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Although many invasive and noninvasive approaches exist, management of keloids and hypertrophic scars remains challenging. By better understanding patient expectations regarding scar treatments, dermatologists can provide higher quality and more satisfying care. Survey patients age 18 to 80 years with a history of hypertrophic, keloid, or disfiguring scars. Overall, 187 participants completed the 25-question survey. Expectations and willingness were measured on a 1-5 Likert scale. Results were analyzed overall and by patient demographics. Older respondents more often expected scar reduction, while younger patients expected scar removal. Compared with Caucasians, Asian respondents were more symptomatic, more likely to have seen a physician, and more willing to undergo invasive therapies. Respondent willingness for treatment and their perceived efficacy significantly differed across gender, age, and race. This study explores a gap in the literature of what role patient expectations play in electing specific treatments. Although patient expectations are complex and context dependent, gaining more understanding of what therapies patients are willing to attempt, and their expectations from those therapies could help guide counseling with the goal setting realistic expectations to improve patient compliance and satisfaction.

Background: Patient satisfaction is a proxy for healthcare quality, with physicians evaluated and reimbursed based on patient satisfaction scores. Despite the growing influence of patient satisfaction, factors that impact patient satisfaction in dermatology remain unclear. Methods: We analyzed 225 responses to an online survey evaluating patient expectations, willingness, and satisfaction regarding dermatology appointments. Patient willingness and satisfaction were measured on a 1-5 Likert scale. Results: Respondents were most willing to discuss their condition and to be examined with a dermatoscope. Respondents were least willing to wear a patient gown without underwear and to be photographed. Highly satisfying factors included a written treatment plan, provider medication recommendations, and use of gloves during physical exams. Highly dissatisfying factors included waiting 60 minutes, taking off underwear with a patient gown, and being photographed with a cellphone.Patient willingness and satisfaction differed significantly by gender and age. Male respondents reported less satisfaction than female respondents if a nurse explained the treatment plan. Older respondents were significantly more willing to change into a patient gown, to be photographed, to be examined with a dermatoscope, and to undergo a biopsy than younger respondents. Older and female respondents preferred written plans, while younger and male respondents preferred verbal plans. Younger respondents reported higher satisfaction with an email follow-up compared to older respondents, who preferred a phone call.Conclusion: These findings may represent relatively easy ways to improve patient satisfaction scores. Further insight into factors affecting patient satisfaction may enhance patient experience and engagement, thereby improving clinical outcomes.

BACKGROUND: It is often difficult to accurately predict how a melanoma will progress because melanomas can be so diverse in their genetic and histological makeup. OBJECTIVE: We sought to characterize the current state and progression of biomedical markers towards their utilization as prognostic indicators for patients with melanoma. METHODS: A literature search of the research repository databases PubMed and GoogleScholar was conducted using the following inclusion criteria: (1) published within the last 10 years, and (2) use of overall survival, disease progression, or clinical outcome as primary endpoints. Search terms included various permutations of “biomarkers,” “prognostic,” “immunologic,” “serologic,” “visual,” and “melanoma.” Results were evaluated for statistical power, results significance, and experimental design integrity. RESULTS: The prognostic capabilities of clinical tests for malignant melanoma have made great strides in the last few years, with several serologic and immunohistochemical biomarkers being preliminarily linked to various measures of clinical prognosis. While clinical feasibility of a single sensitive and specific biomarker remains unfeasible, use of select combinations of tested biomarkers remain viable. CONCLUSION: Diagnostic and prognostic genetic assays have begun to cross over from research to commercial application, giving physicians additional tools during the early stages of diagnosis to optimize and individualize treatments.

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Nephrogenic systemic fibrosis (NSF), previously known as nephrogenic fibrosing dermopathy, is a debilitating skin condition that causes fibrotic changes in the set- ting of renal failure. Gadolinium-based contrast agents (GBCA), erythropoietin (EPO), and vascular interven- tion are the most widely known associated factors in the pathogenesis. A 53-year-old female with chronic renal insufficiency secondary to fibrillary glomerulo- nephritis (FGN) presented with generalized hardening of skin 1 week after her renal transplant. Due to her numerous medical and surgical health problems, she had received six imaging procedures with GBCA with the last being eight months prior to the onset of her skin symptoms. She had also historically been treated with high doses of EPO. Histopathologic examination was consistent with NSF. In susceptible renal fail- ure patients who develop NSF after GBCA exposure, the onset of symptoms is usually within a 2-3 month time frame, which undermines but not eliminates the proposed role of GBCA in our patient. It can be pro- posed that despite having various risk factors, while being exposed to high doses of EPO, vascular trau- ma during renal transplant facilitated the onset of her symptoms.

Superantigens (SAgs) are virulent polypeptides that are produced by a variety of infectious organisms. They are capable of causing nonspecific T cell activation by circumventing normal antigen processing in the human host. The genetic makeup of the host plays a role in conferring susceptibility or protection against SAgs. They are linked to a variety of conditions, ranging from toxic shock syndrome to recurrent toxin-mediated perineal erythema. The early recognition of signs and symptoms of SAg-mediated illnesses is important to ensure prompt medical treatment.

Eczema herpeticum is an easily missed entity most commonly seen in the pediatric population and carries the risk of systemic compromise and a 10% mortality rate. Clinicians should maintain high clinical suspicion when encountering children or young adults with a history of atopic dermatitis or other erosive dermatoses and who present with vesicular lesions, punched-out erosions, and systemic symptoms. We present 3 severe cases of eczema herpeticum that were potentially overlooked and demonstrate the need for elevated awareness to avoid potential pitfalls.

The Photon Radiosurgery System (PRS), developed by the Photoelectron Corporation in Lexington, Massachusetts, produces low-energy x-rays from the tip of a needle-like probe at a high dose-rate. This portable device can be located directly over the target volume, delivering a uniform dose while sparing surrounding normal structures. To evaluate its radiotherapeutic profile, a prospective phase I Food and Drug Administration trial was performed utilizing this device in the management of nonmelanomatous skin cancers. Target doses ranged from 10 Gray in one fraction to 30 Gray in three weekly fractions. Thirty-eight lesions in 18 patients were treated. The overall completed response rate for all histologies at 12 months was 83%. No significant acute or late morbidity was encountered. Our results to date demonstrate that low-energy x-rays produced by the PRS were as effective in managing nonmelanomatous skin tumors as other radiation treatment modalities without the need for cumbersome shielding or radiation precautions.

Melanoma is a lethal melanocytic neoplasm. Unfortunately, the histological diagnosis can be difficult at times. Distinguishing ambiguous melanocytic neoplasms that are benign nevi from those that represent true melanoma is important both for treatment and prognosis. Diagnostic biomarkers currently used to assist in the diagnosis of melanoma are usually specific only for melanocytic neoplasms and not necessarily for their ability to metastasize. Traditional prognostic biomarkers include depth of invasion and mitotic count. Newer diagnostic and prognostic biomarkers utilize immunohistochemical staining as well as ribonucleic acid, micro-ribonucleic acid, and deoxyribonucleic acid assays and fluorescence in situ hybridization. Improved diagnostic and prognostic biomarkers are of increasing importance in the treatment of melanoma with the development of newer and more targeted therapies. Herein, the authors review many of the common as well as newer diagnostic and prognostic biomarkers used in melanoma.

Since the recognition of Kaposi's sarcoma as a manifestation of the acquired immunodeficiency syndrome, subsequent malignancies such as non-Hodgkin's B-cell lymphoma and primary central nervous system lymphoma have been found to be associated with individuals infected with the human immunodeficiency virus (HIV). The epidemiology, clinical manifestations, and current concepts of pathogenesis are reviewed in this article. In addition, the relation between HIV and other malignancies, including Hodgkin's lymphoma, T-cell lymphomas, and anorectal carcinoma, is discussed. In general, HIV-related malignancies are more aggressive, respond poorly to treatment, and are associated with an extremely high rate of mortality.

This report is intended to summarize the use of Interferon in the treatment of Kaposi's sarcoma (KS) associated with AIDS. The review is basically focused on the trials in the United States, which resulted in approval by the Food & Drug Administration (FDA) of the use of recombinant interferon alpha for the treatment of Kaposi's sarcoma.

The Photon Radiosurgery System (PRS), developed by the Photoelectron Corporation in Lexington, Massachusetts, produces low-energy x-rays from the tip of a needle-like probe at a high dose-rate. This portable device can be located directly over the target volume, delivering a uniform dose while sparing surrounding normal structures. To evaluate its radiotherapeutic profile, a prospective phase I Food and Drug Administration trial was performed utilizing this device in the management of nonmelanomatous skin cancers. Target doses ranged from 10 Gray in one fraction to 30 Gray in three weekly fractions. Thirty-eight lesions in 18 patients were treated. The overall completed response rate for all histologies at 12 months was 83%. No significant acute or late morbidity was encountered. Our results to date demonstrate that low-energy x-rays produced by the PRS were as effective in managing nonmelanomatous skin tumors as other radiation treatment modalities without the need for cumbersome shielding or radiation precautions.

To determine whether enzymatic p53 glycosylation leads to angiotensin II formation followed by p53 phosphorylation, prolonged activation of the renin-angiotensin system, and apoptosis, ventricular myocytes were exposed to levels of glucose mimicking diabetic hyperglycemia. At a high glucose concentration, O-glycosylation of p53 occurred between 10 and 20 min, reached its peak at 1 h, and then decreased with time. Angiotensin II synthesis increased at 45 min and 1 h, resulting in p38 mitogen-activated protein (MAP) kinase–driven p53 phosphorylation at Ser 390. p53 phosphorylation was absent at the early time points, becoming evident at 1 h, and increasing progressively from 3 h to 4 days. Phosphorylated p53 at Ser 18 and activated c-Jun NH2-terminal kinases were identified with hyperglycemia, whereas extracellular signal-regulated kinase was not phosphorylated. Upregulation of p53 was associated with an accumulation of angiotensinogen and AT1 and enhanced production of angiotensin II. Bax quantity also increased. These multiple adaptations paralleled the concentrations of glucose in the medium and the duration of the culture. Myocyte death by apoptosis directly correlated with glucose and angiotensin II levels. Inhibition of O-glycosylation prevented the initial synthesis of angiotensin II, p53, and p38-MAP kinase (MAPK) phosphorylation and apoptosis. AT1 blockade had no influence on O-glycosylation of p53, but it interfered with p53 phosphorylation; losartan also prevented phosphorylation of p38-MAPK by angiotensin II. Inhibition of p38-MAPK mimicked at a more distal level the consequences of losartan. In conclusion, these in vitro results support the notion that hyperglycemia with diabetes promotes myocyte apoptosis mediated by activation of p53 and effector responses involving the local renin-angiotensin system.

Several publications describe the presence of the human T cell lymphotropic virus type I (HTLV-I) in Jewish individuals born in Mash-had, Iran. We report here the results of HTLV-I serological and genetic studies in the non-Jewish population of Mash-had as well as a neighboring area: Gonbad-Kavous. Seven hundred and seven serum samples from Mash-had (694 healthy individuals and 13 patients with lymphoma) and 90 from Gonbad-Kavous were tested for HTLV antibodies by gelatin particle agglutination assay (PA) and confirmatory Western blots (WBs). Seropositive rates of 3.0% (21 of 694) in Mash-had, 0% (0 of 90) in Gonbad-Kavous, and 100% (13 of 13) in lymphoma cases were observed. HTLV-I DNA sequence were amplified by polymerase chain reaction directly from the fresh PBMCs of seropositive individuals. Phylogenetic analysis of the viral DNA sequence indicated that the HTLV-I present in Mash-had belong to the HTLV-I cosmopolitan clade. Altogether, these data indicate that Mash-had, located in northeastern Iran, is a newly recognized endemic center for HTLV-I.

The relationship between 22 histologic variables and survival was investigated in 93 patients with acquired immunodeficiency syndrome (AIDS)-associated Kaposi's sarcoma (KS). All the patients were homosexual men in whom KS was the initial manifestation of AIDS. All patients were followed for at least 12 months or until death. Histologic specimens of the initial KS biopsy were reviewed in a blind manner by two of the authors and were evaluated for the presence of a number of histologic features. In a univariate analysis nodular lesions of KS ( v patch or plaque lesions), the absence of hemosiderin, the absence of irregular vascular spaces, and the presence of spindle cell nodules were all significantly associated with increased length of survival. Two variables previously shown to be related to survival (CD4:CD8 cell ratio, initial lesion on lower extremities) were included in a multivariate analysis (Cox model) in addition to the histologic variables. Complete data were avaiable from 85 patients. In the multivariate analysis a higher helper to suppressor T-cell ratio, initial lesion on lower extremities, presence of spindle cell nodules, and nodular histology ( v patch or plaque histology) were all significantly associated with increased length of survival. These data suggest that in AIDS-associated KS, as in reticuloendothelial neoplasms, histologic features may be useful in idenitifying prognostically different subgroups of patients.

The immunodeficient state that evolves in persons infected with the human immunodeficiency virus (HIV) appears to increase their risk of certain types of cancer. Among these are primary lymphoma of the central nervous system, undifferentiated non-Hodgkin's lymphoma, squamous cell carcinoma, anorectal carcinoma, and cutaneous malignancies. These malignancies are similar in incidence to those seen in other immunodeficient patients. Lymphoma, in particular, is associated with a more aggressive disease state. In HIV infected patients, the disease is usually diagnosed at a more advanced stage, frequently has extranodal involvement, and usually responds poorly to chemotherapy. Viruses, such as Epstein-Barr virus and papillomavirus, have been implicated in the pathogenesis of lymphoma and other malignancies in immunosuppressed patients, including those with HIV infection.

Immunochemical studies (sequential immunoprecipitation followed by SDS-PAGE and two-dimensional gel electrophoresis) have shown that the monoclonal antibody (MoAb) 26.163 reacts with HLA-DR, DQ, and DP antigens. Testing with isolated alpha and beta chains of HLA class II antigens and immunoblot analysis also demonstrated that the determinant defined by the MoAb 26.163 is localized on beta chains and does not require their association with alpha chains for its expression. The MoAb 26.163 appears to be the first example of a monoclonal antibody with specificity for the gene products of HLA-DR, DQ, and DP loci.

We analyzed the neurological complications in 25 patients with Kaposi's sarcoma, 5 encountered at Memorial Sloan-Kettering Cancer Center and 20 culled from the literature. Patients with all clinical forms of Kaposi's sarcoma [14 classical cases, 2 African cases, 5 cases associated with immunosuppressive therapy and 4 cases associated with acquired immunodeficiency syndrome (AIDS)] suffered neurological dysfunction which included neoplastic involvement of the nervous system (Kaposi's sarcoma or another primary), autoimmune disorders and opportunistic infections. Neoplastic involvement was recorded most frequently in patients with classical and African Kaposi's sarcoma and was favored in a setting of extensive tumor dissemination. Opportunistic infections (cryptococcal meningitis and cerebral toxoplasmosis) were observed in all forms of Kaposi's sarcoma but were most frequent in AIDS cases and correlated with the degree of immune dysfunction. Our data suggest that more diverse opportunistic central nervous system infections, neurological disorders of an autoimmune nature, and neoplastic involvement of the nervous system are to be anticipated in AIDS.

Identification of familial cases of Kaposi's sarcoma may help elucidate the role of genetic factors in this disease. To assess the prevalence of familial occurrences, the ethnic distribution of Kaposi's sarcoma and the prevalence of other diseases in our patient population, we have reviewed all cases of Kaposi's sarcoma seen at Memorial Sloan-Kettering Cancer Center between 1954 and 1975. Each patient was categorized on the basis of sex, age of onset of Kaposi's sarcoma, ethnic background, nativity, family history of Kaposi's sarcoma and prevalence of other diseases. Only one documented occurrence of familial Kaposi's sarcoma was found out of 90 cases reviewed. The frequency of familial Kaposi's sarcoma in our patient population supports the findings of other investigators. An ethnic predominance of Kaposi's sarcoma was substantiated, with most patients being immigrants from high-incidence areas (54 of 77) and predominantly of Jewish and Italian heritage (52 Jewish and 17 Italian of 87).