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Background: Knowledge of melanoma presentations among pediatric and adolescent and young adult (AYA) patients are limited because of studies with small sample sizes., Objective: The objective of this study was to determine the incidence trends and melanoma presentations based on age, sex, race, and ethnicity using a large cohort of diagnoses from 1997 to 2020., Methods: A retrospective cohort study was completed using the National Childhood Cancer Registry from 1997 to 2020., Results: Incidence rates were 1.74 (95% CI: 1.64-1.84) and 62.05 (95% CI: 61.6-62.5) per 1-million-person years for pediatric and AYA patients, respectively. Women encompassed 62.3% of the cohort. Non-Hispanic White patients represented 87.5% of all diagnoses, with significantly higher incidence rates of melanoma compared with all other racial and ethnic groups in both age groups, respectively (P < .001; P < .001). Superficial spreading was the most common of the specified histologic subtypes. The most common location in pediatric patients was the lower extremity, compared with trunk in AYA. There were statistically significant differences in the distributions of primary tumor location by sex, as well as by race and ethnicity, in both pediatric and AYA groups., Limitations: Limitations in this study include retrospective data, selection, and miscoding from individual registries., Conclusion: There are significant differences in tumor characteristics among pediatric and AYA patients with cutaneous melanoma. Trends in incidence rates are decreasing for young patients diagnosed with cutaneous melanoma., Competing Interests: Conflicts of interest Dr Wysong is the recipient of the Institutional Research Grant for Castle Biosciences. There were no incentives or transactions, financial or otherwise, relevant to this manuscript., (Copyright © 2024 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Mucous membrane pemphigoid is a rare autoimmune disease affecting mucosal surfaces. Pediatric cases are exceptionally rare, one subtype being vulvar pemphigoid. Juvenile vulvar pemphigoid can be challenging to diagnose due to its rarity and subtle initial symptoms. We present a case of an 8-year-old girl successfully diagnosed early in the disease course via histopathology, and immunofluorescence. Detecting MMP can be complex due to variations in epitope binding typically not included in commercial ELISA assays, necessitating comprehensive workup. Missed diagnosis may lead to progression to systemic involvement with severe consequences; thus, timely diagnosis and treatment are crucial., (© 2024 The Authors. Pediatric Dermatology published by Wiley Periodicals LLC.)

Dupilumab is an interleukin-4 receptor antagonist important in the treatment of refractory atopic dermatitis (AD), particularly among pediatric patients. Two boys with a history of AD and cardiac transplant who developed psoriasiform dermatitis in response to dupilumab therapy are reported. These patients paradoxically developed an immune-mediated adverse drug reaction despite taking systemic immunosuppressive agents. While the literature suggests possible pathomechanisms for psoriasiform dermatitis despite immunosuppression, further research is necessary to better characterize this unique and unexpected phenomenon., (© 2023 The Authors. Pediatric Dermatology published by Wiley Periodicals LLC.)

Introduction: Mercaptopurine (6MP) and methotrexate (MTX) are commonly used for maintenance chemotherapy for acute lymphoblastic leukemia (ALL). These medications have been associated with various side effects such as myelosuppression, colitis, and thyroiditis in addition to numerous cutaneous adverse events. Cutaneous side-effects most reported include mucositis, alopecia, xerosis, and pruritus. We report an interesting case of hand-foot syndrome to 6MP in a child on maintenance therapy for B-cell ALL from an alteration in medication metabolism., Case: We report a 10-year-old male on maintenance chemotherapy for pre-Bcell ALL who presented to the hospital with worsening oral lesions and erythematous, fissured plaques on the palms and soles. Maintenance therapy consisted of IV vincristine and 5-day pulse of steroids every 12 weeks, daily 6MP, and weekly MTX, which were increased to  ≥ 150% of standard dosing due to persistent absolute neutrophil counts  > 1500. Metabolites obtained on admission demonstrated elevated 6MMP metabolites at 35,761 (normal < 5700). TPMT and NUDT15 enzyme activity were normal and no alterations in genotyping were discovered., Outcome: Patient's oral chemotherapy, including both 6MP and MTX, were stopped and allopurinol 100 mg daily was initiated, which lead to overall improvement., Discussion: Clinical findings of acute mucositis and worsening of hand-foot syndrome, in the setting of inadequate myelosuppression in a child on maintenance therapy for ALL should raise concerns to consider altered metabolism pathway leading to toxic metabolite buildup. Allopurinol can play in improving cutaneous manifestation and chemotherapeutic dosing in patients with altered metabolism., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose of Review: This review highlights recent developments in the field of pediatric allergic contact dermatitis (ACD) and patch testing. We will review updates on the pathophysiology of contact dermatitis, discuss new contact allergens, explore the impact of dupilumab on patch testing, and provide pearls for the diagnosis and management of ACD in children., Recent Findings: ACD is not a single immunologic phenomenon but rather has contributions from multiple inflammatory pathways. Emerging contact allergens include ingredients found in "slime" toys, glucose monitors and insulin pumps, and electronic equipment. Data thus far suggests that patch testing results are generally reliable in the face of concurrent dupilumab use., Summary: ACD is likely underrecognized and underdiagnosed in pediatric patients, including infants and young children. Providers should keep patient-specific factors and emerging trends in mind when addressing suspected ACD, consider contact dermatitis when they encounter challenging cases of atypical, refractory, or chronic dermatitis, and feel comfortable performing patch testing in children., Competing Interests: Conflict of InterestThe authors received no funding in the preparation of this manuscript. The authors have no conflicts of interest or competing interests to disclose., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022.)

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive hematologic malignancy that can present with multiorgan involvement including the skin. While this entity accounts for 0.1% of all cutaneous lymphomas in adults, fewer than 90 pediatric cases have been described in the literature. We present three cases of pediatric BPDCN, highlighting the variable cutaneous and clinical presentation., (© 2021 Wiley Periodicals LLC.)

We report a case of a patient with ectodermal dysplasia attributed to a heterozygous 321C&gt;A mutation in WNT10A who developed overlying autoimmune mediated hair loss. To the best of our knowledge this is the first reported case of alopecia areata in a patient with WNT10A heterozygous ectodermal dysplasia. This case highlights the importance of considering multiple pathways of hair loss in patients with underlying genetic defects and raises the possibility of a shared genetic predisposition.

Competing Interests: The authors have no conflicts of interest to declare.

Increasing age and comorbidities as well as the duration of chronic dialysis make it difficult to establish and maintain a functioning vascular access in patients with terminal kidney failure. The risk of a central venous stenosis or occlusion is greatly increased with a central venous catheter and cardiological or oncological interventions. The implantation of the Hemodialysis Reliable Outflow (HeRO®) graft (Merit Medical Systems Inc., South Jordan, UT, USA) is meanwhile an established combined interventional/surgical procedure for restoration of the stenosed or occluded venous outflow. In this way the vascular access in the upper extremity can be preserved and the important vascular resource of the lower extremity can be spared. In our center a total of 73 successful implantations have been carried out since 2013. The demand is increasing. With growing clinical experience, the surgical intervention has become an established low risk procedure. According to our clinical experiences, after an implantation a reintervention for acute thrombosis is necessary 2-3 times per year. With appropriate experience revision interventions are usually technically easy to carry out. In cases of complete occlusion of the central venous circulation in the region of the superior vena cava, which cannot be passed by the HeRO® graft, a combined intervention with the Surfacer® System (inside-out procedure) is possible and meaningful. When necessary, the HeRO® graft can also be used with an early cannulation graft in order to avoid a temporary dialysis catheter. Despite the increasing numbers of HeRO® graft implantations, this option remains a reserve procedure in our center. The interventional procedures without implantation of foreign material should first be attempted and established vascular surgical alternatives, such as an internal jugular vein graft should be given priority., (© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2021.)

Infantile hemangiomas (IH) are a common benign tumor of infancy, most being uncomplicated and not requiring therapy. Some IH may require treatment; the pediatric provider must be familiar with morphology, distribution, natural history, and associations of IH. Several treatment options are available for IH: current standard of care, oral propranolol. Other therapies include wound care; topical beta-blocker therapy for small, superficial, and uncomplicated IH; treatment of IH residua. In addition to functional compromise and other complications, potential for permanent deformity and eventual psychosocial stigmatization are important when considering the need for treatment of IH in a neonate or infant., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Self-esteem does matter! It matters so much that Oprah dedicated an entire issue of "O" magazine to address the subject. "It's a woman's most treasured possession" (Winfrey, 2000a). Self-esteem has a profound influence on adolescent health promotion behaviors. This study contributes to understanding the role self-esteem plays in the behavior of adolescents. Utilizing a secondary data analysis, race and gender self-esteem differences among adolescents were investigated. The sample of 1,237 students (46% African-American and 52% White) from rural southern areas consisted of 744 females and 493 males. Self-esteem was assessed using the Miller Self-esteem Questionnaire (SEQ). The Hendricks Perceptual Health Promoting Determinants Model (HPHD) provided the theoretical framework for the study. The results of the study revealed a statistically significant difference in various aspects of self-esteem according to race and gender. African-Americans and males had a higher self-esteem which is consistent with many prior studies.