytes in the nail matrix. We present a case of a Haitian girl who presented with transverse melanonychia involving all 10 fingernails in the setting of hyperthyroidism and acute liver injury. Melanonychia has been described only one time in the literature in the setting of hyperthyroidism though this patient also underwent radium treatment which could have led to nail changes.
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Affiliation(s)
- Robert E Accordino
- Department of Medical Education, Mount Sinai School of Medicine, New York, NY 10029, USA.
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29
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Fernandes NF, Mercer SE, Kleinerman R, Lebwohl MG, Phelps RG. Amyloidosis cutis dyschromica associated with atypical Parkinsonism, spasticity and motor weakness in a Pakistani female. J Cutan Pathol 2011; 38:827-31. [PMID: 21645034 DOI: 10.1111/j.1600-0560.2011.01719.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Amyloidosis cutis dyschromica is a rare form of cutaneous amyloidosis in which there is deposition of keratinocyte-derived amyloid with involvement of almost the entire integument, leading to diffuse dyschromia without associated systemic abnormalities. We report the case of a 40-year-old female who presented with the onset of diffuse hyperpigmentation shortly after birth, which was followed by the widespread development of numerous 2-5 mm hypopigmented macules. Biopsy of the one of these macules revealed eosinophilic globular material in the papillary dermis with Congo red birefringence which also stained positively for high-molecular weight cytokeratin. Electron microscopy confirmed the presence of 11 nm hollow fibrils, consistent with amyloid. Similar clinical changes were noted in a younger male sibling. Both patients also suffered from an unexplained neurological disorder characterized by atypical Parkinsonism, spasticity and motor weakness. This association has not been shown before and may represent a heretofore unreported contiguous gene syndrome.
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Affiliation(s)
- Neil F Fernandes
- Department of Dermatology, The Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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Geller L, Raciti PM, Mercer SE, Phelps RG. Lupus-like lesions in a 28-month-old boy with chronic granulomatous disease on long-term voriconazole prophylaxis. J Cutan Pathol 2011; 38:677-8. [DOI: 10.1111/j.1600-0560.2011.01714.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Yoo JY, Blum RR, Singer GK, Stern DK, Emanuel PO, Fuchs W, Phelps RG, Terry SF, Lebwohl MG. A randomized controlled trial of oral phosphate binders in the treatment of pseudoxanthoma elasticum. J Am Acad Dermatol 2011; 65:341-348. [PMID: 21496949 DOI: 10.1016/j.jaad.2010.05.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 05/06/2010] [Accepted: 05/10/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pseudoxanthoma elasticum (PXE) is a rare connective tissue disorder involving fragmentation and mineralization of elastic fibers predominantly in the skin, eyes, and cardiovascular system. OBJECTIVE The objective of this study was to assess the efficacy of sevelamer hydrochloride on the reversal of elastic fiber calcification and clinical lesions of PXE. METHODS This was a randomized, double-blind, placebo-controlled, two-part prospective study. In the first year, 40 patients with PXE were randomized to receive either sevelamer hydrochloride (800 mg by mouth three times daily) or placebo in a 1:1 ratio. In the second year, all patients received sevelamer hydrochloride (800 mg by mouth three times daily). RESULTS In the first year, the placebo and treatment groups' mean calcium scores decreased from 29.52 to 15.97 (41.93% mean improvement) and 27.48 to 16.75 (38.37% mean improvement), respectively. In the second year, the mean calcium scores decreased to 13.36 (53.94%) and 14.03 (51.35%) in these groups. The mean clinical score in the placebo group decreased from 6.25 to 6.05 at year 1 (2% improvement) whereas the mean clinical score in the sevelamer hydrochloride group decreased from 7.10 to 6.55 (7% improvement). In year 2, the scores in the original placebo and sevelamer hydrochloride groups decreased to 5.33 (14% improvement) and 5.72 (19% improvement), respectively. LIMITATIONS Magnesium stearate in our placebo and active drugs may have played a confounding role in this study, contributing to the small differences observed in these two groups. CONCLUSION Sevelamer hydrochloride produced a reduction in both calcification levels and clinical scores; however, this difference was not statistically significant compared with placebo. Future clinical studies should examine the inhibitory role and potential therapeutic effect of magnesium in PXE.
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Affiliation(s)
- Jane Y Yoo
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York
| | - Robin R Blum
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York
| | - Giselle K Singer
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York
| | - Dana K Stern
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York
| | - Patrick O Emanuel
- Department of Dermatopathology, Mount Sinai School of Medicine, New York, New York
| | - Wayne Fuchs
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York
| | - Robert G Phelps
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York; Department of Dermatopathology, Mount Sinai School of Medicine, New York, New York
| | | | - Mark G Lebwohl
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York.
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Yanofsky VR, Mercer SE, Phelps RG. Histopathological variants of cutaneous squamous cell carcinoma: a review. J Skin Cancer 2010; 2011:210813. [PMID: 21234325 PMCID: PMC3018652 DOI: 10.1155/2011/210813] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Accepted: 11/04/2010] [Indexed: 11/18/2022] Open
Abstract
Nonmelanoma skin cancer (NMSC) is the most common form of cancer in the Caucasian population, with squamous cell carcinoma (SCC) accounting for the majority of NMSC-related metastases and death. While most SCC lesions are indolent tumors with low malignant potential, a wide diversity of SCC subtypes exist, several of which are associated with markedly more aggressive behaviors. Distinguishing these high-risk variants from their counterparts is possible through microscopic analysis, since each subtype possesses unique histopathological features. Early identification of high-risk lesions can allow for more rapid therapeutic intervention, reducing the likelihood of metastasis and death. The authors review specific histopathological features and associated clinical outcomes of the primary subdivisions of SCC.
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Affiliation(s)
| | - Stephen E. Mercer
- Division of Dermatopathology, Mount Sinai School of Medicine, One Gustave L. Levy Place, NY 10029, USA
| | - Robert G. Phelps
- Division of Dermatopathology, Mount Sinai School of Medicine, One Gustave L. Levy Place, NY 10029, USA
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Abraham NF, Mercer SE, Pandey S, LaBombardi VJ, Phelps RG. A diffuse painful desquamating rash. Neth J Med 2010; 68:370-374. [PMID: 21116031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- N F Abraham
- Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USA
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Abstract
BACKGROUND Aphthous stomatitis, a common mucocutaneous disorder, is a well accepted complication of sirolimus therapy. This association has been reported less frequently with tacrolimus. CASE We present an 11-year old male with Budd-Chiari syndrome who experienced profound worsening of chronic aphthous ulcers after immunosuppressive therapy was changed from tacrolimus to sirolimus. CONCLUSION Since these drugs are used widely in the pediatric transplantation population, this report serves to heighten awareness of this debilitating phenomenon, and to stress the importance of exercising caution when sirolimus and tacrolimus are administered in combination to pediatric patients.
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Affiliation(s)
- Nancy Habib
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
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Yadegari M, Whyte MP, Mumm S, Phelps RG, Shanske A, Totty WG, Cohen SR. Buschke-Ollendorff syndrome: absence of LEMD3 mutation in an affected family. ACTA ACUST UNITED AC 2010; 146:63-8. [PMID: 20083694 DOI: 10.1001/archdermatol.2009.320] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Buschke-Ollendorff syndrome (BOS), an autosomal dominant disorder, features small, acquired, asymptomatic, symmetrical foci of osteosclerosis detected radiographically in epimetaphyseal bone (osteopoikilosis) (OPK) together with connective tissue nevi or juvenile elastomas. Heterozygous, loss-of-function, germline mutation in the LEMD3 gene (which encodes an inner nuclear membrane protein called LEMD3, or MAN1) has been repeatedly documented in patients with BOS or OPK. OBSERVATIONS We describe a father and son with multiple yellowish papules and nodules coalescing into cobblestone nevoid plaques consistent with nevus elasticus. Radiographs of the father show multiple, small, bone islands within the hands, wrists, distal femurs, proximal tibias, and left distal fibula consistent with OPK. Although the clinical findings are diagnostic of Buschke-Ollendorf syndrome, analysis of the LEMD3 gene showed no exonic mutations. CONCLUSION Absence of LEMD3 mutation in the exons and splice sites of a family with BOS suggests that there is genetic heterogeneity for this disorder.
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Affiliation(s)
- Michelle Yadegari
- Division of Dermatology, Department of Medicine, Children's Hospital at Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467, USA
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Vidal C, Kapelusznik L, Goldberg M, Halverstam C, Daefler S, Calfee D, Phelps RG. The dermatologic manifestation of novel influenza A(H1N1). ACTA ACUST UNITED AC 2010; 146:101-2. [PMID: 20083711 DOI: 10.1001/archdermatol.2009.344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Dudelzak J, Hussain M, Phelps RG, Gottlieb GJ, Goldberg DJ. Evaluation of histologic and electron microscopic changes after novel treatment using combined microdermabrasion and ultrasound-induced phonophoresis of human skin. J COSMET LASER THER 2009; 10:187-92. [PMID: 19012051 DOI: 10.1080/14764170802524445] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mechanical exfoliation using microdermabrasion has been used as a minimally invasive treatment of photodamage, as well as to improve absorption of topical agents. Phonophoresis, a method of electrically assisted percutaneous delivery of macromolecules, relies on ultrasonic waves producing alterations within the stratum corneum that result in increased absorption. OBJECTIVE To determine the effects on photodamaged facial skin that resulted from the ultrasound-enhanced delivery of a combined hyaluronic acid, retinol, and peptide-containing complex following microdermabrasion. METHODS Seven individuals, aged 40-65, with Fitzpatrick skin types I-III and class I-III rhytids, underwent eight weekly aluminum oxide crystal microdermabrasion procedures (Parisian Peel; Aesthetic Technologies, Golden, CO, USA), followed by administration of a topical combined hyaluronic acid, retinol, and peptide-containing complex, propelled through ultrasound phonophoresis. The participants continued manual twice-daily application of the topical complex between treatments. Clinical evaluation included digital photography, and patient and investigator assessment of changes in skin dryness, texture, brightness, tone, and rhytids. The 3-month post-treatment histologic evaluation consisted of pre- and post-treatment biopsies evaluated for microscopic and ultrastructural changes. RESULTS An overall mild clinical improvement in the skin was noted. A slight increase in vascularity within the papillary dermis, increased reticulin stain (type III collagen), and ultrastuctural evidence of increased type I collagen indicate dermal injury with resulting new collagen formation. CONCLUSION Microdermabrasion followed by ultrasonic phonophoretic application of topical products represents a novel dermal delivery approach to photorejuvenation.
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Affiliation(s)
- Jacob Dudelzak
- Skin Laser & Surgery Specialists of NY and NJ, New York, New York, USA
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Saggar S, Zeichner JA, Brown TT, Phelps RG, Cohen SR. Kaposi’s Sarcoma Resolves After Sirolimus Therapy in a Patient With Pemphigus Vulgaris. ACTA ACUST UNITED AC 2008; 144:654-7. [DOI: 10.1001/archderm.144.5.654] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Fuchs BS, Sapadin AN, Phelps RG, Rudikoff D. Diagnostic dilemma: crusted scabies superimposed on psoriatic erythroderma in a patient with acquired immunodeficiency syndrome. Skinmed 2007; 6:142-4. [PMID: 17483659 DOI: 10.1111/j.1540-9740.2007.05723.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 45-year-old man with AIDS presented with extensive erythema and scaling involving the face, trunk, and upper and lower extremities, and mild nail dystrophy. The patient had been diagnosed with psoriasis 2 years previously, and at the time of presentation was using emollients and topical corticosteroid creams with little improvement. He was receiving zidovudine, lamivudine, trimethoprim/sulfamethoxazole, acyclovir, rifabutin, and hydroxyzine. Pertinent laboratory data included CD4 lymphocytes (10 cells/mm(3)), viral load (32,000 copies per mL) white blood cell count (3.4 x 10(3)/microL), hemoglobin (13.5 g/dL), and platelets (204 x 10(3)/microL). Because of the extensive eruption and lack of response to topical agents, the patient was started on acitretin 25 mg daily. The patient had shown no signs of improvement 4 weeks later and was noted to have brownish gray crusted plaques involving the beard area, neck, upper part of the back, arms, trunk, genitals, and thighs in addition to his erythroderma (Figure 1 and Figure 2). Microscopic examination of scales from the upper part of the back revealed numerous scabies mites and eggs. He was then treated with lindane shampoo on the scalp and beard area and permethrin 5% cream to the body. The patient returned 2 weeks later with some improvement after thrice-weekly applications of this regimen; however, scrapings from the trunk once again revealed live scabies mites. Microscopic examination of scales that had fallen on the examination table revealed multiple mites and eggs. The patient was then given permethrin 5% cream, which he applied 3 times a week for 2 weeks, and 1 dose of oral ivermectin, 200 micro/kg. This resulted in a marked decrease in crusting and scaling. With resolution of the scabies lesions, the patient displayed marked erythema and scaling of the trunk and extremities consistent with generalized psoriasis (Figure 3). Treatment with acitretin resulted in gradual resolution of the erythroderma. A few months later, the patient presented with nodules on the upper part of the back, which on biopsy revealed a scabies mite (Figure 4).
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Affiliation(s)
- Brian S Fuchs
- Department of Dermatology, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029, USA
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Abstract
The dermatology staff was called to evaluate abnormal hair on a 22-month-old Hispanic girl whose parents were first cousins. Her medical history was significant for leptomeningitis with subsequent neurologic devastation, gastroesophageal reflux disease, and recurrent respiratory infections. Her hospital course was complicated by sepsis, liver dysfunction, pan-cytopenia, and disseminated intravascular coagulation. She had developed normally for the first year of life. At 13 months she became progressively lethargic and developed floppy muscle tone; a delay in mental and motor milestones was recognized. Results of a metabolic workup were negative. On examination she was noted to have generalized excessively fair skin when compared with her parents. She had silver-gray hair (Figure 1) and white eyebrows and body hair. Her maternal grandfather and granduncles had silver hair since childhood, but were without health problems. A maternal family member was said to have light skin. The presumed diagnosis before pathologic examination was Chediak-Higashi syndrome. Hematoxylin and eosin stain tests revealed prominent melanocytes in the basal layer of the epidermis. The melanocytes were large and distended with a large volume of melanin (Figure 2). The adjacent keratinocytes were completely devoid of melanin. Application of Masson-Fontana ammoniac silver stain highlighted prominent melanocytic melanin and a relative paucity of melanin in the adjacent keratinocytes (Figure 3). Microscopic examination of her hair revealed clumps of melanin of various sizes and shapes irregularly distributed throughout the hair shaft. Ultrastructural examination of the epidermis showed the melanocytes were distended by an accumulation of large stage IV mature melanosomes. Peripheral blood smear failed to show abnormal granules, even after repeated examination. Based on the clinical features and the pathologic findings, a diagnosis of Griscelli syndrome type 2 was made.
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Affiliation(s)
- Patrick O Emanuel
- Department of Dermatopathology, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029, USA.
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Abstract
A case of an osteogenic desmoplastic melanoma occurring on the sole of the foot of a 60-year-old African American man is described. The tumor measured 4.8 cm in greatest dimension, invaded to a thickness of 2.2 cm and metastasized to four of ten inguinal lymph nodes. The majority of the tumor had a classic desmoplastic phenotype with malignant spindle cells set in a sclerotic and myxoid matrix and foci of lymphocyte aggregation. In other areas, there were thick trabeculae of bone rimmed by malignant epithelioid melanocytes. There was a markedly atypical lentiginous hyperplasia in the overlying epidermis. Imaging showed no continuity with the underlying calcaneus. The tumor was characterized immunohistochemically by S100 positivity. Pathologists should be aware of this diagnosis and should differentiate it from osteosarcoma.
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Affiliation(s)
- Patrick O Emanuel
- Department of Dermatopathology, Mount Sinai Medical Center, New York, NY, USA.
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Moore JO, Palep SR, Saladl RN, Gao D, Wang Y, Phelps RG, Lebwohl MG, Wei H. Effects of Ultraviolet B Exposure on the Expression of Proliferating Cell Nuclear Antigen in Murine Skin¶. Photochem Photobiol 2007. [DOI: 10.1111/j.1751-1097.2004.tb00134.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
A 57-year-old Hispanic man with a personal and family history of bullae and photosensitivity presented with a fungating, ulcerated squamous cell carcinoma on his left hand (Figure 1). Physical examination showed conjunctival injection, ectropion, symblepharon, urethral stricture, loss of teeth, short stature, and nail dystrophy. There was reticulated erythema, atrophy, hyperpigmentation and hypopigmentation, and telangiectasia of sun-exposed skin of the face, neck, and hands consistent with poikiloderma (Figure 2). In addition, there was foreshortening of the left thumb and sclerodermoid changes of his hands (Figure 3). Radiation therapy was applied to shrink the tumor before a local excision was performed. However, a local recurrence followed and axillary lymph nodes became clinically palpable, necessitating amputation and lymph node dissection. Extensive histologic evaluation of the specimen obtained following left arm amputation and lymph node dissection showed moderate-to-poorly differentiated deeply invasive squamous cell carcinoma. Two of 3 axillary lymph nodes were positive for metastatic carcinoma. A random biopsy of the trunk showed epidermal atrophy, telangiectasia, a perivascular lymphocytic infiltration, and pigment-laden macrophages consistent with poikiloderma. Electron microscopy illustrated extensive reduplication of the basement membrane, with loops, curls, and free extensions of the basal lamina in the superficial dermis; reduced numbers of hemidesmosomes and anchoring fibrils; and a basement membrane focally devoid of basal cells (Figure 4). On the basis of the clinical features and the characteristic basement zone changes, a diagnosis of Kindler syndrome was made.
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Affiliation(s)
- Patrick O Emanuel
- Department of Dermatopathology, Mount Sinai Medical Center, New York, NY 10029, USA
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Abstract
BACKGROUND AND OBJECTIVE Mesotherapy, as broadly defined, represents a variety of minimally invasive techniques in which medications are directly injected into the skin and underlying tissue in order to improve musculoskeletal, neurologic, and cosmetic conditions. There are few clinical studies evaluating the efficacy and safety of mesotherapy in any form. This study evaluates the histologic and clinical changes associated with one of the simplest formulations of mesotheraphy commonly used for skin rejuvenation. STUDY DESIGN Ten subjects underwent four sessions of mesotherapy involving multiple injections of a multivitamin and hyaluronic acid solution. Treatment was conducted at 4 monthly intervals. All subjects had pre- and post-treatment photographs and skin biopsies. Skin biopsies were evaluated with routine histology, mucin and elastin stains, and electron microscopy. Patient surveys were also evaluated. RESULTS Evaluation of photographs at 0, 3, and 6 months revealed no significant clinical differences. Light microscopic examination of pre- and posttreatment specimens showed no significant changes. Electron microscopic analysis of collagen fibers measurements did show smaller diameter fibres posttreatment. CONCLUSION No significant clinical or histologic changes were observed after multivitamin mesotherapy for skin rejuvenation. Multivitamin and hyaluronic acid solution facial mesotherapy does not appear to provide any significant benefit.
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Affiliation(s)
- Snehal P Amin
- Skin Laser and Surgery Specialists of NY and NJ, New York, NY 10022, USA
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Moore JO, Palep SR, Saladi RN, Gao D, Wang Y, Phelps RG, Lebwohl MG, Wei H. Effects of ultraviolet B exposure on the expression of proliferating cell nuclear antigen in murine skin. Photochem Photobiol 2006; 80:587-95. [PMID: 15623348 DOI: 10.1562/0031-8655(2004)080<0587:eoubeo>2.0.co;2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Proliferating cell nuclear antigen (PCNA) is an active nuclear protein involved in DNA replication, recombination and repair. PCNA is found throughout the basal layer in normal skin and in all layers of the epidermis in malignancy. This study evaluates PCNA's expression after acute and chronic UV-B irradiation. Skh-1 hairless mice exposed to 1.5 and 4.5 kJ/m2 of UV-B were sacrificed at 6, 12, 24, 48, 72 and 168 h. Immunohistochemical analysis revealed PCNA expression throughout the basal layer of untreated skin, with diminished expression at 6 h, indicative of immediate UV damage, and evidenced by the observable upregulation in pyrimidine dimer formation early on. Subsequently, PCNA immunoreactivity progressively increased, demonstrating an aberrant upward epidermal migratory pattern in association with chronic exposure. The 4.5 kJ/m2 group exhibited prolonged recovery in staining and also demonstrated this altered migratory pattern with chronic exposure. Progressive reactivation of PCNA expression occurs with repair. PCNA migration to upper layers of the epidermis indicates proliferation and possibly a subsequent increased malignant potential. We conclude that PCNA can serve as a marker of DNA repair and indirectly as an indicator of UV-B-induced damage, expression being time dependent and dose related. Specific immunoreactivity patterns and the observable atypia in keratinocytes are relevant in elucidating malignant potentiation.
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Affiliation(s)
- Julian O Moore
- Department of Dermatology, Mount Sinai School of Medicine, New York, NY 10029, USA
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