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Veerabagu SA, Zhang J, Krausz AE, Fix WC, Cheng B, Sobanko JF, Etzkorn JR, Shin TM, Higgins HW, Giordano CN, McMurray SL, Walker JL, Miller CJ. Low local recurrence rates after Mohs micrographic surgery for cutaneous squamous cell carcinoma of the nail unit. J Am Acad Dermatol 2024; 90:832-833. [PMID: 38043591 DOI: 10.1016/j.jaad.2023.11.043] [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: 07/28/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Surya A Veerabagu
- Department of Dermatology, University of New Mexico, Albuquerque, New Mexico
| | - Junqian Zhang
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aimee E Krausz
- Department of Dermatology, Main Line Health, Paoli, Pennsylvania
| | - William C Fix
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York
| | - Brian Cheng
- Department of Medicine, Indiana University, Vincennes, Indiana
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - H William Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene N Giordano
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stacy L McMurray
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joanna L Walker
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Kong J, Cuevas-Castillo F, Nassar M, Lei CM, Idrees Z, Fix WC, Halverstam C, Mir A, Elbendary A, Mathew A. Bullous drug eruption after second dose of mRNA-1273 (Moderna) COVID-19 vaccine: Case report. J Infect Public Health 2021; 14:1392-1394. [PMID: 34294590 PMCID: PMC8264280 DOI: 10.1016/j.jiph.2021.06.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022] Open
Abstract
Background In December 2020, Moderna released the mRNA-1273 vaccine. The most common side effects are headache, muscle pain, redness, swelling, and tenderness at the injection site. In addition, there have been dermatological adverse events, such as hypersensitivity reactions. Although rare, various bullous eruptions have been described following vaccination. Bullous pemphigoid has been reported to occur most often after receipt of influenza and the diphtheria-tetanus-pertussis vaccine. To the best of our knowledge, there have been no reports of bullous drug eruptions resulting from mRNA vaccines. Case summary A 66-years-old obese Guyanese male presented with a bullous rash following receipt of a commercial COVID-19 mRNA vaccine. He received the first dose uneventfully. However, within 24 h of receiving the second dose, he developed fever, myalgias, and malaise accompanied by a painful blistering rash of his torso, arms, and legs. His fever and myalgias improved after 24 h, but his painful rash did not, and five days after the initial symptoms, he presented to the hospital. There were many violaceous, poorly demarcated patches on his trunk, arms, and thighs on examination, many of which had large flaccid bullae within, and a few areas on his buttocks, posterior shoulder, and scrotum were eroded. The exam was also significant for lower extremity muscle tenderness, stiffness with preserved strength. A skin biopsy showed epidermal necrosis and sparse perivascular dermatitis concerning Stevens-Johnson syndrome or erythema multiforme. However, in the absence of mucous membrane involvement or targetoid lesions, the diagnosis of an extensive bullous fixed drug eruption was made. Conclusion This case illustrates that the bullae eruption occurred as a result of receiving the Moderna vaccination.
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Affiliation(s)
- Joyce Kong
- Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals Queens, NY, USA.
| | | | - Mahmoud Nassar
- Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals Queens, NY, USA.
| | - Chi M Lei
- Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals Queens, NY, USA.
| | - Zarwa Idrees
- Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals Queens, NY, USA.
| | - William C Fix
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Caroline Halverstam
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Adnan Mir
- Dermpath Diagnostics, Weill Cornell Medicine Department of Dermatology, and New York Medical College Department of Dermatology, White Plains, NY, USA.
| | - Amira Elbendary
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Alwin Mathew
- Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals Queens, NY, USA.
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Abstract
CASE A 57-year-old man presented with a Mycobacterium fortuitum prosthetic joint infection (PJI) after right total hip arthroplasty refractory to the initial revision surgery and cement spacer placement. The patient was subsequently treated with 2-stage total joint arthroplasty revision surgery using an antibiotic-laden spacer customized to include meropenem and delayed reimplantation to allow for prolonged, systemic antimicrobial treatment with multiple antimicrobials, including levofloxacin and linezolid. CONCLUSIONS There is little evidence to guide practitioners in the diagnosis and treatment of PJI caused by rare, rapidly growing mycobacteria (RGM) such as M. fortuitum. This case demonstrates a successful strategy for the treatment of RGM PJI.
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Affiliation(s)
- William C Fix
- 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 2Department of Orthopaedic Surgery, Adult Hip and Knee Reconstruction, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 3Section of Infectious Diseases, Pennsylvania Hospital, Philadelphia, Pennsylvania
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Fix WC, Miller CJ, Etzkorn JR, Shin TM, Howe N, Sobanko JF. Comparison of Accuracy of Patient and Physician Scar Length Estimates Before Mohs Micrographic Surgery for Facial Skin Cancers. JAMA Netw Open 2020; 3:e200725. [PMID: 32159810 PMCID: PMC7066479 DOI: 10.1001/jamanetworkopen.2020.0725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Patients are satisfied when surgical outcomes meet their expectations. Dissatisfaction with surgical scars is one of the most common reasons that patients sue surgeons who perform Mohs micrographic surgery (MMS). OBJECTIVE To measure the accuracy of patient and physician estimations of scar length prior to skin cancer removal with MMS. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted between December 1, 2017, and February 28, 2018, at the MMS clinic of a single tertiary referral center health system. A total of 101 adults presenting for MMS for treatment of facial skin cancers volunteered for this study, and 86 surgeons who performed the MMS procedure participated. MAIN OUTCOMES AND MEASURES Patients and physicians independently drew the anticipated scar length on the patients' skin prior to surgery. Preoperative estimates by patients and surgeons were compared with actual postoperative scar length. RESULTS Of the 101 patients who participated, 57 patients (56.4%) were men and 57 patients (56.4%) were aged 65 years or older. Eighty-four patients (83.2%) underestimated scar length, whereas 67 of the 86 surgeons (77.9%) correctly estimated the scar length (P < .001). The actual postoperative scar length was 2.2 (interquartile range, 1.5-3.6) times larger than the patients' preoperative estimate but only 1.1 (interquartile range, 1.0-1.2) times larger than the surgeons' preoperative estimate (P < .001). Preoperative consultation with the surgeon, a personal history of MMS, or patient-directed research about MMS were not associated with improvement of patients' estimations of scar length. CONCLUSIONS AND RELEVANCE This study's findings suggest that patients with facial skin cancers have unrealistic expectations regarding scars that measure, on average, less than half the length of the actual postoperative scars. Surgeons appear to accurately estimate the length of most surgical scars and have an opportunity to set realistic patient expectations about scar length before surgery.
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Affiliation(s)
- William C. Fix
- Medical student at time of writing, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Jeremy R. Etzkorn
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia
| | - Thuzar M. Shin
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia
| | - Nicole Howe
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia
| | - Joseph F. Sobanko
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia
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Fix WC, Cornejo C, Duffy KA, Hathaway ER, Kalish JM, Rubin AI, Treat JR. Pediatric chondrodermatitis nodularis helicis (CNH) in a child with Beckwith-Wiedemann syndrome (BWS). Pediatr Dermatol 2019; 36:388-390. [PMID: 30773672 DOI: 10.1111/pde.13765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Chondrodermatitis nodularis helicis is an idiopathic degenerative process that presents as a painful nodule, papule, or ulcer on the helix or antihelix. It predominantly affects adults and is thought to be associated with trauma to the ear. We describe a case of pediatric chondrodermatitis nodularis helicis occurring in a child with a history of Beckwith-Wiedemann syndrome that was successfully treated with an excisional biopsy and relief from a recurrent source of pressure on the ear.
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Affiliation(s)
- William C Fix
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christine Cornejo
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kelly A Duffy
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Evan R Hathaway
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer M Kalish
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adam I Rubin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - James R Treat
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Fix WC, Chiesa-Fuxench ZC, Shin T, Etzkorn J, Howe N, Miller CJ, Sobanko JF. Use of a vibrating kinetic anesthesia device reduces the pain of lidocaine injections: A randomized split-body trial. J Am Acad Dermatol 2019; 80:58-59. [DOI: 10.1016/j.jaad.2018.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/26/2018] [Accepted: 08/11/2018] [Indexed: 11/17/2022]
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Fix WC, Yun SJ, Groft MacFarlane CM, Jambusaria A, Elenitsas R, Chu E, Etzkorn JR, Sobanko JF, Shin TM, Miller CJ. MART-1-labeled melanocyte density and distribution in actinic keratosis and squamous cell cancer in situ: Pagetoid melanocytes are a potential source of misdiagnosis as melanoma in situ. J Cutan Pathol 2018; 45:734-742. [PMID: 29943494 DOI: 10.1111/cup.13309] [Citation(s) in RCA: 2] [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: 02/12/2018] [Revised: 06/15/2018] [Accepted: 06/21/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Actinic keratosis (AK) and squamous cell carcinoma in-situ (SCCIS) within or near melanoma in situ (MIS) can complicate diagnosis due to overlapping clinical and microscopic features. This study aimed to describe basilar melanocyte density and pagetoid spread in AK and SCCIS for improved diagnostic accuracy. METHODS A total of 22 AK and 22 SCCIS biopsies containing a margin of uninvolved epidermis were immunostained with MART-1 (melanoma antigen recognized by T-cells 1). The basilar melanocyte:keratinocyte ratio and the number and distribution of pagetoid melanocytes were compared in AK, SCCIS, and uninvolved epidermis. An in-vitro human skin model was created to assess the impact of keratinocyte atypia on melanocyte distribution. RESULTS The median basilar melanocyte:keratinocyte ratio in SCCIS (1:11.49) was lower than in uninvolved epidermis (1:5.59, P = 0.0011), and the ratio in AK (1:6.94) was similar to uninvolved epidermis (P = 0.987). Pagetoid melanocytes were absent in perilesional skin but common in AK (21/22, P < 0.0001) and SCCIS (22/22, P < 0.0001). Pagetoid melanocytes at or above the mid-spinous layer were more common in SCCIS (21/22) vs AK (7/22, P < 0.0001). Pagetoid melanocytes were present in the in-vitro skin model made with neoplastic but not normal keratinocytes. CONCLUSIONS Pagetoid melanocytes in AK and SCCIS should be interpreted with caution to avoid overdiagnosis of MIS.
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Affiliation(s)
- William C Fix
- Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sook Jung Yun
- Department of Dermatology, Chonnam National University Medical School, Gwangju, South Korea
| | | | - Anokhi Jambusaria
- Division of Dermatology, Department of Internal Medicine, University of Texas Austin, Dell Medical School, Austin, Texas
| | - Rosalie Elenitsas
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Chu
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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