Lymphangitic Melanomatosis: Case Report of Intralymphatic Spread of Melanoma in a 66-year-old Man

ABSTRACT

Melanoma with lymphatic invasion has been associated with increased risk of metastasis, but the mechanisms and clinical implications are poorly understood. Although current reports have documented angiotropic spread of melanoma and suggest lymphatic spread of melanoma to increase the likelihood of metastasis, to our knowledge, lymphangitic metastatic melanoma resembling cutaneous carcinomatosis or presenting with facial hyperpigmentation has not been described. In this case report, we describe extensive cutaneous intralymphatic spread of melanoma, or lymphangitic melanomatosis, producing macular skin pigmentation in a 66-year-old man.

Unusual clinical presentations of cutaneous squamous cell involving distal extremities in four patients: the importance of tissue sampling

INTRODUCTION

cSCC is the second most common cutaneous malignancy worldwide behind basal cell carcinoma. Typically, SCC is diagnosed early before it infiltrates local subcutaneous tissue or metastasizes. However, unusual presentations are possible and can lead to delayed treatment and possibly worse outcomes.

MATERIALS AND METHODS

All patients were White of non-Hispanic or Latino decent. Three-quarters of the cases were male, and a quarter female. The age range was 45 to 78 years. The documented sizes of lesions ranged from 6 cm to 10 cm in diameter. Three of the cases were initially diagnosed as nonhealing wounds, and one was diagnosed as cellulitis.

RESULTS

The authors observed that SCC can present unusually by mimicking nonhealing infected ulcers or skin infections such as cellulitis. Over 18 months, the authors' practice recorded 4 cases of cSCC that were initially treated as persistent infections, which potentially lead to worse outcomes.

CONCLUSION

These cases provide patterns and clues to potentially expedite the diagnosis and treatment of cSCC. Any skin lesion thought to be infectious but not responding to treatment should undergo tissue sampling.

Photodistributed Toxic Epidermal Necrolysis: Case Report and Review of Current Literature

Importance

Cases of photodistributed Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been infrequently reported since the first documented case in 1989. This emerging clinical entity and its underlying mechanism have yet to be fully characterized.

Objective

To report a case of photodistributed SJS/TEN and highlight similarities to other cases reported in the literature.

Design, Setting, and Participants

Case report and literature review of published cases of photodistributed SJS/TEN. The case report describes a 29-year-old woman with recent lamotrigine and trimethoprim-sulfamethoxazole exposure who developed TEN in a photodistributed pattern 1 day after prolonged sun exposure. A search of PubMed using the keywords toxic epidermal necrolysis, Stevens-Johnson syndrome, photo-distributed, photo-induced, and sun-exposed was performed to identify other cases reported in the literature.

Results

Literature review revealed 8 previously reported cases of healthy individuals with known drug and UV radiation (UVR) exposures who subsequently developed SJS or TEN with photodistribution. Cases reviewed were skewed demographically to young women aged 19 to 48 years (8 of 9 patients) with all cases reporting UVR exposure 24 to 72 hours prior to the onset of symptoms.

Conclusions and Relevance

Photodistributed TEN has been increasingly described in the literature and may represent a distinct variant of SJS/TEN. While the pathogenesis remains unclear, the role of UVR as a "second hit" is suggested by the data presented in the cases documented thus far.

Wound Healing on the Dorsal Hands: An Intrapatient Comparison of Primary Closure, Purse-String Closure, and Secondary Intention

Nonmelanoma skin cancers are common on the dorsal hands where reserve tissue is limited. We highlight the case of an elderly man who had 3 nonmelanoma skin cancers on the left hand that were treated on the same day and left similar wounds. The wounds were repaired by primary closure, secondary intention, and purse-string circumferential closure. All wounds healed with excellent and essentially equivalent cosmetic results. For small shallow wounds on the dorsal hands, dermatologic surgeons should have confidence that secondary intention healing likely will lead to acceptable cosmetic and functional results.

Alopecia universalis after drug reaction with eosinophilia and systemic symptoms (Dress)

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse reaction characterized by a morbilliform cutaneous eruption, fever, lymphadenopathy, and multiorgan involvement. Alopecia universalis is a variant of alopecia areata characterized by complete loss of hair on the entire body. Herein, we report a case of alopecia universalis that presented after DRESS.

9 tips to help prevent derm biopsy mistakes

The authors--with expertise in dermatology and pathology--provide pointers that can help you improve your approach to skin biopsy.

Image and statistical analysis of melanocytic histology

AIMS

We applied digital image analysis techniques to study selected types of melanocytic lesions.

METHODS AND RESULTS

We used advanced digital image analysis to compare melanocytic lesions as follows: (i) melanoma to nevi, (ii) melanoma subtypes to nevi, (iii) severely dysplastic nevi to other nevi and (iv) melanoma to severely dysplastic nevi. We were successful in differentiating melanoma from nevi [receiver operating characteristic area (ROC) 0.95] using image-derived features, among which those related to nuclear size and shape and distance between nuclei were most important. Dividing melanoma into subtypes, even greater separation was obtained (ROC area 0.98 for superficial spreading melanoma; 0.95 for lentigo maligna melanoma; and 0.99 for unclassified). Severely dysplastic nevi were best differentiated from conventional and mildly dysplastic nevi by differences in cellular staining qualities (ROC area 0.84). We found that melanomas were separated from severely dysplastic nevi by features related to shape and staining qualities (ROC area 0.95). All comparisons were statistically significant (P < 0.0001).

CONCLUSIONS

We offer a unique perspective into the evaluation of melanocytic lesions and demonstrate a technological application with increasing prevalence, and with potential use as an adjunct to traditional diagnosis in the future.

Alginate microparticles prepared by spray–coagulation method: Preparation, drug loading and release characterization

A spray-coagulation method was developed for the preparation of large scale of porous alginate microparticles. The effect of three variables on porosity was evaluated: (1) alginate solution concentration (2) the concentration of CaCl2 in the coagulation medium and (3) the ratio of guluronic acid to manuronic acid of the alginate. Methylene blue (MB), a highly water-soluble compound and a practically water-insoluble compound, 4-phenylazoaniline (PAA) were used as the model drugs to study drug loading and release characteristics from alginate microparticles. The release of the model compounds from the microparticles was found to depend upon the release medium. Incomplete in vitro release of both model drugs in deionized (DI) water was observed. The release of MB in simulated gastrointestinal fluid (0.1N HCl) was fast and complete, while the release of PAA was slow in 0.1N HCl and fast in phosphate buffer solution (pH 6.8). Interactions between the model drugs and alginate microparticles were identified from scanning electron microscopy (SEM), differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FT-IR) analysis. The results indicated that (1) porous alginate microparticles can be produced by the spray-coagulation method; (2) drugs can be loaded by the adsorption method; (3) and the obtained microparticles may be used for delaying the release of drugs of low water solubility in acidic conditions.

Toward understanding why fairness matters: the influence of mortality salience on reactions to procedural fairness

This article focuses on the question of why fairness matters to people. On the basis of fairness heuristic theory, the authors argue that people especially need fairness when they are uncertain about things that are important to them. Following terror management theory, the authors focus on a basic kind of human uncertainty: fear of death. Integrating these two theoretical frameworks, it is proposed that thinking about their mortality should make fairness a more important issue to people. The findings of three experiments support the authors' line of reasoning: Asking participants to think about their mortality led to stronger fair process effects (positive effects of perceived procedural fairness on subsequent reactions) than not asking them to think about mortality. It is argued that these findings suggest that fairness especially matters to people when they are uncertain about fundamental aspects of human life such as human mortality.