Search

Objective: To determine the feasibility of a piloted wound care curriculum within a busy internal medicine (IM) curriculum., Methods: This prospective pilot study was conducted with 89 IM residents at an academic teaching hospital. The residents were provided a 90-minute workshop in chronic wound care. They anonymously completed a clinical vignette to target practice behavior prior to the workshop. The workshop was mixture of didactic and hands-on practice of sharp debridement and wound dressing selection. Three months later, the residents completed the same clinical vignette along with questions on changes and barriers to change in their practice., Main Outcome Measures: Change in behavior of chronic wound care management, measurements of barriers to change in participant continuity clinics., Main Results: Of the participants, 57 residents (64%) and 25 residents (28%) completed a pre- and postvignette, respectively. Ten (40%) of the postvignette respondents stated that they had made changes in their care. Barriers to change included having a supervising attending physician who is not comfortable with wound care, a lack of wound care resources available in clinic, and a lack of confidence even after the session., Conclusions: It is feasible to insert a chronic wound care education into a busy IM curriculum. Future efforts will be aimed at assessing the wound care needs/resources of the IM outpatient clinics, addressing the comfort of the supervising attending physicians and residents with wound care, and focusing the curriculum on high-yield interventions.

The authors present a case of Merkel cell carcinoma (MCC) with unique immunohistochemical staining characteristics. A 57-year-old woman presented with a firm 0.3 cm tan papule on her left nasal-labial fold that was reportedly increasing in size and bleeding. She had a history of multiple head and neck actinic keratoses, papillary thyroid carcinoma, and a family history of an uncle with melanoma. The clinical differential diagnosis was "non-melanoma skin cancer." Histological examination showed a markedly atypical-appearing basaloid neoplasm, present mostly in the dermis, with focal pagetoid spread into the epidermis. The cells showed hyperchromatic-staining nuclei, crowding, nuclear molding, and scant cytoplasm with atypical mitoses. The findings were consistent with a malignant tumor, highly suspicious for MCC. A pancytokeratin stain was strongly positive and showed perinuclear dot-like positivity. CK20 and CK7 stains were both negative. Synaptophysin was strongly positive, chromogranin was focally positive, CD56 was weakly positive, and neurofilament was positive in a perinuclear dot-like pattern. TTF-1, PAX5, S100, and Melan-A were negative, arguing against metastatic small cell carcinoma of lung or thyroid, B-cell lymphoma, or melanoma, respectively. Although the CK20/CK7 double negativity is very unusual, the staining characteristics of this case are most consistent with a primary cutaneous MCC. Up to 10%-15% of MCCs can be CK20 negative, and those cases are typically CK7 positive. This case is unique, as a CK20/CK7 double negative case has not been previously reported; however, the diagnosis can still be rendered based on the clinical, histological, and other immunohistochemical findings.

Objective: The purpose of this retrospective registry data analysis was to explore the effectiveness of a novel multivalent topical ointment (Terrasil Infection Control Wound Care Ointment; Aspiera Medical, Woonsocket, Rhode Island), containing a patented mineral complex and 0.2% benzethonium chloride in the treatment of nonhealing acute and chronic wounds., Design: Aspiera Medical designed a registry to capture physician experiences and treatment results with Terrasil Infection Control Wound Care Ointment. Physicians were asked to enter deidentified patient data into an online registry., Setting: Wound clinics in the United States were asked to participate in the registry., Patients: Physicians at 4 wound clinics treated 30 patients (26 of whom completed the treatment) with various chronic wounds that had persisted for an average of 6 months and entered treatment data into the registry., Interventions: Patients applied the ointment according to physician orders. Concurrent treatments used by patients included offloading, compression wraps, and dressings, such as collagen and calcium alginate. Patients were treated until complete wound closure or lost to follow-up., Main Outcome Measures: Physicians calculated each patient's percentage wound reduction at each visit., Main Results: Thirty patients were entered into the registry. Pretreatment and posttreatment measurements were available for 26 of them. Patients achieved an average surface area reduction of 84% in a mean of 23 days' treatment., Conclusion: The antimicrobial and moisturizing ointment studied appears to be effective in promoting wound closure in a variety of acute and chronic wounds. Wounds studied included diabetic foot ulcers, venous leg ulcers, venous stasis ulcers, surgical infections, burns, and insect bites. The results of this registry data analysis will be used to inform planned clinical trials.

Sarcomatoid carcinomas are rare malignant tumors, which usually demonstrate a well-differentiated epithelial component in association with a poorly differentiated spindle-cell component. Several different subtypes have been reported and categorized primarily under the differentiated epithelial component, with the majority of cutaneous sarcomatoid carcinomas arising in the setting of a basal cell or squamous cell carcinoma. To date, only 4 cases of sarcomatoid porocarcinoma have been reported in the literature. The authors present a case of an 84-year-old woman with an ulcerated papule on her scalp for several months. Histopathology revealed an exophytic and endophytic epidermal proliferation with multiple mitoses and ductal differentiation overlying a poorly differentiated, infiltrative spindle-cell proliferation in the dermis. Ductal and cystic structures were scattered throughout the malignancy. Immunohistochemistry was notable for strong and diffuse pancytokeratin positivity, p63 positivity, focally positive carcinoembryonic antigen within the ductal lumina, and periodic acid-schiff-positive, diastase-resistant intracellular deposits. They present the findings of this rare case of primary cutaneous sarcomatoid porocarcinoma.