Discoid lupus erythematosus can present in various atypical forms, posing significant diagnostic challenges as it can mimic other infectious or neoplastic dermatoses. Herein, we detail two cases of strictly unilateral, m...Discoid lupus erythematosus can present in various atypical forms, posing significant diagnostic challenges as it can mimic other infectious or neoplastic dermatoses. Herein, we detail two cases of strictly unilateral, multifocal discoid lupus erythematosus and compare them with previously reported cases. This report contributes to the limited literature on this unusual presentation, particularly in individuals with skin of color.
We present a case of human papillomavirus-associated squamous cell carcinoma arising between the ventral toes. A 60-year-old man presented with a 6-year history of a growth between the right fourth and fifth toes that ha...We present a case of human papillomavirus-associated squamous cell carcinoma arising between the ventral toes. A 60-year-old man presented with a 6-year history of a growth between the right fourth and fifth toes that had previously been thought to be secondary to hammertoe deformity. Initial biopsy favored verruca vulgaris with associated fungal hyphae and he was treated accordingly. Subsequent biopsy showed squamous cell carcinoma in situ with positive for high-risk human papillomavirus subtypes 16 and 18. He was successfully treated with Mohs surgery. This is the first published case of human papillomavirus 18-associated interdigital squamous cell carcinoma of the toes treated with Mohs surgery.
Gender-affirming hormone therapy with testosterone may be a component in the treatment plan for transmasculine individuals. Secondary erythrocytosis induced by testosterone therapy and its subsequent complications, such...Gender-affirming hormone therapy with testosterone may be a component in the treatment plan for transmasculine individuals. Secondary erythrocytosis induced by testosterone therapy and its subsequent complications, such as pruritus, have been reported in the literature in cisgender men. This report presents two transmasculine patients who developed generalized pruritus shortly after initiating testosterone therapy for gender-affirming care. Both patients exhibited elevated hemoglobin and hematocrit levels indicative of testosterone-induced erythrocytosis. Despite treatments, including topical corticosteroids, antihistamines, gabapentin, and benzodiazepines, their symptoms persisted. Symptomatic relief was achieved through therapeutic phlebotomy. The occurrence of polycythemia vera-like pruritus underscores a significant but less commonly recognized side effect of testosterone therapy. Balancing effective gender-affirming care and patient goals with the management of associated side effects is essential for optimizing patient outcomes.
Axillary web syndrome, or cording, presents as fibrotic bands that develop beneath the skin, causing pain and restricted shoulder movement. Axillary web syndrome typically arises as a complication following axillary surg...Axillary web syndrome, or cording, presents as fibrotic bands that develop beneath the skin, causing pain and restricted shoulder movement. Axillary web syndrome typically arises as a complication following axillary surgery for breast cancer. We present a unique case of a 38-year-old woman with no history of malignancy, breast surgery, or trauma, who developed AWS following a punch biopsy after initially presenting with a subcutaneous nodule in the right axilla. This case highlights the need for increased exploration of the pathogenesis of axillary web syndrome, suggesting a potentially higher incidence of axillary web syndrome than currently reported owing to its self-limiting nature. In addition, the case demonstrates the importance of dermatological awareness of this condition, as its presentation is not limited to breast cancer patients who have undergone major axillary and breast procedures.
Mature plasmacytoid dendritic cell proliferation is a condition associated with myeloid neoplasms, most commonly chronic myelomonocytic leukemia. Plasmacytoid dendritic cells can resemble lymphocytes and histiocytes morp...Mature plasmacytoid dendritic cell proliferation is a condition associated with myeloid neoplasms, most commonly chronic myelomonocytic leukemia. Plasmacytoid dendritic cells can resemble lymphocytes and histiocytes morphologically and immunophenotypically. Mature plasmacytoid dendritic cell proliferation may therefore go unrecognized if the diagnosis is not suspected and appropriate stains for plasmacytoid dendritic cells are not performed. Herein, we present a case of mature plasmacytoid dendritic cell proliferation masquerading clinically and histologically as histiocytoid Sweet syndrome. The patient, who had previously been diagnosed with mature plasmacytoid dendritic cell proliferation that presented as pink, edematous, pruritic papules and plaques, had initially resolved following induction chemotherapy for acute myelomonocytic leukemia. However, he presented later with indurated purpuric plaques on the trunk within weeks of receiving filgrastim for neutropenia. Biopsies demonstrated marked dermal edema, interstitial, superficial, and deep infiltrate with histiocytoid appearing cells concerning for histiocytoid Sweet syndrome. Further work-up demonstrated that the infiltrate was predominantly composed of CD3-, CD4+, CD34-, CD123+, CD56-, CD68-, myeloperoxidase negative mononuclear cells consistent with mature plasmacytoid dendritic cell proliferation. This case demonstrates that MPDCP should be considered in the differential diagnosis of eruptions that clinically and histologically look like histiocytoid Sweet syndrome but stain negatively for myeloperoxidase.
Dermatofibrosarcoma protuberans is an uncommon locally aggressive mesenchymal neoplasm that classically presents with a proliferation of monomorphic spindled cells with thin nuclei and scant cytoplasm. We report a man in...Dermatofibrosarcoma protuberans is an uncommon locally aggressive mesenchymal neoplasm that classically presents with a proliferation of monomorphic spindled cells with thin nuclei and scant cytoplasm. We report a man in his twenties who presented for an unrelated skin concern and was incidentally noted to have a large, atrophic scar-like depression of the left supraclavicular neck and shoulder. The plaque was photographed and the patient was instructed to follow-up in one year, and careful photo comparison revealed the lesion had subtly enlarged and darkened in color. Accordingly, a punch biopsy revealed features of myxoid dermatofibrosarcoma protuberans, a dermal proliferation of spindled cells with mucinous degeneration and more cellular areas with extensive nuclear palisading resembling the Verocay bodies of a neurofibroma. Clinicians should be aware of the broad clinicopathologic spectrum of DFSP to ensure timely diagnosis and effective treatment. Myxoid dermatofibrosarcoma protuberans is a rare and clinically challenging diagnosis, as the mucinous areas can impart a bluish hue. Dermatofibrosarcoma protuberans can also be atrophic, with the loss of the normal dermal thickness corresponding to a clinical appearance easily mistaken for anetoderma or atrophic scar. Palisaded nuclei resembling the Verocay bodies of schwannoma are sometimes seen and can further obfuscate the diagnosis.
Malignant melanoma lesions arising in tattoo pigment pose diagnostic challenges, but current literature lacks quantitative data on delayed diagnosis. This study reports a new case involving multiple melanoma lesions in t...Malignant melanoma lesions arising in tattoo pigment pose diagnostic challenges, but current literature lacks quantitative data on delayed diagnosis. This study reports a new case involving multiple melanoma lesions in tattoo pigment, alongside a systematic review of past cases. Our objectives were to evaluate the potential for delayed diagnosis in patients with melanoma lesions in tattoo pigment and its impact on prognosis, comparing tumor characteristics with large-scale melanoma studies. A systematic review was conducted using PubMed and Ovid MEDLINE. Included studies were English-language reports of melanoma lesions in tattoo pigment, identifying new cases via case reports/series. Independent review and discussion resolved discrepancies. The review yielded 37 articles with 42 reports of melanoma lesions in tattoo pigment, totaling 43 cases. Of these, 35 were invasive, with mean and median Breslow thickness of 2.49mm and 0.9mm, respectively, which is higher than in large-scale studies. Patients also had a higher incidence of invasive lesions at diagnosis. The increased Breslow depth and risk of dermal invasion suggest a higher risk for delayed diagnosis and worse prognosis in melanoma arising in tattoo pigment. Further analysis of dermatoscopic differences is needed to improve diagnostic guidelines and avoid delayed diagnosis.
Statistical mistakes can undermine research credibility. Identifying common errors may help researchers avoid them in future studies. This study evaluated the frequency and types of statistical mistakes in dermatology jo...Statistical mistakes can undermine research credibility. Identifying common errors may help researchers avoid them in future studies. This study evaluated the frequency and types of statistical mistakes in dermatology journal articles and identified article characteristics that predict these errors. A cross-sectional analysis was conducted on articles published in the 2023 volumes of 8 dermatology journals. Articles were screened for statistical tests, with a target sample of 200 selected pseudorandomly. Multivariable logistic regressions assessed predictors of statistical mistakes, including journal impact factor, statistician involvement, funding source, first author highest degree, and statistical package. Of the 189 articles analyzed, 78% contained at least one statistical mistake. Reporting mistakes were found in 67% and test selection errors in 46%. The absence of statistician involvement (aOR 2.49, P=0.03) and low journal impact factor (aOR 3.82, P=0.02) predicted the presence of at least one mistake. This sample from 8 journals is not representative of all dermatology literature. Original data were not available for testing of test assumptions, so appropriate test selection was determined using statistical conventions. Statistical mistakes are prevalent in dermatology literature. Researchers should review statistical best practices and consider involving a statistician in their work.
Solar elastosis is a form of photoaging theorized to result from long-term exposure to ultraviolet radiation. Clinically, solar elastosis manifests as yellow, atrophic, rhytid skin with a leathery appearance, most common...Solar elastosis is a form of photoaging theorized to result from long-term exposure to ultraviolet radiation. Clinically, solar elastosis manifests as yellow, atrophic, rhytid skin with a leathery appearance, most commonly affecting sun-exposed areas such as the face, neck, chest, or arms. Owing to its well-documented association with an elevated risk of skin cancer, recognizing the presence of solar elastosis is essential for clinicians. In this case, we evaluate a presentation of solar elastosis confined strictly to the perioral region, sparing the remainder of sun-exposed facial areas.
Soft tissue chondroma is a rare benign tumor that occurs more often in the distal limbs and is unattached to the underlying bone. An 11-year-old boy, presented with a nodule of the subungual area of the right big toe. Ob...Soft tissue chondroma is a rare benign tumor that occurs more often in the distal limbs and is unattached to the underlying bone. An 11-year-old boy, presented with a nodule of the subungual area of the right big toe. Objectively, the nail plate was partially destroyed owing to protrusion. Digital dermoscopy revealed yellow keratinous masses in the subungual area, with fibers adhering to the surface. Post-traumatic hemorrhages were observed in the tumor. Owing to functional discomfort, the patient underwent removal of the mass under local anesthesia. The histological picture is consistent with subungual soft tissue chondroma. Subungual soft tissue chondroma is more common in adults, but can affect people of all ages.
Wolf isotopic response refers to a new skin disorder manifesting in the area of a previous skin lesion that has healed. A variety of disease processes and dermatoses have been described that evoke an isotopic response. W...Wolf isotopic response refers to a new skin disorder manifesting in the area of a previous skin lesion that has healed. A variety of disease processes and dermatoses have been described that evoke an isotopic response. We report a man with metastatic hepatocellular carcinoma who received palliative radiation and later experienced a pembrolizumab-induced lichenoid dermatitis at the same site of radiation, representing a cutaneous immune-related adverse event displaying an isotopic response.
Herein we present a 48-year-old man who was diagnosed with a nodular basal cell carcinoma (BCC) of the left chin that was revealed on Mohs frozen sections to be a rippled-pattern BCC with invasion into muscle and necessi...Herein we present a 48-year-old man who was diagnosed with a nodular basal cell carcinoma (BCC) of the left chin that was revealed on Mohs frozen sections to be a rippled-pattern BCC with invasion into muscle and necessitated interdisciplinary care for concern for a concurrent salivary gland carcinoma. Rippled-pattern BCC has been documented in fewer than ten cases, though this may also be attributed to confusion regarding nomenclature. Microscopically, rippled-pattern BCC exhibits distinctive features that differentiates it from other patterns. The tumor cells form interconnected networks or cords with intervening mucinous spaces within a fibrotic stroma resulting in a rippled appearance. As they are generally considered nodular BCCs, management of rippled-pattern BCCs can involve surgical excision, Mohs micrographic surgery, or other appropriate treatment modalities based on the tumor's location, size, and degree of invasion.`.
Adiposis dolorosa (Dercum disease) is a rare condition characterized by diffuse and recurring painful lipomas on the trunk and extremities. Patients are typically middle-aged females with an elevated BMI presenting with...Adiposis dolorosa (Dercum disease) is a rare condition characterized by diffuse and recurring painful lipomas on the trunk and extremities. Patients are typically middle-aged females with an elevated BMI presenting with chronic pain. Physical examination reveals soft subcutaneous nodules and masses, tender to palpation. The associated pain significantly impacts quality of life and requires therapeutic intervention. The most common treatment option is surgical excision. Alternative options should be considered for patients with numerous lipomas where surgical management is not practical or is not desired. Deoxycholic acid injections are a viable alternative non-surgical technique. We present a case of a 55-year-old woman who presented with a history of Dercum disease and worsening pain associated with multiple lipomas. The patient desired a non-surgical intervention. She was subsequently treated with three rounds of deoxycholic acid injections with reduction in pain and improved mobility. Intralesional deoxycholic acid injections are a safe and effective nonsurgical alternative for patients with multiple lipomas.
Subcutaneous fat necrosis of the newborn is a disease affecting neonates in the first weeks to months of life. It is characterized by dermal edema and underlying fat necrosis, typically presenting with firm, erythematous...Subcutaneous fat necrosis of the newborn is a disease affecting neonates in the first weeks to months of life. It is characterized by dermal edema and underlying fat necrosis, typically presenting with firm, erythematous subcutaneous plaques and nodules, often located on the shoulders, back, buttocks, thighs, and extremities. We report an unusual presentation of liquefactive subcutaneous fat necrosis of the newborn in a two-week old term infant. The neonatal period was complicated by respiratory failure requiring intubation and severe encephalopathy. After completion of therapeutic hypothermia, the patient developed fluctuant and liquefactive nodules on her back. The neonate also had initial hypocalcemia that required treatment and then developed hypercalcemia, that resolved without intervention. The nodules and plaques on her back persisted into the first year of life and then gradually started to improve when she was 13 months old.
Paracoccidioidomycosis is a systemic fungal disease with a highly variable distribution, endemic to Central and South America with the highest prevalence in Brazil, Argentina, and Colombia. The chronic presentation of th...Paracoccidioidomycosis is a systemic fungal disease with a highly variable distribution, endemic to Central and South America with the highest prevalence in Brazil, Argentina, and Colombia. The chronic presentation of the disease is commonly observed in adult men and they manifest with pulmonary and mucocutaneous lesions. We report a fatal case of disseminated paracoccidioidomycosis in a 68-year-old immunocompetent man, with pulmonary, skin, mucosal, and cerebral involvement. Mucocutaneous lesions were decisive for the etiological diagnosis.