Cutaneous metastatic tonsillar squamous cell carcinoma (SCC) is extremely rare and indicates a poor prognosis. To our knowledge, only 8 cases of cutaneous metastatic tonsillar SCC previously have ...been reported in the English literature. Here, we present the third case of a female with cutaneous metastatic tonsillar SCC.
Background: There are shortcomings in the quality and accuracy of submitted clinical information on skin biopsy requisition forms (SBRFs). Most SBRFs are completed via electronic medical records ...(EMR), and the effect of this on the work flow and the quality of submitted clinical information must be evaluated to identify targets in clinician-dermatopathologist communication for improvement.Objective: This review of the literature explored how SBRFs are currently handled by clinicians in the context of EMR, barriers to effective clinician-dermatopathologist communication, and suggestions for improvement.Methods: A literature search was conducted on Medline, Cinahl, and Scopus including the keywords of dermatology*, dermapatholog*, dermatopathology*, and requisition*. 20 articles were retrieved. 17 articles were included from this search and from cross-referencing articles.Results: This review reaffirmed the inadequacy of clinical information provided to dermatopathologists. Standardization of and formal education in completing SBRFs, along with dermatopathologist access to information and images via shared EMR may improve histopathologic interpretation of specimens and allow for cost-effective patient care.Limitations: This review was restricted to the English language. Previous studies have primarily been retrospective study designs and survey studies.Conclusion: The development of user-friendly standardized SBRFs with validated criteria are necessary. Clinician awareness of how to appropriately convey information and terminology on the SBRF may significantly improve the work flow of both clinicians and dermatopathologists and patient outcomes.
Patients with a history of or a predisposition to autoimmune or collagen vascular diseases are inclined to develop drug-induced subacute cutaneous lupus erythematosus (SCLE) due to ...terbinafine therapy. Here, we report a case of terbinafine-induced SCLE in a male patient, although classic SCLE most commonly affects females, and he did not have a diagnosis of or a history suggestive of a predisposition to autoimmune or collagen vascular diseases. Although the mechanism for terbinafine-induced SCLE has not been fully elucidated, we suggest that there may be distinctive mechanisms of terbinafine-induced SCLE of patients with and without a predisposition to or history of autoimmune or connective tissue diseases, which should be a focus of future research.
As burnout is an issue facing our profession, developing and nurturing a greater purpose which promotes a sense of gratitude and purpose in medicine is important for physician wellness and ...resilience. We often develop our sense of purpose through the internalization of values and ideas of people we have met in life. Mentors play an important role in helping us realize and develop our skills and talents, which may not have been readily apparent to us.
In this essay, I, as a physician pursuing dermatology, describe my experiences and what I’ve learned from inspirational teachers and mentors in my education and training that helped me realize the gifts and talents I have to offer the world as a dermatologist. Then, my mentors describe how a specific experience or hobby has helped them develop a greater sense of purpose and gratitude in their careers. These are a few of the infinite possibilities which can nurture a sense of gratitude and purpose in our lives, and our goal is for others to reflect on and to expand on these possibilities and share them with colleagues.
Malignant melanoma and particularly metastatic melanoma represent a diagnostic challenge due to the wide variety of histologic patterns, resemblance to benign entities, and extensive range of ...clinical presentations. A high index of suspicion for melanoma is important for accurate diagnosis, especially when there is a previous history of malignancy. Here, we present a patient with a history of melanoma and locally metastatic melanoma, who subsequently developed a nodule on his right forearm near the site of his previous melanoma excision. Histologically, the melanoma appeared as granuloma annulare (GA) with benign cytologic features, but was identified as metastatic melanoma using SOX-10 immunohistochemical staining. Other malignancies, including lymphomas, leukemias, sarcomas, and cutaneous metastases of internal malignancies, have mimicked GA and interstitial granulomatous processes. Therefore, further immunohistochemical staining should be performed to assess for metastatic disease in the setting of a histological pattern that resembles a benign granulomatous process in a patient with a history of malignancy, including malignant melanoma.
Social distancing has played an important role in reducing the transmission of COVID-19, and, if the general public uniformly followed social distancing guidelines, we would theoretically expect no ...new diagnoses of sexually transmitted diseases (STDs) during this time period. However, during the COVID-19 era, we have diagnosed multiple cases of syphilis and molluscum contagiosum histopathologically with an increased incidence in our practice from the dates of March 1 to August 28, 2020, compared with these dates in 2019. The vast majority of these cases were not suspected by referring clinicians. Dermatologists are experts in the recognition of the cutaneous manifestations of venereal diseases which is critical to appropriate diagnosis and management, and they should continue to provide care during this pandemic.
Individuals who acquire STDs during this time may increase the strain on already limited health care resources by disregarding social distancing recommendations. All medical providers must consider how we can better encourage individuals to abide by social distancing recommendations, optimize care for patients during the pandemic, and prevent the misallocation of valued health care resources.
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