General Surgery
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
How would you treat him?Refer to a dermatologist, if clinical diagnosis is uncertain, for a diagnostic shave biopsy.5I would refer the patient to a plastic surgeon for Mohs micrographic surgery.If this were not available the lesion should be excised with a 4–5 mm margin. As it is close to the eye, I would liaise with my plastic surgical colleagues; he is likely to need an advancement flap for primary closure.If the lesion is advanced, then primary radiotherapy is an option.Generally, these have a good prognosis.
Biopharmaceutics Aspects of Dermally Applied Drug Delivery Systems
Tapash K. Ghosh in Dermal Drug Delivery, 2020
Skin Biopsy: Skin biopsy is probably the most invasive method to quantify permeation of active drug after the application of a topical formulation. It is generally performed under local anesthesia. Therefore, the use of this method has not been favored for tissue sampling and analysis of in vivo drug concentration. Two forms of skin biopsies have been explored. Shave biopsy involves removal to the level of the dermis, and Punch biopsy involves tissue removal to the subcutaneous level. This method provides a “snapshot” of drug disposition in the various skin levels; however, it involves a lot of trauma to the skin [22].
Benign lesions
Richard P. Usatine, Daniel L. Stulberg, Graham B. Colver in Cutaneous Cryosurgery, 2014
The most common appearance is a rough-surfaced plaque apparently “stuck on” the skin surface. Other features include a surface that may be “crumbly,” dull, or resembling a “currant bun”; less often they are shiny. Reticular lesions begin life as a solar lentigo but slowly become palpable. Lesions on the face often start as solar lentigines. Pedunculated lesions have a narrow neck and are seen particularly in the axillae and inguinal region, and on the eyelids. Irritated or infected SKs may swell, redden, and develop deeper pigment, all of which can suggest malignant change. A shave biopsy may resolve the diagnostic dilemma.
BAPoma presenting as an incidental scalp papule: case report, literature review, and screening recommendations for BAP1 tumor predisposition syndrome
Published in Journal of Dermatological Treatment, 2022
Marcus Zaayman, Peter Nguyen, Annika Silfvast-Kaiser, Jillian Frieder, Cameron West, Katherine Tumminello, So Yeon Paek
A 51-year-old female presented to the dermatology clinic for follow up regarding hidradenitis suppurativa (HS). At this visit, the patient also noted a firm, translucent papule to her left frontal hairline (Figure 1). Past medical history was significant only for HS. A shave biopsy of the skin lesion was performed (Figure 2). Histopathologic evaluation was consistent with a BAP1-inactivated spitzoid tumor (‘BAPoma’), revealing a circumscribed intradermal proliferation of melanocytes, with enlarged vesicular nuclei, rare mitoses superficially, no junctional component, and patchy lymphocytic infiltrate in the dermis. Nuclear BAP1 staining was absent. Upon histopathologic diagnosis, a thorough family history was obtained which revealed a history of metastatic ocular melanoma in the patient’s father, brother, and paternal grandmother (PGM). Her brother had also had multiple atypical melanocytic lesions excised. All of her PGM’s siblings had been affected with various cancers, although specifics could not be recalled. This case was discussed at our Multidisciplinary Skin Tumor Board at which time genetic counseling, ophthalmology consultation, total body skin examination, and complete excision of the BIMT was recommended. At the time of manuscript submission, no further updates were available, as the patient was hindered from obtaining further work-up due to loss of health insurance.
Sweet syndrome and erythema nodosum in a young patient with ulcerative colitis
Published in Baylor University Medical Center Proceedings, 2023
Katherine Gonzalez, Janice Thomas, John Givler, Lindsey Stockton
On admission, the patient was started on methylprednisolone sodium succinate 81.25 mg intravenously every 8 hours. Gastroenterology was consulted for her UC flare and recommended the intravenous steroids be reduced to 40 mg every 8 hours. Infectious disease started the patient on vancomycin 750 mg intravenously every 8 hours. To rule out infectious causes of rash, Cryptococcus antigen, Histoplasma antigen, Blastomyces dermatitidis antibody, varicella zoster IgG serology, fungal culture, blood culture, and methicillin-resistant Staphylococcus aureus (MRSA) culture were ordered and came back negative. After MRSA came back negative, vancomycin was discontinued. Dermatology conducted a shave biopsy on a small subcentimeter lesion on the back. The epidermis showed a small erosion, mild spongiosis with exocytosis of a few neutrophils. The dermis was extensively infiltrated with numerous neutrophils with significant leukocytoclasis, consistent with SS. No overt vasculitis or ulceration was noted.
A solitary angiokeratoma on the toe of a teenaged girl
Published in Baylor University Medical Center Proceedings, 2022
Jess Hatfield, Allie K. Preston, Sophia J. Hendrick
An 18-year-old woman presented to our clinic for treatment of a “wart” that had been present for several years. The lesion was occasionally painful but otherwise she denied any symptoms other than undesirable cosmetic appearance. Prior to presentation, she had tried many over-the-counter wart treatments without success. Physical exam revealed a 4 mm verrucous papule with areas of visible hemecrust on her right plantar second toe (Figure 1). Over the course of several months, we proceeded with multiple in-office treatments for her wart, including paring with cryotherapy as well as three rounds of Candida antigen injections into the base of the lesion. After none of these treatments was successful, a shave biopsy was taken for analysis (Figure 2). Histological analysis revealed ectatic, thin-walled vessels in the papillary dermis, elongated rete ridges, and compact hyperkeratosis. Immunohistochemically, the tissue was WT-1 and GLUT-1 negative in endothelial cells (Figure 2c, 2d). D2-40 was partially positive within the endothelial lining (Figure 2b).
Related Knowledge Centers
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