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Nahm WJ, Juarez M, Abdul-Hay M, Bhatt A, Meehan SA, Shvartsbeyn M. Leukemia Cutis in Relapsed Acute Myeloid Leukemia: A Call for Distinct Classification. Am J Case Rep 2024; 25:e943577. [PMID: 38760926 DOI: 10.12659/ajcr.943577] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
BACKGROUND Acute myeloid leukemia is characterized by dysregulated proliferation and maturation arrest of myeloid precursors, precipitating a spectrum of complications. Among these, leukemia cutis refers specifically to ectopic deposition and proliferation of malignant myeloid cells within the skin. This infiltration pathogenesis remains unclear. Although there are numerous reports of leukemia cutis in the setting of acute myeloid leukemia or primary acute myeloid leukemia, there are no specific reports of leukemia cutis in the setting of relapsed acute myeloid leukemia. CASE REPORT A 59-year-old woman, with a history of remission from poor-risk acute myeloid leukemia, previously treated with chemotherapy and allogenic bone marrow transplant, presented with shortness of breath, lethargy, anemia, thrombocytopenia, and subcutaneous nodules on lower extremities. Leukemia cutis was diagnosed, in the setting of relapsed acute myeloid leukemia. After unsuccessful salvage chemotherapy and being deemed unsuitable for further treatment, she pursued palliative care and died a month later. CONCLUSIONS Our case highlights a lack of reporting or making a distinction of those patients with relapsed acute myeloid leukemia and leukemia cutis. Consequently, it can be deduced that patients who simultaneously have relapsed acute myeloid leukemia and leukemia cutis are expected to fare worse in terms of clinical outcomes than those with primary acute myeloid leukemia and leukemia cutis. Relapsed acute myeloid leukemia patients with leukemia cutis should be classified as a distinct group, warranting further research into aggressive therapeutic targets and survival rates, while emphasizing the need for more vigilant follow-up and lower biopsy thresholds for cutaneous lesions in patients with treated hematologic malignancies.
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Affiliation(s)
- William J Nahm
- New York University Grossman School of Medicine, New York City, NY, USA
| | - Michelle Juarez
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York City, NY, USA
| | - Maher Abdul-Hay
- Blood and Marrow Transplantation Program, Perlmutter Cancer Center, New York University Langone Health, New York City, NY, USA
| | - Ahan Bhatt
- Division of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Shane A Meehan
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York City, NY, USA
| | - Marianna Shvartsbeyn
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York City, NY, USA
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Sikora M, Buontempo MG, Ramachandran V, Knutsen DA, Meehan SA, Hejazi EZ, Caplan AS, Lo Sicco KI, Tattersall IW. Eosinophilic Pustular Folliculitis in an HIV-Positive 63-Year-Old Male. Am J Med 2024:S0002-9343(24)00204-3. [PMID: 38588935 DOI: 10.1016/j.amjmed.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/07/2024] [Accepted: 03/16/2024] [Indexed: 04/10/2024]
Affiliation(s)
| | - Michael G Buontempo
- Department of Dermatology, Hackensack Meridian School of Medicine, Nutley, NJ
| | - Vignesh Ramachandran
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
| | - Dorothy A Knutsen
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Langone Health, New York, NY
| | - Shane A Meehan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
| | - Emily Z Hejazi
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Avrom S Caplan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
| | - Kristen I Lo Sicco
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
| | - Ian W Tattersall
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY.
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Buontempo MG, Ramachandran V, Freedman J, Meehan SA, Lo Sicco K, Saitta PA. General dermatology and dermatology in primary health care. Clin Exp Dermatol 2024:llae086. [PMID: 38504473 DOI: 10.1093/ced/llae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/15/2024] [Accepted: 03/18/2024] [Indexed: 03/21/2024]
Abstract
This manuscript presents a Specialty Certificate Examination case in general dermatology and primary health care, featuring a 54-year-old woman with a chronic growth on her left buttock. The case posed a diagnostic challenge, based on the presence of multiple soft nodules, and histological findings of mature adipocytes within the dermis.
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Affiliation(s)
- Michael G Buontempo
- Department of Dermatology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Vignesh Ramachandran
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Jeremy Freedman
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Shane A Meehan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Peter A Saitta
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
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4
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Russo AT, Buffolino R, Shvartsbeyn M, Meehan SA. Black Fungus of the Foot: An Unusual Presentation of COVID-19-Associated Mucormycosis. J Am Podiatr Med Assoc 2024; 114:22-118. [PMID: 37471290 DOI: 10.7547/22-118] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Mucormycosis, also known as black fungus, is a rare but aggressive fungal disease with high morbidity and mortality rates that tends to affect patients who are severely immunocompromised. Early recognition of the infection and prompt intervention is critical for treatment success. In recent years the coronavirus disease of 2019 (COVID-19) pandemic has resulted in a surge in the number of cases of mucormycosis. This study aims to report an unfortunate event involving an immunocompromised elderly man with mucormycosis of the foot who died as a result of sepsis caused by COVID-19. It is important to have a high clinical suspicion for mucormycosis when a clinical lesion develops, and to appropriately perform biopsy the lesion in question, particularly in the context of COVID-19. Raising awareness of COVID-19-associated mucormycosis may allow for early detection of the disease, thus enabling the initiation of rapid treatment, ultimately saving lives.
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Affiliation(s)
- Ashley T Russo
- *Department of Orthopedic Surgery, Division of Podiatry, NYU Grossman Long Island School of Medicine, Mineola, NY
| | - Raffaella Buffolino
- *Department of Orthopedic Surgery, Division of Podiatry, NYU Grossman Long Island School of Medicine, Mineola, NY
| | - Marianna Shvartsbeyn
- †The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
| | - Shane A Meehan
- †The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
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5
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Taranto V, Shvartsbeyn M, Meehan SA, Siegel LJ. Dronedarone-induced phototoxic dermatitis. Int J Dermatol 2023; 62:1553-1554. [PMID: 37700581 DOI: 10.1111/ijd.16845] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 08/20/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023]
Affiliation(s)
- Viktoria Taranto
- New York Institute of Technology, College of Osteopathic Medicine, 101 Northern Blvd, Glen Head, NY, USA
| | - Marianna Shvartsbeyn
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Shane A Meehan
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Louis J Siegel
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
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Li-Geng T, Sartori DJ, Shoucri S, Meehan SA, Karagounis TK. A 30-Year-Old Man With Finger Pain and Swelling. Clin Infect Dis 2023; 77:657-658. [PMID: 37607354 DOI: 10.1093/cid/ciac975] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Affiliation(s)
- Tony Li-Geng
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Daniel J Sartori
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Sherif Shoucri
- Division of Infectious Disease and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Shane A Meehan
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Theodora K Karagounis
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
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7
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Castillo RL, Sidhu I, Dolgalev I, Chu T, Prystupa A, Subudhi I, Yan D, Konieczny P, Hsieh B, Haberman RH, Selvaraj S, Shiomi T, Medina R, Girija PV, Heguy A, Loomis CA, Chiriboga L, Ritchlin C, Garcia-Hernandez MDLL, Carucci J, Meehan SA, Neimann AL, Gudjonsson JE, Scher JU, Naik S. Spatial transcriptomics stratifies psoriatic disease severity by emergent cellular ecosystems. Sci Immunol 2023; 8:eabq7991. [PMID: 37267384 PMCID: PMC10502701 DOI: 10.1126/sciimmunol.abq7991] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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] [Received: 05/02/2022] [Accepted: 05/10/2023] [Indexed: 06/04/2023]
Abstract
Whereas the cellular and molecular features of human inflammatory skin diseases are well characterized, their tissue context and systemic impact remain poorly understood. We thus profiled human psoriasis (PsO) as a prototypic immune-mediated condition with a high predilection for extracutaneous involvement. Spatial transcriptomics (ST) analyses of 25 healthy, active lesion, and clinically uninvolved skin biopsies and integration with public single-cell transcriptomics data revealed marked differences in immune microniches between healthy and inflamed skin. Tissue-scale cartography further identified core disease features across all active lesions, including the emergence of an inflamed suprabasal epidermal state and the presence of B lymphocytes in lesional skin. Both lesional and distal nonlesional samples were stratified by skin disease severity and not by the presence of systemic disease. This segregation was driven by macrophage-, fibroblast-, and lymphatic-enriched spatial regions with gene signatures associated with metabolic dysfunction. Together, these findings suggest that mild and severe forms of PsO have distinct molecular features and that severe PsO may profoundly alter the cellular and metabolic composition of distal unaffected skin sites. In addition, our study provides a valuable resource for the research community to study spatial gene organization of healthy and inflamed human skin.
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Affiliation(s)
- Rochelle L. Castillo
- Division of Rheumatology, Department of Medicine, NYU Langone Health, NY, NY 10016
- NYU Psoriatic Arthritis Center, NYU Langone Health, NY, NY 10016
| | - Ikjot Sidhu
- Department of Pathology, NYU Langone Health, NY, NY 10016
- Applied Bioinformatics Laboratories, NYU Langone Health, NY, NY 10016
| | - Igor Dolgalev
- Applied Bioinformatics Laboratories, NYU Langone Health, NY, NY 10016
- Translational Immunology Center, NYU Langone Health, NY, NY 10016
| | - Tinyi Chu
- Computational and Systems Biology program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, NY, NY 10065
| | - Aleksandr Prystupa
- Department of Pathology, NYU Langone Health, NY, NY 10016
- Applied Bioinformatics Laboratories, NYU Langone Health, NY, NY 10016
| | - Ipsita Subudhi
- Department of Pathology, NYU Langone Health, NY, NY 10016
| | - Di Yan
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, NY, NY 10016
| | | | - Brandon Hsieh
- Department of Pathology, NYU Langone Health, NY, NY 10016
| | - Rebecca H. Haberman
- Division of Rheumatology, Department of Medicine, NYU Langone Health, NY, NY 10016
- NYU Psoriatic Arthritis Center, NYU Langone Health, NY, NY 10016
| | | | - Tomoe Shiomi
- Center for Biospecimen Research and Development, NYU Langone Health, NY, NY 10016
| | - Rhina Medina
- Division of Rheumatology, Department of Medicine, NYU Langone Health, NY, NY 10016
- NYU Psoriatic Arthritis Center, NYU Langone Health, NY, NY 10016
| | - Parvathy Vasudevanpillai Girija
- Division of Rheumatology, Department of Medicine, NYU Langone Health, NY, NY 10016
- NYU Psoriatic Arthritis Center, NYU Langone Health, NY, NY 10016
| | - Adriana Heguy
- Department of Pathology, NYU Langone Health, NY, NY 10016
- Genome Technology Center, NYU Langone Health, NY, NY 10016
| | | | - Luis Chiriboga
- Department of Pathology, NYU Langone Health, NY, NY 10016
- Center for Biospecimen Research and Development, NYU Langone Health, NY, NY 10016
| | - Christopher Ritchlin
- Allergy, Immunology and Rheumatology Division, Center of Musculoskeletal Research, University of Rochester Medical School, Rochester NY 14642
| | - Maria De La Luz Garcia-Hernandez
- Allergy, Immunology and Rheumatology Division, Center of Musculoskeletal Research, University of Rochester Medical School, Rochester NY 14642
| | - John Carucci
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, NY, NY 10016
| | - Shane A. Meehan
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, NY, NY 10016
| | - Andrea L. Neimann
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, NY, NY 10016
| | - Johann E. Gudjonsson
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109
| | - Jose U. Scher
- Division of Rheumatology, Department of Medicine, NYU Langone Health, NY, NY 10016
- NYU Psoriatic Arthritis Center, NYU Langone Health, NY, NY 10016
| | - Shruti Naik
- Department of Pathology, NYU Langone Health, NY, NY 10016
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, NY, NY 10016
- Perlmutter Cancer Center, NYU Langone Health, NY, NY 10016
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8
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DiLorenzo MA, Medrano N, Chen JN, Bawany F, Tran DC, Taunk P, Meehan SA, Pomeranz MK, Mgbako O. Bictegravir-Induced Drug Reaction With Eosinophilia and Systemic Symptoms in a Patient With Acute Human Immunodeficiency Virus. Open Forum Infect Dis 2023; 10:ofad066. [PMID: 36879628 PMCID: PMC9985146 DOI: 10.1093/ofid/ofad066] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Although drug reaction with eosinophilia and systemic symptoms (DRESS) is associated with antiretrovirals, there are no published reports of bictegravir-induced DRESS. Bictegravir is recommended as first-line treatment for patients with human immunodeficiency virus (HIV). Recognition of DRESS, its skin manifestations, and potential complications is vital for appropriate care and management of acute HIV.
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Affiliation(s)
- Madeline A DiLorenzo
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Nicola Medrano
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Jason N Chen
- Department of Internal Medicine, NYU Langone Health, New York, New York, USA
| | - Fatima Bawany
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York, USA
| | - Duy C Tran
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York, USA
| | - Pulkit Taunk
- Department of Internal Medicine, NYU Langone Health, New York, New York, USA
| | - Shane A Meehan
- Department of Pathology, NYU Langone Health, New York, New York, USA
| | - Miriam Keltz Pomeranz
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York, USA
| | - Ofole Mgbako
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Langone Health, New York, New York, USA
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9
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Belzer A, Ramachandran V, Meehan SA, Pomeranz MK, Matatova M. A rare case of pruritic papular eruption of human immunodeficiency virus in a patient without a diagnosis of acquired immunodeficiency syndrome. JAAD Case Rep 2022; 32:23-25. [PMID: 36606203 PMCID: PMC9807780 DOI: 10.1016/j.jdcr.2022.11.021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Annika Belzer
- Yale School of Medicine, New Haven, Connecticut,Correspondence to: Annika Belzer, BS, 188 Willow St, Apartment No. 2, New Haven, CT 06511.
| | - Vignesh Ramachandran
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York
| | - Shane A. Meehan
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York,Department of Pathology, NYU Langone Health, New York, New York
| | - Miriam K. Pomeranz
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York
| | - Marina Matatova
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York
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10
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Kolla AM, Bieber AK, Meehan SA. Peculiar Cutaneous Findings in a Patient With Rectal Adenocarcinoma. Gastroenterology 2022; 162:e11-e13. [PMID: 34146569 DOI: 10.1053/j.gastro.2021.06.021] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/07/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Avani M Kolla
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Amy K Bieber
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York.
| | - Shane A Meehan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
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11
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Criscito MC, Meehan SA, Stevenson ML. A red plaque on the face of a healthy man. JAAD Case Rep 2022; 21:74-76. [PMID: 35198704 PMCID: PMC8844803 DOI: 10.1016/j.jdcr.2021.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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12
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Krueger L, Saizan AL, Meehan SA, Ezzedine K, Hamzavi I, Elbuluk N. Seborrheic macular hypopigmentation: a case series proposing a new pigmentary disorder. J Eur Acad Dermatol Venereol 2021; 36:e361-e362. [PMID: 34927764 DOI: 10.1111/jdv.17884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022]
Affiliation(s)
- L Krueger
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - A L Saizan
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - S A Meehan
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - K Ezzedine
- Department of Dermatology, AP-HP, Henri Mondor University Hospital, UPEC, Créteil, France
| | - I Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - N Elbuluk
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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13
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Larson V, Seidenberg R, Caplan A, Brinster NK, Meehan SA, Kim RH. Clinical and histopathological spectrum of delayed adverse cutaneous reactions following COVID-19 vaccination. J Cutan Pathol 2021; 49:34-41. [PMID: 34292611 PMCID: PMC8444807 DOI: 10.1111/cup.14104] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [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: 04/07/2021] [Revised: 06/04/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022]
Abstract
Background As more people become vaccinated against the SARS‐CoV‐2 virus, reports of delayed cutaneous hypersensitivity reactions are beginning to emerge. Methods In this IRB‐approved retrospective case series, biopsy specimens of potential cutaneous adverse reactions from the Pfizer‐BioNTech or Moderna mRNA vaccine were identified and reviewed. Clinical information was obtained through the requisition form, referring clinician, or medical chart review. Results Twelve cases were included. Histopathological features from two injection‐site reactions showed a mixed‐cell infiltrate with eosinophils and a spongiotic dermatitis with eosinophils. Three biopsy specimens came from generalized eruptions that showed interface changes consistent with an exanthematous drug reaction. Three biopsy specimens revealed a predominantly spongiotic pattern, consistent with eczematous dermatitis. Small‐vessel vascular injury was seen in two specimens, which were diagnosed as urticarial vasculitis and leukocytoclastic vasculitis, respectively. There were two cases of new‐onset bullous pemphigoid supported by histopathological examination and direct immunofluorescence studies. Eosinophils were seen in 10 cases. Conclusions Dermatopathologists should be aware of potential cutaneous adverse reactions to mRNA‐based COVID‐19 vaccines. Histopathological patterns include mixed‐cell infiltrates, epidermal spongiosis, and interface changes. Eosinophils are a common finding but are not always present. Direct immunofluorescence studies may be helpful for immune‐mediated cutaneous presentations such as vasculitis or bullous pemphigoid.
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Affiliation(s)
- Valerie Larson
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Roy Seidenberg
- Laser & Skin Surgery Center of New York, New York, New York, USA
| | - Avrom Caplan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Nooshin K Brinster
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Shane A Meehan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Randie H Kim
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
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14
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Affiliation(s)
- Gillian K. Weston
- The Ronald O. Perelman Department of Dermatology, Dermatopathology Section, NYU Grossman School of Medicine, New York
| | - Haneol S. Jeong
- The Ronald O. Perelman Department of Dermatology, Dermatopathology Section, NYU Grossman School of Medicine, New York
| | - Euphemia W. Mu
- The Ronald O. Perelman Department of Dermatology, Dermatopathology Section, NYU Grossman School of Medicine, New York
- Piedmont Plastic Surgery & Dermatology, Cornelius, North Carolina
| | - David Polsky
- The Ronald O. Perelman Department of Dermatology, Dermatopathology Section, NYU Grossman School of Medicine, New York
- Laura and Isaac Perlmutter Cancer Center, NYU Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Shane A. Meehan
- The Ronald O. Perelman Department of Dermatology, Dermatopathology Section, NYU Grossman School of Medicine, New York
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15
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Mu EW, Stokar E, Franks L, Meehan SA. Histopathologic reaction patterns to differentially cross-linked hyaluronic acid fillers: A retrospective case series. J Cutan Pathol 2021; 48:758-762. [PMID: 33350498 DOI: 10.1111/cup.13947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/22/2020] [Revised: 11/21/2020] [Accepted: 12/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hyaluronic acid filler reactions have been increasingly observed in recent years. Our study investigates whether the increased number of filler reactions observed since 2014 is associated with a specific histopathologic inflammatory pattern and type of filler. METHODS The institution's dermatopathology electronic database was retrospectively searched for histopathologic reactions to hyaluronic acid from January 2014 to December 2019. The age, sex, type of filler, procedure, location, and histopathologic patterns were recorded. RESULTS From 2014 to 2019, there were 15 cases of granulomatous reactions to hyaluronic acid filler. In 10 of these cases, there was a characteristic inflammatory pattern characterized by tightly cuffed palisades of histiocytes with varying numbers of eosinophils. Of the 11 cases in which the type of filler was known, all used Vycross technology, a novel manufacturing process in the production of hyaluronic acid filler. CONCLUSION A characteristic histopathologic pattern of discrete foci of tightly cuffed palisaded granulomas with eosinophils is associated with fillers manufactured using Vycross technology.
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Affiliation(s)
- Euphemia W Mu
- The Ronald O. Perelman Department of Dermatology, New York School of Medicine, New York, New York, USA
| | - Evan Stokar
- The Ronald O. Perelman Department of Dermatology, New York School of Medicine, New York, New York, USA
| | - Linda Franks
- The Ronald O. Perelman Department of Dermatology, New York School of Medicine, New York, New York, USA
| | - Shane A Meehan
- The Ronald O. Perelman Department of Dermatology, New York School of Medicine, New York, New York, USA
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Roman J, Krueger LD, Young TK, Rieder EA, Rothman LR, Lakdawala N, Nagler AR, Meehan SA, Orlow SJ, Oza VS. The "bumpy" adolescent nose: Acne associated angiofibroma-like nasal papules. Pediatr Dermatol 2021; 38:45-49. [PMID: 32767593 DOI: 10.1111/pde.14319] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVE Papular scars are a recently described clinical phenotype of acne scarring characterized by papules occurring on the nose and chin. We have observed a similar presentation of nasal papules among patients seen in our clinic for acne and sought to further characterize the clinical and histopathological characteristics of this entity. METHODS In this single-site case series, a retrospective review of electronic medical records of patients with nasal papules in association with acne vulgaris between April 2018 and April 2019 was performed. Clinical and histopathologic findings were recorded. RESULTS We identified 20 patients who presented with a similar clinical phenotype of predominantly skin-colored, dome-shaped papules concentrated on the nose and chin in association with a history of more classic facial acne vulgaris. Papular lesions were seen predominately in adolescent Hispanic males. Concomitant acne on other areas of the face was identified in 18 patients at presentation while two patients had a history of adolescent acne. Biopsies were performed for five patients. Histopathologic examination demonstrated features of fibrosis and dilated thin-walled blood vessels, typical of angiofibromas. CONCLUSION We present a series of adolescent patients with large, flesh-colored to erythematous papules seen predominantly on the nose. These lesions are histologically indistinguishable from angiofibromas and may represent an under-recognized yet disfiguring sequela of acne that may disproportionately affect adolescents with skin of color.
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Affiliation(s)
- Jorge Roman
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Loren D Krueger
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Trevor K Young
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Evan A Rieder
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lisa R Rothman
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Nikita Lakdawala
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Arielle R Nagler
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Shane A Meehan
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Seth J Orlow
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Vikash S Oza
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
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17
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Affiliation(s)
- Di Yan
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Evan Stokar
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Adam Jacoby
- New York University Langone Health's Hansjörg Wyss Department of Plastic Surgery, New York, New York
| | - Bruce E Gelb
- New York University Langone Transplant Institute, New York, New York
| | - Eduardo D Rodriguez
- New York University Langone Health's Hansjörg Wyss Department of Plastic Surgery, New York, New York
| | - Shane A Meehan
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
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Agnihotri T, Adotama P, Kalowitz-Bieber A, Stokar E, Meehan SA, Latkowski JA. A case of primary cutaneous marginal zone lymphoma presenting with rosacea-like eruption. JAAD Case Rep 2020; 6:902-904. [PMID: 32875041 PMCID: PMC7452266 DOI: 10.1016/j.jdcr.2020.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/26/2022] Open
Affiliation(s)
- Tanvir Agnihotri
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Prince Adotama
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Amy Kalowitz-Bieber
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Evan Stokar
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Shane A Meehan
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Jo-Ann Latkowski
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
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19
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Young TK, Gutierrez D, Meehan SA, Pellett Madan R, Oza VS. Neutrophilic panniculitis arising from hematogenous spread of methicillin-resistant Staphylococcus aureus. Pediatr Dermatol 2020; 37:531-533. [PMID: 32124476 DOI: 10.1111/pde.14123] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Infectious panniculitis from hematogenous spread is uncommon and usually occurs in immunocompromised patients. Dissemination of gram-positive organisms to the subcutaneous tissue is rare with only several reports of disseminated panniculitis caused by Streptococcal species. We report a case of an immunocompetent 2-year-old boy presenting with diffuse neutrophilic panniculitis arising from methicillin-resistant Staphylococcus aureus septicemia. This case represents a highly atypical manifestation of severe MRSA infection and serves as a reminder to consider MRSA as a cause of disseminated neutrophilic panniculitis, particularly in high-risk populations.
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Affiliation(s)
- Trevor K Young
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Daniel Gutierrez
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Shane A Meehan
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Rebecca Pellett Madan
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Vikash S Oza
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
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20
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Lederhandler M, Chen L, Meehan SA, Brinster NK, Neimann A. A case of porphyria cutanea tarda in the setting of hepatitis C infection and tobacco usage. Dermatol Online J 2019; 25:13030/qt11p0982m. [PMID: 32045169] [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] [Received: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 06/10/2023] Open
Abstract
Porphyria cutanea tarda (PCT) is the most common type of porphyria, presenting in middle-aged patients with a photodistributed vesiculobullous eruption, milia, and scars. Porphyria cutanea tarda occurs in relation to inhibition of uroporphyrinogen decarboxylase, a key enzyme in the heme biosynthesis pathway. A number of genetic and acquired factors increase susceptibility to PCT by reducing uroporphyrinogen decarboxylase activity. A handful of other vesiculobullous conditions may mimic PCT both clinically and histologically; therefore, both skin biopsy and laboratory evaluation are helpful in confirming the diagnosis. We report a case of PCT in the setting of cigarette usage and untreated hepatitis C infection.
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Affiliation(s)
- M Lederhandler
- The Laser Skin & Surgery Center of New York, New York, NY New York University Langone Medical Center, The Ronald O. Perelman Department of Dermatology, New York, NY.
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21
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Lederhandler M, Stokar E, Meehan SA, Geronemus RG. Deep initial Mohs stage for scalp cutaneous squamous cell carcinoma to avoid occult tumor. J Am Acad Dermatol 2019; 82:e129-e130. [PMID: 31836558 DOI: 10.1016/j.jaad.2019.12.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Margo Lederhandler
- Laser & Skin Surgery Center of New York, New York, New York; The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
| | - Evan Stokar
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Shane A Meehan
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Roy G Geronemus
- Laser & Skin Surgery Center of New York, New York, New York; The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
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22
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Mu EW, Pusic M, Coneybeare M, Meehan SA. Learning Analytics to Enhance Dermatopathology Education Among Dermatology Residents. J Drugs Dermatol 2019; 18:1231-1236. [PMID: 31860211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND: With the advent of digital microscopy, learning analytics can be leveraged to advance teaching of dermatopathology in dermatology residency. OBJECTIVE: To analyze the acquisition and decay of dermatopathology visual recognition skills and areas of diagnostic confusion amongst residents using learning metrics generated by a web-based learning tool. METHODS: This was a prospective, longitudinal study of dermatology residents who studied digital photomicrographs of 18 routine diagnostic entities using an online software platform. Residents at different years of training were given 60 minutes to complete assessments on three occasions (initial test with follow-ups at one and three months). RESULTS: 4,938 responses were analyzed. Accuracy and time to diagnosis improved within each assessment and between the first and second assessments. First year residents showed knowledge decay when tested at three months (67% vs 64%; P=0.002) while third year residents retained knowledge and continued to improve upon their accuracy after three months (83% to 91%, <0.001). Learning analytics highlighted diagnostically challenging cases for residents that contradicted experts’ predictions (R=0.48). CONCLUSIONS: The use of learning analytics and interactive digital platforms enhances dermatopathology curriculum development by identifying challenging diagnostic entities, assessing mastery of subject material, and optimizing review schedules. J Drugs Dermatol. 2019;18(12):1231-1236.
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23
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Curtiss P, Riley K, Meehan SA, Elbuluk N. Photolichenoid dermatitis: a presenting sign of human immunodeficiency virus. Cutis 2019; 104:242-244. [PMID: 31809532] [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: 06/10/2023]
Abstract
Photolichenoid dermatitis is an uncommon eruptive dermatitis that often occurs in association with a photosensitizing drug. Photodermatitis, in general, is an uncommon clinical manifestation of human immunodeficiency virus (HIV), most often affecting patients of African and Native American descent. Photolichenoid dermatitis has infrequently been reported in patients with HIV who have not been exposed to a photosensitizing drug. We report a case of an African patient with a photodistributed depigmenting eruption without exposure to a photosensitizing drug. Histologic examination revealed a patchy perivascular and bandlike lymphocytic infiltrate with melanophages, interface changes, and dyskeratotic keratinocytes, consistent with photolichenoid dermatitis. Laboratory examination was significant for a positive HIV-2 antibody. Photolichenoid dermatitis may be a presenting sign of HIV infection and may not necessarily be associated with exposure to a photosensitizing drug. Testing for HIV should be done in patients who present with photodistributed depigmenting eruptions, even in the absence of exposure to a photosensitizing drug, and particularly in patients of African and Native American descent.
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Affiliation(s)
- Paul Curtiss
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
| | - Kathryn Riley
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
| | - Shane A Meehan
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
| | - Nada Elbuluk
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
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24
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Affiliation(s)
- Daniel Gutierrez
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
- Correspondence to: Daniel Gutierrez, MD, The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th St, 11th Floor, New York, NY 10016.
| | - Loren D. Krueger
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Andrea Tan
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joyce H. Park
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
- Kaiser Permanente San Jose Medical Center, San Jose, California
| | - George Lipkin
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Shane A. Meehan
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
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25
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W. Mu E, Chen L, Rothman L, Rubio‐Gonzalez B, Marks E, Persad L, Cockerell CJ, Leboit P, Meehan SA. Excision recommendation rates of atypical (dysplastic) nevi amongst experienced dermatopathologists. J Cutan Pathol 2019; 46:798-799. [DOI: 10.1111/cup.13513] [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: 04/23/2019] [Revised: 05/14/2019] [Accepted: 05/17/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Euphemia W. Mu
- The Ronald O. Perelman Department of DermatologyNew York University School of Medicine New York New York
- Piedmont Plastic Surgery & Dermatology Charlotte North Carolina
| | - Lu Chen
- The Ronald O. Perelman Department of DermatologyNew York University School of Medicine New York New York
| | - Lisa Rothman
- The Ronald O. Perelman Department of DermatologyNew York University School of Medicine New York New York
| | - Belen Rubio‐Gonzalez
- Pathology DepartmentUniversity of California San Francisco San Francisco California
| | - Etan Marks
- UT Southwestern/Cockerell Dermatopathology Dallas Texas
| | - Leah Persad
- UT Southwestern/Cockerell Dermatopathology Dallas Texas
| | | | - Phil Leboit
- Pathology DepartmentUniversity of California San Francisco San Francisco California
| | - Shane A. Meehan
- The Ronald O. Perelman Department of DermatologyNew York University School of Medicine New York New York
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26
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Liang SE, Cohen JM, Meehan SA, Rothman LR, Liebman TN. A 68-Year-Old Man on Azathioprine With New Systemic Symptoms and Widespread Skin Eruption. Clin Infect Dis 2019; 68:1427-1430. [DOI: 10.1093/cid/ciy440] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sydney E Liang
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine
| | - Jeffrey M Cohen
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine
| | - Shane A Meehan
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine
| | - Lisa R Rothman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine
| | - Tracey N Liebman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine
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27
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Lederhandler M, Chen L, Meehan SA, Brinster NK, Neimann A. A case of porphyria cutanea tarda in the setting of hepatitis C infection and tobacco usage. Dermatol Online J 2019. [DOI: 10.5070/d32512046727] [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: 11/08/2022] Open
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28
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Wiznia LE, Cohen JM, Beasley JM, Meehan SA, Latkowski JAM. Lymphomatoid papulosis. Dermatol Online J 2018; 24:13030/qt4xt046c9. [PMID: 30677799] [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] [Received: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 06/09/2023] Open
Abstract
Lymphomatoid papulosis is often regarded as a low-grade variant of cutaneous T cell lymphoma (CTCL). Given the excellent long-term prognosis, recent consensus guidelines indicate that patients can be monitored off therapy. We report a case of a 67-year-old man who presented with lymphomatoid papulosis, with necrotic papules that have been intermittently present for over forty years.
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Affiliation(s)
- Lauren E Wiznia
- The Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, New York.
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29
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Tong LX, Penn L, Meehan SA, Kim RH. Necrobiosis lipoidica. Dermatol Online J 2018; 24:13030/qt0qg3b3zw. [PMID: 30677798] [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] [Received: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 06/09/2023] Open
Abstract
We present a case of necrobiosis lipoidica (NL) of the right abdomen in a 75-year-old man. A skin biopsy performed showed a layered infiltrate of mono and multinucleated histiocytes palisaded around degenerated collagen bundles. Laboratory workup was unremarkable. The patient was treated with topical corticosteroids with cessation of progression of his disease, although the eruption did not resolve. There are a number of treatments for NL reported in the literature, all with varying efficacy. Although NL lesions are usually asymptomatic, patients with NL must be monitored closely for signs of ulceration or malignant transformation, in which case more aggressive treatment options may be warranted.
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Affiliation(s)
| | | | | | - Randie H Kim
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
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Wiznia LE, Steuer AB, Penn LA, Meehan SA, Femia AN. Generalized essential telangiectasia. Dermatol Online J 2018; 24:13030/qt2926z3f5. [PMID: 30677795] [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] [Received: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 06/09/2023] Open
Abstract
The pathophysiology of generalized essential telangiectasia is not well understood. Generalized essential telangiectasia is an uncommon disorder in which widespread telangiectasias of unknown cause develop without associated systemic or antecedent dermatologic disease. We report a case of generalized essential telangiectasia in an otherwise healthy 49-year-old man.
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Affiliation(s)
- Lauren E Wiznia
- The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York.
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31
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Price A, Tavazoie M, Meehan SA, Leger M. Id reaction associated with red tattoo ink. Cutis 2018; 102:E32-E34. [PMID: 30566564] [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: 06/09/2023]
Affiliation(s)
- Alexandra Price
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Florida, USA
| | | | - Shane A Meehan
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
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Sukhdeo K, Yoon GH, Rothman L, Meehan SA, Levin MK, Kim RH. Mirtazapine-induced hyperpigmentation with type II histopathologic findings. JAAD Case Rep 2018; 4:1077-1079. [PMID: 30511003 PMCID: PMC6250903 DOI: 10.1016/j.jdcr.2018.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lattanzi M, Deng FM, Chiriboga LA, Femia AN, Meehan SA, Iyer G, Voss MH, Sundatova Y, Huang WC, Balar AV. Durable response to anti-PD-1 immunotherapy in epithelioid angiomyolipoma: a report on the successful treatment of a rare malignancy. J Immunother Cancer 2018; 6:97. [PMID: 30285856 PMCID: PMC6167873 DOI: 10.1186/s40425-018-0415-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 06/15/2018] [Accepted: 09/18/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Malignant angiomyolipoma is an uncommon tumor of the class of perivasciular epithelioid cell neoplasms (PEComas). These tumors are characteristically driven by deleterious mutations in the tumor suppressors TSC1 and TSC2, whose gene products typically act to inhibit mTOR. There are several cases of malignant angiomyolipoma which exhibit transient responses to mTOR inhibitors, forming the basis of current practice guidelines in malignant PEComa. However the tumors ultimately acquire resistance, and there is no well-established second-line option. Despite the increasing prevalence of immunotherapy across a wide range of solid tumors, little is known about the immune infiltrate and PD-L1 expression of angiomyolipoma. Furthermore, there is no reported case on the treatment of malignant angiomyolipoma with an immune checkpoint inhibitor. CASE PRESENTATION A 38 year-old man presented with gross hematuria and was diagnosed with renal epithelioid angiomyolipoma. Despite surgical resection, the tumor recurred and metastasized. Targeted genomic sequencing revealed a deleterious mutation in TSC2, and the patient was treated with the mTOR inihbitor everolimus. The patient went on to have a partial response but ultimately progressed. He was then treated with the anti-PD-1 immune checkpoint inhibitor nivolumab, and achieved a durable near-complete response which is ongoing after two years of treatment. Immunohistochemical staining of tumor tissue revealed strong PD-L1 expression and a brisk T-cell infiltrate. CONCLUSIONS We report on the first durable systemic treatment of malignant epithelioid angiomyolipoima with the use of PD-1 antibody nivolumab. Given the absence of prospective clinical trials in this exceedingly rare disease, particularly in the second-line setting, immune checkpoint inhibitors like nivolumab should be considered.
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Affiliation(s)
| | - Fang-Ming Deng
- Department of Pathology, NYU Langone Health, New York, NY, USA.,Department of Urology, NYU Langone Health, New York, NY, USA.,Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | | | - Alisa N Femia
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, NY, USA
| | - Shane A Meehan
- Department of Pathology, NYU Langone Health, New York, NY, USA.,Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, NY, USA
| | - Gopa Iyer
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Martin H Voss
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Yuliya Sundatova
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA.,Genitourinary Medical Oncology Program, NYU School of Medicine, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, 160 East 34th Street, 10th Floor, New York, NY, 10016, USA
| | - William C Huang
- Department of Urology, NYU Langone Health, New York, NY, USA.,Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Arjun V Balar
- Department of Medicine, NYU Langone Health, New York, NY, USA. .,Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA. .,Genitourinary Medical Oncology Program, NYU School of Medicine, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, 160 East 34th Street, 10th Floor, New York, NY, 10016, USA.
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Mu EW, Khurram NA, Pei Z, Feng H, Cassai N, Meehan SA, Latkowski JA. 55-year-old man with ulcers in inguinal fold and intergluteal cleft found to have systemic Langerhans cell histiocytosis. JAAD Case Rep 2018; 4:837-840. [PMID: 30238052 PMCID: PMC6143693 DOI: 10.1016/j.jdcr.2018.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/24/2023] Open
Affiliation(s)
- Euphemia W Mu
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | | | - Zhiheng Pei
- Department of Pathology, New York University School of Medicine, New York, New York.,Department of Veterans Affairs New York Harbor Healthcare System, New York, New York
| | - Hao Feng
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Nicholas Cassai
- Department of Veterans Affairs New York Harbor Healthcare System, New York, New York
| | - Shane A Meehan
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.,Department of Pathology, New York University School of Medicine, New York, New York
| | - Jo-Ann Latkowski
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.,Department of Veterans Affairs New York Harbor Healthcare System, New York, New York
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Zakhem GA, Terushkin V, Mu EW, Polsky D, Meehan SA. Margin Assessment for Punch and Shave Biopsies of Dysplastic Nevi. J Drugs Dermatol 2018; 17:810-812. [PMID: 30005107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Biopsies of atypical melanocytic nevi are among the most commonly performed procedures by dermatologists. Margin assessment is often used to guide re-excision, but can be a point of confusion as negative margins reported in the planes of sections examined do not always reflect complete removal of a lesion. This study investigates the rates of false negative margins after both punch and shave biopsies. METHODS We performed a retrospective analysis of 50 consecutive punch and shave biopsy specimens (1) diagnosed as DN, and (2) reported as having clear margins in the planes of section examined. Identified specimen blocks were then sectioned through to examine true margin involvement. RESULTS Of the 50 specimens identified, 20% (n = 10) were found to have positive margins upon additional sectioning. We found no difference between the groups with respect to biopsy technique, type of nevus, degree of atypia, or gender. CONCLUSION This study observed false negative peripheral margin status in a sizeable proportion of biopsy specimens, which did not vary significantly based on biopsy technique or pathologic characteristics. This finding reflects a limitation of standard tissue processing, in which a limited proportion of the true margin is evaluated, and may be of note to many dermatologists who base their decision to re-excise on the reporting of margin involvement. J Drugs Dermatol. 2018;17(7):810-812.
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Laird ME, Sukhdeo K, Ho A, Hoffmann RK, Meehan SA, Kim RH. Concentric targetoid scaly plaques in a patient with severe rheumatoid arthritis. Int J Dermatol 2018; 57:913-914. [PMID: 29638000 DOI: 10.1111/ijd.13991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/06/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Mary E Laird
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Kumar Sukhdeo
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Anthony Ho
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Rachel K Hoffmann
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Shane A Meehan
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Randie H Kim
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
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Gareau DS, Krueger JG, Hawkes JE, Lish SR, Dietz MP, Mülberger AG, Mu EW, Stevenson ML, Lewin JM, Meehan SA, Carucci JA. Line scanning, stage scanning confocal microscope (LSSSCM). Biomed Opt Express 2017; 8:3807-3815. [PMID: 28856051 PMCID: PMC5560842 DOI: 10.1364/boe.8.003807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/07/2017] [Accepted: 07/08/2017] [Indexed: 05/24/2023]
Abstract
For rapid pathological assessment of large surgical tissue excisions with cellular resolution, we present a line scanning, stage scanning confocal microscope (LSSSCM). LSSSCM uses no scanning mirrors. Laser light is focused with a single cylindrical lens to a line of diffraction-limited width directly into the (Z) sample focal plane, which is parallel to and near the flattened specimen surface. Semi-confocal optical sections are derived from the linear array distribution (Y) and a single mechanical drive that moves the sample parallel to the focal plane and perpendicular to the focused line (X). LSSSCM demonstrates cellular resolution in the conditions of high nuclear density within micronodular basal cell carcinoma.
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Affiliation(s)
- Daniel S. Gareau
- Investigative Dermatology, The Rockefeller University, 1230 York Ave., New York, NY 10065,
USA
| | - James G. Krueger
- Investigative Dermatology, The Rockefeller University, 1230 York Ave., New York, NY 10065,
USA
| | - Jason E. Hawkes
- Investigative Dermatology, The Rockefeller University, 1230 York Ave., New York, NY 10065,
USA
| | - Samantha R. Lish
- Investigative Dermatology, The Rockefeller University, 1230 York Ave., New York, NY 10065,
USA
| | - Michael P. Dietz
- Investigative Dermatology, The Rockefeller University, 1230 York Ave., New York, NY 10065,
USA
| | - Alba Guembe Mülberger
- Investigative Dermatology, The Rockefeller University, 1230 York Ave., New York, NY 10065,
USA
| | - Euphemia W. Mu
- Ronald O. Pearleman Department of Dermatology, New York University, 240 E. 38th St., New York, NY 10016,
USA
| | - Mary L. Stevenson
- Ronald O. Pearleman Department of Dermatology, New York University, 240 E. 38th St., New York, NY 10016,
USA
| | - Jesse M. Lewin
- Department of Dermatology, Columbia University Medical Center, 161 Fort Washington Avenue, 12th Floor, New York, NY 10032,
USA
| | - Shane A. Meehan
- Ronald O. Pearleman Department of Dermatology, New York University, 240 E. 38th St., New York, NY 10016,
USA
| | - John A. Carucci
- Ronald O. Pearleman Department of Dermatology, New York University, 240 E. 38th St., New York, NY 10016,
USA
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Mu EW, Lewin JM, Stevenson ML, Meehan SA, Carucci JA, Gareau DS. Use of Digitally Stained Multimodal Confocal Mosaic Images to Screen for Nonmelanoma Skin Cancer. JAMA Dermatol 2017; 152:1335-1341. [PMID: 27603676 DOI: 10.1001/jamadermatol.2016.2997] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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
Importance Confocal microscopy has the potential to provide rapid bedside pathologic analysis, but clinical adoption has been limited in part by the need for physician retraining to interpret grayscale images. Digitally stained confocal mosaics (DSCMs) mimic the colors of routine histologic specimens and may increase adaptability of this technology. Objective To evaluate the accuracy and precision of 3 physicians using DSCMs before and after training to detect basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in Mohs micrographic surgery fresh-tissue specimens. Design This retrospective study used 133 DSCMs from 64 Mohs tissue excisions, which included clear margins, residual BCC, or residual SCC. Discarded tissue from Mohs surgical excisions from the dermatologic surgery units at Memorial Sloan Kettering Cancer Center and Oregon Health & Science University were collected for confocal imaging from 2006 to 2011. Final data analysis and interpretation took place between 2014 and 2016. Two Mohs surgeons and a Mohs fellow, who were blinded to the correlating gold standard frozen section diagnoses, independently reviewed the DSCMs for residual nonmelanoma skin cancer (NMSC) before and after a brief training session (about 5 minutes). The 2 assessments were separated by a 6-month washout period. Main Outcomes and Measures Diagnostic accuracy was characterized by sensitivity and specificity of detecting NMSC using DSCMs vs standard frozen histopathologic specimens. The diagnostic precision was calculated based on interobserver agreement and κ scores. Paired 2-sample t tests were used for comparative means analyses before and after training. Results The average respective sensitivities and specificities of detecting NMSC were 90% (95% CI, 89%-91%) and 79% (95% CI, 52%-100%) before training and 99% (95% CI, 99%-99%) (P = .001) and 93% (95% CI, 90%-96%) (P = .18) after training; for BCC, they were 83% (95% CI, 59%-100%) and 92% (95% CI, 81%-100%) before training and 98% (95% CI, 98%-98%) (P = .18) and 97% (95% CI, 95%-100%) (P = .15) after training; for SCC, they were 73% (95% CI, 65%-81%) and 89% (95% CI, 72%-100%) before training and 100% (P = .004) and 98% (95% CI, 95%-100%) (P = .21) after training. The pretraining interobserver agreement was 72% (κ = 0.58), and the posttraining interobserver agreement was 98% (κ = 0.97) (P = .04). Conclusions and Relevance Diagnostic use of DSCMs shows promising correlation to frozen histologic analysis, but image quality was affected by variations in image contrast and mosaic-stitching artifact. With training, physicians were able to read DSCMs with significantly improved accuracy and precision to detect NMSC.
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Affiliation(s)
- Euphemia W Mu
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Jesse M Lewin
- Department of Dermatology, Columbia University, New York, New York
| | - Mary L Stevenson
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Shane A Meehan
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York3Department of Pathology, Dermatopathology Section, New York University School of Medicine, New York
| | - John A Carucci
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Daniel S Gareau
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York
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Criscito MC, Mu EW, Meehan SA, Polsky D, Kopeloff I. Dermoscopic features of a solitary fibrofolliculoma on the left cheek. J Am Acad Dermatol 2017; 76:S8-S9. [PMID: 28087042 DOI: 10.1016/j.jaad.2016.03.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/18/2016] [Accepted: 03/26/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Maressa C Criscito
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Euphemia W Mu
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Shane A Meehan
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - David Polsky
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
| | - Iris Kopeloff
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
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Affiliation(s)
| | | | | | | | | | - Andrew G. Franks
- Correspondence to: Andrew G. Franks, Jr, MD, 240 East 38th St, 11th floor, New York, NY 10016.240 East 38th St, 11th floorNew YorkNY10016
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Abikhair M, Roudiani N, Mitsui H, Krueger JG, Pavlick A, Lee J, Therrien JP, Meehan SA, Felsen D, Carucci JA. MAGEA3 Expression in Cutaneous Squamous Cell Carcinoma Is Associated with Advanced Tumor Stage and Poor Prognosis. J Invest Dermatol 2017; 137:775-778. [DOI: 10.1016/j.jid.2016.10.036] [Citation(s) in RCA: 9] [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] [Received: 10/02/2016] [Revised: 10/13/2016] [Accepted: 10/27/2016] [Indexed: 01/10/2023]
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Mazori DR, Shvartsbeyn M, Meehan SA, Tarsis SL. Transformation of porokeratosis ptychotropica into invasive squamous cell carcinoma. Int J Dermatol 2017; 56:679-680. [DOI: 10.1111/ijd.13575] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 01/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel R. Mazori
- The Ronald O. Perelman Department of Dermatology; New York University Langone Medical Center; New York NY USA
| | - Marianna Shvartsbeyn
- The Ronald O. Perelman Department of Dermatology; New York University Langone Medical Center; New York NY USA
| | - Shane A. Meehan
- The Ronald O. Perelman Department of Dermatology; New York University Langone Medical Center; New York NY USA
| | - Sara L. Tarsis
- The Ronald O. Perelman Department of Dermatology; New York University Langone Medical Center; New York NY USA
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Kim RH, Meehan SA. Immunostain use in the diagnosis of melanomas referred to a tertiary medical center: a 15-year retrospective review (2001-2015). J Cutan Pathol 2016; 44:221-227. [PMID: 27873341 DOI: 10.1111/cup.12867] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 10/21/2016] [Revised: 11/11/2016] [Accepted: 11/18/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Little is known regarding the clinical practice of immunohistochemistry in the diagnosis of melanoma. We aimed to assess the incidence of immunostain usage by referring pathologists and dermatopathologists in melanoma cases sent for consultative review. As a secondary objective, associations between immunostain use and specific melanoma characteristics were also evaluated. METHODS This is a retrospective review of consultation reports of referred melanomas at a tertiary academic center in New York, NY from 2001 to 2015. Univariate regression analysis was performed on melanomas with accompanying immunostains and on characteristics such as Breslow's depth, location, prognostic factors and morphologic subtypes. Associations between immunostain usage and these characteristics were analyzed using Fisher's exact test. RESULTS Immunostain use significantly increased over the study period (p < 0.001) and was more likely to be associated with melanomas that were thicker [odds ratio (OR) = 2.5; 1.7-3.6]; located on the head and neck (OR = 1.6; 1.4-1.9) or acral sites (OR = 1.5; 1.1-2.0); had ulceration (OR = 2.1; 1.6-2.8), dermal mitoses (OR = 1.3; 1.1-1.5), or perineural invasion (OR = 3.6; 2.0-6.5); or were of desmoplastic (OR = 7.4; 4.5-12), amelanotic (OR = 7.1; 3.6-14), or nevoid subtypes (OR = 4.0; 1.7-8.9). CONCLUSIONS Immunostain use in the diagnosis of melanoma has increased significantly in the past 15 years for reasons that remain unclear.
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Affiliation(s)
- Randie H Kim
- Dermatopathology Section, The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Shane A Meehan
- Dermatopathology Section, The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
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Myers K, Terushkin V, Meehan SA, Cohen DE. Gyrate erythema in the setting of tinea pedis. Dermatol Online J 2016; 22:13030/qt7b45z8z9. [PMID: 28329539] [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] [Received: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023] Open
Abstract
Gyrate erythema, which also is known as erythemaannulare centrifugum (EAC), is a reactive dermatitisthat is thought to occur in response to an underlyingtrigger. The superficial form is characterized bythe typical, centrifugally-expanding, annular,erythematous patches or plaques with a distincttrailing scale. The deep form also is a centrifugallyexpanding,erythematous plaque but with induratedborders and absence of scale. These cutaneousfindings are thought to be reactive, most often inresponse to infections or drugs and, less likely, tounderlying malignant conditions.
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Affiliation(s)
- Kathryn Myers
- Ronald O. Perelman Department of Dermatology, NYU School of Medicine, NYU Langone Medical Center
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Hausauer AK, Hoffmann R, Terushkin V, Meehan SA, Femia AN, Pomeranz MK. Acral keratoses and squamous-cell carcinomas likely associated with arsenic exposure. Dermatol Online J 2016; 22:13030/qt434929px. [PMID: 28329540] [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] [Received: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023] Open
Abstract
Chronic arsenic exposure is known to inducepunctate keratoses with an increased risk ofprimary squamous-cell carcinoma. Drinking wateris currently the major source of arsenic exposureworldwide and is considered one of the mostsubstantial environmental carcinogens. We describethe case of a 61-year-old Hungarian woman withscattered, acral, hyperkeratotic papules and a historyof five palmoplantar squamous-cell carcinomasas well as two other extremity non-melanomaskin cancers. Prior to immigration, she had livedin a county of Southern Hungary that is known tohave elevated concentrations of inorganic arsenicin the drinking water above the World HealthOrganization's current maximum threshold forsafety. To date, this report is the first to describethe phenomenon of palmoplantar squamouscellcarcinomas in a patient from this region andunderscores the importance of vigilant screening inthose individuals who have spent substantial time inhigh-risk regions internationally and domestically.
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Affiliation(s)
- Amelia K Hausauer
- Ronald O. Perelman Department of Dermatology, NYU School of Medicine, NYU Langone Medical Center
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Rothman LR, Kim RH, Meehan SA, Femia A. Silicone granulomas with ulcers. Dermatol Online J 2016; 22:13030/qt1gc7400w. [PMID: 28329542] [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] [Received: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023] Open
Abstract
We present a 42-year-old transgender womanwith woody induration over her buttocks andlower extremities as well as persistent ulcers of thebuttocks. The lesions developed ten years prior to herpresentation and approximately five years after shereceived illegal silicone injections to her buttocks.Histopathologic examination was consistent witha silicone granuloma. Silicone granuloma is a notan uncommon side effect of silicone injections andmore often occurs when the filler is administeredby non-physician practitioners, as is the case in thispatient. Ulcerative silicone granulomas, however,rarely are reported. In this case, the patient'shemodialysis treatments, which required longperiods of weight bearing on her buttocks, may havepredisposed her to ulcers in this area, and the ulcersmay have been in part due to poor vascular supplyas well as physical pressure. Treatment of this patientis relatively challenging, owing to her multiplecomorbidities that include end-stage renal diseaseand congestive heart failure.
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Affiliation(s)
- Lisa R Rothman
- Ronald O. Perelman Department of Dermatology, NYU School of Medicine, NYU Langone Medical Center
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Farhadian JA, Terushkin V, Meehan SA, Kornreich C. Skin-limited relapse of systemic anaplastic large-cell lymphoma. Dermatol Online J 2016; 22:13030/qt9gz970jm. [PMID: 28329531] [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] [Received: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023] Open
Abstract
Anaplastic large-cell lymphomas (ALCLs) are agroup of CD30-positive non-Hodgkin lymphomasthat are linked by common morphologic andimmunophenotypic features but have varyingclinical and genetic characteristics. The World HealthOrganization classification currently recognizes threesubtypes of ALCL: systemic anaplastic lymphomakinase-positive ALCL, systemic anaplastic lymphomakinase-negative (ALK-) ALCL, and primary cutaneousALCL. Here we present a 42-year-old man with ahistory of systemic ALK- ALCL, who was in remissionfor six months before relapsing with skin-limitedanaplastic large-cell lymphoma.
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Affiliation(s)
- Joshua A Farhadian
- Ronald O. Perelman Department of Dermatology, NYU School of Medicine, NYU Langone Medical Center
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