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Background: Subungual melanoma (SUM) is a rare type of cutaneous malignant melanoma (CMM) associated with poor prognosis, while data regarding its prevalence are scarce. Objectives: We sought to provide a comprehensive systematic review and meta‐analysis of the prevalence rates of SUM among all types of CMM, considering certain demographic and clinical characteristics. Methods: The MEDLINE electronic database was searched systematically to identify eligible studies providing prevalence rate estimates of SUM in patients with CMM. Included studies were further analysed to estimate the relative prevalences of SUM according to study design, study years, geographical region and sex distribution. Results: Twenty‐eight studies met the inclusion criteria. The overall SUM prevalence was 1.9% (95% CI [1.5%–2.3%]). The prevalence of SUM did not differ significantly between population‐ and hospital‐based studies and remained stable over time. However, it was found to be significantly higher in Asians compared to patients of other geographical regions as well as in studies with more men than women compared to those with female preponderance (p < 0.001). Conclusions: In all, the overall SUM prevalence among all subtypes of CMM was estimated at 1.9%, without significant changes over time, and was found to exhibit significant variability between subgroups of different geographical regions. [ABSTRACT FROM AUTHOR]

This report describes the clinical, onychoscopic, nail clipping, and histopathologic features of a malignant onychopapilloma. A 71‐year‐old male presented to our outpatient clinic for a stable, asymptomatic lesion on his left middle finger that had been present for 2 years. Prior nail clipping histopathology showed nail plate thinning with subungual abnormal onychocytes. Clinical examination revealed a 2‐mm‐wide streak of longitudinal xanthonychia extending to the proximal nail fold, with distal hyperkeratosis and onycholysis. Onychoscopy showed irregular longitudinal nail plate ridging with scattered punctate hemorrhagic foci. An excisional nail unit biopsy demonstrated cellular atypia of the nail bed epithelium, matrix metaplasia, longitudinal abnormal onychocytes, increased Ki‐67 staining, and negative HPV immunoperoxidase staining, confirming the diagnosis of malignant onychopapilloma. [ABSTRACT FROM AUTHOR]

Basal cell nevus syndrome (BCNS) is an autosomal dominant condition caused most often by a loss‐of‐function mutation in the Patched‐1 (PTCH1) gene. It is characterized by the development of varied benign and malignant tumors, including numerous cutaneous basal cell carcinomas (BCCs). The PTCH1 gene is integral in hair follicle development and loss of function mutation may lead to BCCs with an infundibulocystic histopathology in BCNS patients. Few studies have described the histopathological features of BCCs in BCNS. The recognition of these histopathologic features by dermatologists, dermatopathologists, and others caring for children will allow earlier and more effective identification of BCNS. We performed a retrospective analysis of 25 BCCs in 11 patients aged 5 to 19 years with BCNS and evaluated the histopathologic features on hematoxylin‐eosin‐stained sections. Our study found that 80% of BCCs in BCNS patients occurred on the head and neck with 64% of the specimens demonstrating infundibulocystic differentiation. Infundibulocystic differentiation is a common finding in BCCs found in BCNS. The finding of cutaneous neoplasms consistent with BCC with infundibulocystic differentiation in children is common in pediatric patients with BCNS and can be considered to be an early marker of the disorder, prompting further clinical investigation. [ABSTRACT FROM AUTHOR]

Background/Objectives: Lichen striatus is a unilateral inflammatory dermatosis that rarely affects the nail unit. When the inflammation involves the nail unit, classic lichenoid nail changes are easily detectable, more often limited to only one portion of the nail. Usually the nail dystrophy coexists with periungual skin papules following Blaschko's lines, but it could also be an isolated feature. Because a nail unit biopsy presents difficulties in execution, especially in a child, the aim of our study has been to describe the nail unit dermoscopy features of lichen striatus hoping to provide a valid aid to clinicians in the diagnosing this rare disorder. Methods: We reviewed the images of five pediatric patients with a clinical diagnosis of lichen striatus. Data about sex, age, localization, predisposing/triggering factors, and associated disorders are reported. Results: The diagnosis of lichen striatus can be challenging as there are clinically overlapping features with related dermatoses. A common diagnostic pitfall occurs with inflammatory linear verrucous epidermal nevus and lichen planus. Involvement of only one part of the nail plate with linear longitudinal fissuring, ridging, and distal splitting, especially if seen with perionychial skin lesions, is characteristic of lichen striatus. Conclusions: Nail lichen striatus is rare, and there is sparse published literature on it. When the changes in lichen striatus are limited to the nail, the diagnosis may easily be missed. We therefore believe that dermoscopy is an important diagnostic maneuver, which should be integrated into the evaluation of patients with potential lichen striatus, and in particular is helpful for clinicians unwilling or unable to perform a nail unit biopsy. [ABSTRACT FROM AUTHOR]

Verruciform xanthoma (VX) is a rare finding thought to be caused by epidermal damage from trauma or inflammation and has been reported in a limited number of patients with recessive dystrophic epidermolysis bullosa (RDEB). Herein, we describe a 20‐year‐old woman with RDEB who developed a large, verrucous, pink plaque on the posterior thigh that was histologically proven to be a VX. We review cases of VX in patients with RDEB and summarize the clinical features, pathophysiology, and management principles. [ABSTRACT FROM AUTHOR]

In this issue of I Dermatologic Surgery i , Oh and colleagues[1] present data regarding a supplemental nail unit biopsy technique that may assist in the diagnosis of nail unit melanoma: a punch biopsy of the Hutchinson sign. The diagnosis of nail unit melanoma may be delayed for a number of reasons including physician reluctance to biopsy the nail unit, failure of clinicians to recognize the potential clinical presentation of nail unit melanoma, and dermatopathologist unfamiliarity with the sometimes challenging histopathologic features of nail unit melanoma. [Extracted from the article]

Hands-on nail surgery workshop leads to sustained improvement in comfort with nail surgery by fellows of the American Academy of Dermatology. In this issue of I Dermatologic Surgery i , Stiff and colleagues[1] present short- and long-term data related to improvement in nail surgical skills developed by Fellows of the American Academy of Dermatology who attended a hands-on nail surgery cadaver workshop during the annual and summer meetings of the American Academy of Dermatology in 2019. [Extracted from the article]

Subcutaneous fat necrosis (SCFN) is an inflammatory disorder of the adipose tissue that commonly presents in neonates as tender subcutaneous nodules on the trunk and extremities with hypercalcemia as a potential complication. We report the case of a 3‐month‐old female who presented with circular alopecia of the scalp and was found to have histopathologically confirmed SCFN. Recognition of SCFN as a cause for alopecia in young infants may allow prompt screening for hypercalcemia and reduce the risk for associated morbidity and mortality. [ABSTRACT FROM AUTHOR]

Although dapsone and low-dose prednisolone are usually effective in treating childhood EBA, refractory cases do exist, highlighting the need for further investigation into alternative immune-modulating therapies in children. Epidermolysis bullosa acquisita (EBA) is an acquired bullous dermatosis mediated by autoantibodies directed against collagen VII, a major component of the anchoring fibrils of the dermal-epidermal junction. Indirect immunofluorescence (IIF) revealed IgG4 antibodies at the dermal floor of salt-split skin, and enzyme-linked immunosorbent assay (ELISA) was positive for collagen VII antibodies. [Extracted from the article]

This article discusses the treatment of a newly described nail unit malignant neoplasm called malignant onychopapilloma using Mohs micrographic surgery. The authors highlight the successful outcome of a case where they performed a layered closure of the incision and realigned the nasal ala. They also emphasize the role of dermatologists and Mohs surgeons in diagnosing and managing intranasal basal cell carcinoma (BCC) limited to the nasal vestibular epithelium. The article provides references to other studies on the management of nail unit squamous cell carcinoma, nail unit melanoma, and benign nail unit tumors. The authors are affiliated with the Department of Dermatology at the Hospital of the University of Pennsylvania. [Extracted from the article]

Keywords: nail unit; nail unit histopathology; trachyonychia EN nail unit nail unit histopathology trachyonychia 349 350 2 02/19/21 20210301 NES 210301 In this issue of our Journal of Cutaneous Pathology, Hur et al1 present the most extensive data on the histopathology of adult trachyonychia to date. As Hur et al mention, there is also value in a nail unit biopsy in the adult population for the evaluation of trachyonychia, as it may reveal another unlikely cause, such as systemic amyloidosis.5-8 It is interesting to consider the surgical technique of the nail matrix punch biopsy which was employed by Hur et al. If a decision is made for an adult patient to undergo nail unit biopsy in the evaluation of trachyonychia, a matrix punch biopsy is an efficient method to obtain further diagnostic information. [Extracted from the article]

First, the surgical approach of a longitudinal excision for a lesion of longitudinal erythronychia that includes portions of the matrix lunula area, the nail bed, and hyponychium allows for maximal evaluation of these nail unit anatomic areas, and allows for definitive diagnosis of entities which would be considered in the differential diagnosis such as onychopapilloma, squamous cell carcinoma, amelanotic melanoma, as well as others. The closest contender would be nail unit Bowen disease, and as the authors point out in the text and tables, there are significant clinical and histopathologic features that differentiate malignant onychopapilloma from ungual Bowen disease. 2 Baran R, Perrin C. Longitudinal erythronychia with distal subungual keratosis: onychopapilloma of the nail bed and Bowen's disease. [Extracted from the article]

Nail unit melanoma (NUM) is an uncommon form of melanoma and is often diagnosed at later stages. Approximately two-thirds of NUMs are present clinically as longitudinal melanonychia, but longitudinal melanonychia has a broad differential diagnosis. Clinical examination and dermoscopy are valuable for identifying nail findings concerning malignancy, but a biopsy with histopathology is necessary to confirm a diagnosis of NUM. Surgical treatment options for NUM include en bloc excision, digit amputation, and Mohs micrographic surgery. Newer treatments for advanced NUM include targeted and immune systemic therapies. NUM in pediatric patients is extremely rare and diagnosis is challenging since both qualitative and quantitative parameters have only been studied in adults. There is currently no consensus on management in children; for less concerning melanonychia, some physicians recommend close follow-up. However, some dermatologists argue that the "wait and see" approach can cause delayed diagnosis. This article serves to enhance the familiarity of NUM by highlighting its etiology, clinical presentations, diagnosis, and treatment options in both adults and children. [ABSTRACT FROM AUTHOR]

The lunula is the semi-lunar shaped area seen at the proximal aspect of the nail unit. It is the most distal aspect of the nail matrix that can be visualized through the transparent nail plate. The term red lunula describes erythema that partially or completely replaces the normal white color of the lunula. Red lunulae have been associated with a number of dermatologic and systemic conditions. However, the etiology and histopathology of the red lunula have not been characterized. We report a case of red lunulae of the fingernails in an adult male. Histopathologic examination revealed an increased density of benign-appearing and mildly dilated vascular channels present in the superficial papillary dermis of the nail matrix. To our knowledge, this is the first report of distinct pathologic findings seen on histologic examination of a red lunula. The increased vascularity of the lunula seen microscopically correlates with the clinically observed red color. These findings raise the possibility that systemic or local factors are responsible for angiogenesis within the nail unit in disorders associated with the red lunula. [ABSTRACT FROM AUTHOR]

From a clinical standpoint, this study confirms the usefulness of nail unit punch biopsies for the diagnosis of nail unit lichen planus. As the study presented by Kharghoria in this issue of our JCP focused specifically on nail unit lichen planus, future work may be able to tell if the "frayed nail plate" may be found in other dermatoses affecting the nail unit. It would also be interesting to see if the finding of the "frayed nail plate" can be detected in nail-clipping samples from patients with nail unit lichen planus or other nail unit dermatoses, as this would advance the diagnostic potential of such samples and potentially avoid more invasive nail unit biopsy techniques. [Extracted from the article]

Nail unit dermatopathology is a growing field filled with many challenges. Many advances in this field have been made in the last 5 years. This review article provides an update on new information and studies published in that period of time. We divided these works into different sections, including clinical and pathologic challenges in diagnosis and treatment of nail disorders, nail unit biopsy and processing techniques, normal nail unit histology, nail plate structural and growth pathology, metabolic disease, inflammatory conditions, onychomycosis, benign growths, malignant growths, and dyschromias. Specific highlights include advances in the marking and orientation of nail unit biopsies for improved histologic interpretation, improved nail plate softening techniques, new methods for histologic evaluation of onychomycosis, descriptions of newly described benign growths unique to the nail unit, and the morphologic and immunohistochemical distinction between benign and malignant pigmented lesions of the nail unit. [ABSTRACT FROM AUTHOR]

The article discusses the use of nail surgery in managing nail defects. It notes that this surgical operation is performed for diagnostic biopsy when neoplastic and inflammatory conditions are suspected. It is employed to manage longitudinal melanonychia and longitudinal erythronychia where excision is performed on the entire lateral matrix and matrix horn to prevent cysts and neoplasm recurrence. The success of nail surgery depends on several factors including an effective anesthesia.

A perineurioma is a benign peripheral nerve sheath neoplasm thought to be derived from cells of the perineurium, the cellular sheathing of peripheral nerve fascicles. The histological, immunohistochemical (positive for epithelial membrane antigen, collagen type IV, laminin and vimentin but not S-100 protein) and ultrastructural features of a perineurioma form the basis for diagnosis. Two types of perineuriomas are recognized, intraneural and soft tissue (extraneural) forms. Sclerosing perineurioma is considered a variant of the soft tissue perineurioma. In all but one of the reported cases, this subtype presented as a solitary clinical lesion with a predilection for the fingers and palms of young adults. In 2002, Huang and Sung described a 16-year-old boy with one sclerosing perineurioma on each hand. The unusual case presented herein is a 21-year-old woman manifesting more than 30 cutaneous sclerosing perineuriomas on the hands and arms. This case is the most extensive presentation of sclerosing perineuriomas documented to date and extends the clinical presentation spectrum of these lesions. [ABSTRACT FROM AUTHOR]

Background Most cases of myiasis in North America are caused by fly larvae from South America or Africa, as these cases represent travelers returning from endemic regions. The etiology of creeping eruptions and furuncular lesions in North American patients who have no history of recent travel can therefore be a diagnostic problem. Among cases acquired in North America, Cuterebra species are the usual cause. Dermatologists and dermatopathologists should be aware that this unusual infestation may occur without a travel history. Method Here we report a case of Cuterebra cutaneous myiasis acquired in New Jersey. A world literature review of articles on Cuterebra myiasis in humans, without age or year restriction, was performed. The pertinent references of those articles were also searched. Results Most cases occur in the skin, as a furuncle. Sometimes a cutaneous creeping eruption is present. Children account for at least half of the reported cases. The infestations tend to occur in the late summer, and most frequently in the north-eastern and southern states of the United States. An overview of the clinical and histopathologic diagnostic features are presented. Conclusions Though rare, myiasis can occur in North America without a travel history. Awareness of this entity, its epidemiologic patterns and diagnostic characteristics, can prevent lengthy delays in diagnosis and unnecessary treatments. [ABSTRACT FROM AUTHOR]

Patients undergoing cardiac transplantation are routinely screened for prior exposure to Treponema pallidum, the bacterium implicated in syphilis. Although acute syphilis typically presents with a painless genital chancre, chronic syphilis can manifest in protean forms and linger undiagnosed. Left untreated, syphilis can cause multi-system disease, particularly irreversible neurologic damage. We describe a case of cutaneous secondary syphilis, neurosyphilis and luetic hepatitis in a cardiac transplant patient. [Copyright &y& Elsevier]

This article explores a rare case of blue discoloration in a nail tumor called onychomatricoma. The blue pigmentation was found to be caused by a fungal infection called pigmented onychomycosis. The article provides a detailed description of the clinical and histopathological features of the case, emphasizing the challenges in diagnosing and treating the tumor. It also discusses the rarity of blue chromonychia and the potential diagnostic value of nail clippings. The article aims to inform readers about the clinical features, diagnosis, and treatment of onychomatricoma, emphasizing the importance of accurate diagnosis and differentiation from other nail disorders. [Extracted from the article]

Downloaded from http://journals.lww.com/dermatologicsurgery by BhDMf5ePHKbH4TTImqenVA+lpWIIBvonhQl60Etgtdnn9T1vLQWJq/+R2O4Kjt58 on 03/22/2021 Downloaded from http://journals.lww.com/dermatologicsurgery by BhDMf5ePHKbH4TTImqenVA+lpWIIBvonhQl60Etgtdnn9T1vLQWJq/+R2O4Kjt58 on 03/22/2021 Commentary CommentaryonMohsMicrographicSurgeryUsing MART-1ImmunostainingforNailUnitMelanoma inSitu I ntheJanuaryissue,Matsumotoandcolleagues 1 present data from their single institution experience using Mohs micrographic surgery (MMS) for nail unit melanomainsitu. 3 The authors' use of MART-1 staining is essential to their technique, which optimizes accurate histopathologic evaluation of the nail unit tissue so as to provide the best possible treatment for each patient. Both are internationally recognized nail experts and have particular experience with treatment of nail unit melanoma. [Extracted from the article]

The longitudinal nail strip biopsy will make the acquisition of useful histopathologic information more accessible to clinicians, aiding in the diagnosis and management of challenging inflammatory dermatoses affecting the nail unit. Histopathology remains the gold standard for diagnosing disorders of the nail unit, yet nail biopsies are rarely performed in general dermatologic practice.[[1]] Many dermatologists may view the nail biopsy as too complex or risky of an undertaking. [Extracted from the article]

Jellyfish envenomation often causes an immediate painful vesiculopapular eruption. Less commonly it can cause a type IV allergic hypersensitivity that manifests with delayed or recurrent cutaneous lesions at the primary site or distant from the primary site. These secondary reactivations may be related to high antijellyfish immunoglobulin levels, intracutaneously sequestered antigen, or cross-reacting venom. Immunomodulators such as pimecrolimus and tacrolimus and topical and intralesional corticosteroid therapy decrease this recurrent dermatitis. We report a case of a 9-year-old girl with a recurrent jellyfish dermatitis lasting more than 1 year after the initial envenomation. The dermatitis finally resolved after treatment with tacrolimus and intralesional triamcinolone acetonide therapy. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article on dermatophytoma which is a clinicopathologic entity important for dermatologists and dermatopathologists to determine.

Transverse melanonychia is a rare finding often secondary to chemotherapy, orally ingested medications, or other iatrogenic interventions. A 19‐month‐old boy with hemophagocytic lymphohistiocytosis treated with biweekly etoposide and dexamethasone developed transverse bands of pigment in all toenail and fingernail units consistent with transverse melanonychia. We review the literature for reported cases of transverse melanonychia and summarize suspected etiologies. [ABSTRACT FROM AUTHOR]

An editorial is presented on the recommendations related to Appropriate Use Criteria (AUC) from the American Society of Dermatopathology (ASDP) released by the ASDP AUC Task Force. It discusses recommendation for cutaneous Muir-Torre syndrome-associated neoplasms, cutaneous melanoma and dermatofibrosarcoma and categories including 'usually appropriate', 'rarely appropriate', and 'uncertain appropriateness' in daily practice of dermatopathology. "

Introduction: Onychomycosis is the most common nail disorder in adults, with high recurrence and relapse rates. Its diagnosis may be difficult by non-experts because the clinical signs may overlap with other dermatoses. The treatment may be challenging, as it should be patient-tailored. Methods: An online survey was conducted among European Nail Society (ENS) members to provide recommendations on the diagnosis and assessment of distal lateral subungual onychomycosis (DLSO) in non-specialized clinical environments, as well as recommendations for patient referral. Results: DLSO diagnosis is predominantly based on clinical aspects, and microscopy and fungal culture are commonly employed to establish the diagnosis. Assessment of clinical features is the main method for DLSO follow-up, and the main criterion to define cure is a combination of mycologic cure and clinical cure. The most commonly selected treatments for onychomycosis include oral antifungals, topical antifungals, and nail debridement. According to the nail experts, predisposing factors of DLSO to be evaluated include concurrent tinea pedis diagnosis, immunocompromised status, and diabetes. The minimum clinical aspects to be evaluated for DLSO diagnosis should include subungual hyperkeratosis, white-yellow-orange subungual scales, and absence of salmon-pink coloration. Recommendations for clinical signs that should be evaluated to confirm treatment effectiveness include normal appearance and color of the nail, reduction or absence of scales under the nail, and absence of onycholysis. Recommendations for specialist referral include lack of treatment effectiveness, need of additional therapies, concurrent presence of other diseases or comorbidities, severe DLSO, and presence of a dermatophytoma or involvement of the nail matrix. Conclusions: According to the surveyed nail experts, after evaluating clinical signs and predisposing factors for DLSO, the diagnosis should include subungual hyperkeratosis, nail color (yellow-orange), and onycholysis and thickening. In cases of severe DLSO, when there is treatment failure, concomitant diseases/comorbidities, presence of a dermatophytoma or involvement of the nail matrix, or involvement of several/all nails, referral should be considered. [ABSTRACT FROM AUTHOR]

Patients with various forms of epidermolysis bullosa have fragile skin which can act as a breeding ground for multiple microbial agents. Standard wound care practices advocate the use of special dressings on open erosions as well as antibiotic topical medications to treat and prevent cutaneous infections. We report a child with recessive dystrophic epidermolysis bullosa admitted to our institution because of fevers at home. She was treated with multiple antibiotics for a cutaneous infection of the right hand. During her hospital stay, she sustained persistent fevers, and oral erosions developed, with progressive hemorrhagic crusting. Viral culture of the lip grew herpes simplex virus type 1, consistent with a diagnosis of herpetic gingivostomatitis. We present this patient to illustrate the importance of investigating wounds of epidermolysis bullosa patients for viral agents when faced with managing a child with an unclear source of fever. To the best of our knowledge, although this is the first report of herpetic gingivostomatitis in association with epidermolysis bullosa, it is likely to be more prevalent than the literature could suggest. [ABSTRACT FROM AUTHOR]

Abstract: Asymmetric hypertrophy of the labia minora is a variant of normal anatomy that has not been described in the pediatric dermatology literature. Although often asymptomatic, in some cases, it can cause functional, emotional, and psychological problems. We report the clinical characteristics and outcomes of four children who presented with unilateral labium minus hypertrophy. This case series aims to establish awareness of this condition among pediatric dermatologists and provide recommendations regarding management. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including nail histology processing techniques, nail disorders and variability of immunoperoxidase stains.

The article describes the case of a Caucasian male patient who was presented with a history of right jaw nodule. Topics covered include the results of the physical and histopathological examinations, the diagnosis for disseminated coccidioidomycosis given the patient's positive serologies and mono-like illness and the need for travel history and tissue culture in patients with cutaneous lesions unresponsive to therapy.

Bacillus Calmette-Guerin (BCG) vaccine complications in patients with severe combined immunodeficiency (SCID) have been well documented in the literature. We present a case in which the BCG vaccine was administered to an infant who was later diagnosed with SCID and presented with worsening localized BCG reaction upon arrival in the United States. Although the BCG vaccine is not routinely administered in the United States, it is important for physicians to be aware of potential complications of BCG vaccination since prompt treatment can be lifesaving. [ABSTRACT FROM AUTHOR]

While our patient, and 90% of patients included in the review, did not recall any specific trauma to the affected site, it is plausible that minor repetitive traumas secondary to footwear or activity[1] could have gone unnoticed. Keywords: acquired ungual; fibrokeratoma; ungual fibrokeratoma EN acquired ungual fibrokeratoma ungual fibrokeratoma 779 782 4 08/16/23 20230901 NES 230901 INTRODUCTION Acquired ungual fibrokeratomas are uncommon benign fibrous tumors of the nail unit. These tumors can emerge from the proximal nail fold, directly from the nail bed itself,[1] as well as from other areas of the nail unit. [Extracted from the article]

A letter to the editor is presented related to evaluation of alopecia with a single hair.

A 10-year-old boy was diagnosed with non-Herlitz junctional epidermolysis bullosa (nh-JEB) shortly after birth when he developed blisters on his feet and under the toenails. His younger brother was also affected by nh-JEB. Their parents were first cousins. Immunofluorescence mapping showed a blister in the lamina lucida and reduced staining with GB3 antibody against laminin V. Molecular analysis showed a homozygous mutation in the LAMC2 gene. The patient complained of intermittent inability to pass urine, causing significant suprapubic pain, anxiety, and general discomfort. He reported the development of blisters and erosions at the urethral meatus, which caused fusion of the meatal opening. In order to micturate, he had to tear apart the fused tissue, resulting in considerable pain. Physical examination revealed multiple healing erosions and atrophic scars, mainly on the legs ( Fig. 1 ), and anonychia of most of the toenails. The walls of the urethral meatus were adherent ( Fig. 2 ). The urethral meatus could not be opened using a moderate amount of pressure by the examining physicians. Prevention of re-stenosis of the urethral meatus was accomplished with the application of Mepilex® (Mölnlycke, Sweden) to the urethral meatus after each micturition, where it remained until the next episode of micturition. Since the institution of this care regimen 10 months ago, there has been no recurrence of the stenosis. [ABSTRACT FROM AUTHOR]

Melanoma of the nail apparatus is challenging to diagnose for both dermatologists and dermatopathologists. Misdiagnosis or delayed diagnosis of nail unit melanoma can have fatal consequences and legal ramifications. This review educates dermatopathologists on challenges and traps they should be aware of to avoid misdiagnosis of nail unit melanoma. We present illustrative difficult cases that introduce several themes regarding challenges in the diagnosis of nail unit melanoma: specimens with subtle histopathologic findings, challenges in immunoperoxidase interpretation, and how clinical knowledge and surgical procedural knowledge are mandatory to make the diagnosis. Dermatopathologists will be aware of when and how to suspect nail unit melanoma in unusual circumstances. [ABSTRACT FROM AUTHOR]

NFEI is a rare inflammatory dermatosis that requires a combination of careful clinical and histopathologic assessment to establish the diagnosis. Keywords: figurate erythema; infancy; leukocytoclastic; neutrophilic annular erythema EN figurate erythema infancy leukocytoclastic neutrophilic annular erythema 289 293 5 03/20/23 20230401 NES 230401 INTRODUCTION Neutrophilic figurate erythema of infancy (NFEI) is a rare inflammatory dermatosis and variant of annular erythema of infancy.[1] Diagnosis requires careful assessment to exclude other clinical and histopathologic mimickers.[2] Herein, we report a case of neutrophilic figurate erythema in an infant that was originally misdiagnosed histopathologically as leukocytoclastic vasculitis. Figurate erythema, infancy, leukocytoclastic, neutrophilic annular erythema. [Extracted from the article]

We call on dermatologists and dermatopathologists to include nail clipping histopathology as an essential component of the routine evaluation of melanonychia. This manuscript demonstrates a case where an adult woman with broad melanonychia of the right thumbnail declined a nail matrix biopsy, but was amenable to a nail clipping. The nail clipping showed pigmentation, melanocyte remnants, and small cavities in the nail plate. These features have been published previously by our group as a clue to nail unit melanoma within nail clippings.This patient was rapidly triaged for nail matrix biopsy, which demonstrated nail unit melanoma in situ. Every patient with melanonychia can benefit from a nail clipping by examination of the location of the pigmentation within the nail plate for surgical planning, and if melanocyte remnants are detected, the nail clipping also serves as a rapid triage mechanism for nail matrix biopsy to evaluate for nail unit melanoma. Fontana-stained sections will highlight the pigmentation in the nail plate, and its location in the nail plate can easily be described by the dermatopathologist. Nail clippings performed in the setting of clinically apparent melanonychia may show helpful histopathologic findings of pigmented fungi, hemorrhage, external pigmentation, features of other pigmented nail unit tumors, as well as other entities. Nail clipping histopathology can provide extensive information in the evaluation of melanonychia with minimal discomfort for a patient, and little disruption to a physician's clinic flow. With this additional case of a nail unit melanoma diagnosed after initial concern found in a nail clipping, as well as other information in the literature, it is clear that melanocyte remnants found in nail clippings are reliable concerning features related to nail unit melanoma in adults. With knowledge of these histopathologic features in nail clippings and the significance of melanocyte remnants, the dermatopathologist can play a crucial role in the use of a nail clipping as a life-saving diagnostic maneuver. Accordingly, given the potential benefit to patients in this setting, as well as other uses of a nail clipping in the evaluation of melanonychia, we call on dermatologists and dermatopathologists to innovate the routine evaluation of melanonychia through the routine employment of nail clippings for histopathologic evaluation. [ABSTRACT FROM AUTHOR]

Keywords: cutaneous metastasis; gastric carcinoma; plasmacytoid differentiation; plasmacytoma EN cutaneous metastasis gastric carcinoma plasmacytoid differentiation plasmacytoma 8 11 4 01/02/23 20230101 NES 230101 Abbreviations DGC diffuse-type gastric cancer GC gastric carcinoma PCP primary cutaneous plasmacytoma SRC signet-ring cell carcinoma INTRODUCTION Gastric carcinoma (GC) is one of the most common visceral malignancies globally and a leading cause of cancer death. Signet-ring cell carcinoma (SRC) is a histopathological subtype of DGC featuring malignant cells with abundant intracellular mucin that pushes the nuclei to the periphery of the cells, imparting a signet-ring appearance.[1] While GC is common, cutaneous metastases of GC are exceedingly rare. [Extracted from the article]

A response by Adam I. Rubin; Elbert H. Chen and D. Ratner to several letters to the editor in response to their article "Basal-Cell Carcinoma" in the November 24, 2005 issue is presented.

This article reports on basal-cell carcinoma. According to the American Cancer Society, skin cancer is the most common of all cancers, accounting for about half of all cancers in the U.S. Of the over one million cases of skin cancer that will be diagnosed in the U.S. this year, basal-cell carcinomas will constitute approximately 80 percent of all the non-melanoma skin cancers. Cutaneous basal-cell carcinoma differs from the uncommon basal-cell carcinoma or basaloid carcinomas that arises in areas such as the prostate, pancreas, lung, cervix, salivary gland, thymus, and anal canal.

The article presents the case study of a 36-year-old male construction worker with a history of onychodystrophy which developed after his right thum nail was crushed between two steel plates. The patient's medical history is discussed as well as the pathological examination of his nail. The results led to the diagnosis of amelanotic nail unit melanoma which is a rare disease and can be difficult to diagnose.

A 26‐year‐old male presented with a 2‐year history of a hyperkeratotic growth from the left index finger. Histopathology was consistent with an acquired digital fibrokeratoma with changes of a pleomorphic fibroma. Lesional cells were negative for CD34, Rb, and p53, and were positive for FXIIIa. We introduce the pleomorphic acquired digital fibrokeratoma as a novel clinicopathologic entity. [ABSTRACT FROM AUTHOR]

When patients present with painful nodules at the sites of known injection, a medication-induced injection-site panniculitis should be considered on the differential diagnosis. These nodules arose hours-to-days following an insulin injection, persisted for many months, and occurred at all anatomic regions where the injections were performed, including the abdomen, back, and thighs. Keywords: immune complex formation; insulin panniculitis; lobular panniculitis EN immune complex formation insulin panniculitis lobular panniculitis e12 e13 2 04/23/21 20210301 NES 210301 CASE PRESENTATION A thirteen-year-old male patient presented for evaluation of multifocal painful abdominal nodules. [Extracted from the article]

Onychotillomania represents an unusual dermatosis affecting the nail unit. The term refers to 'neurotic picking at a nail until it is permanently altered'. It can be difficult for dermatologists to diagnose, as typically patients will deny the self-destructive behavior and the clinical features may mimic other inflammatory conditions affecting the nail unit. Aside from the difficulty in establishing the diagnosis clinically, the histopathologic features of onychotillomania are nonspecific. With this limited knowledge, dermatopathologists could have difficulty in correlating the clinical and histopathologic features and determining the correct diagnosis. Establishing the diagnosis is critical, as onychotillomania is sometimes associated with major depression and obsessive-compulsive disorder, and can be a clue to uncovering these debilitating psychiatric disorders. Here we present two cases of onychotillomania and emphasize the clinical-pathological confrontation necessary to secure the diagnosis. [ABSTRACT FROM AUTHOR]

In another study,7 in which different colors of nail polish and different brands of nail polish were studied, similar patterns for the nail polish were seen except that the finely granular material was mostly polarizable. In the 19th century, nail cosmetics became more commonly used worldwide; nail polish itself was popularized in the 20th century and many different forms of nail cosmetics were introduced to the fashion industry, including basic nail polish, gel nail polish, acrylics, breathable nail polish, and others.1 In the last few decades, further innovations have been made in nail art, introducing various forms of nail polish and nail stickers.2 Magnetic nail polish is a new trend in nail cosmetics that is quickly becoming popular. For example, the acrylate ingredient, which is also present in this magnetic nail polish, is the main allergenic component among most types of nail polishes, including acrylic nails, gel nails, solar nails, ultraviolet nails, nail wraps, and silk nails. [Extracted from the article]

Junctional epidermolysis bullosa with pyloric atresia (JEB-PA) is an autosomal recessive blistering disease including lethal and non-lethal variants due to mutations in ITGB4 and ITGA6. It is unclear whether PA is caused directly by the mutations in these genes or by other factors. Skin biopsies from patients with JEB were processed for immunofluorescence mapping. When staining for integrin β4 or α6 was absent or reduced, ITGB4 was screened for mutations. A review of known mutations of ITGB4 and the phenotypes of patients with JEB-PA was undertaken. Three novel ITGB4 mutations were identified in 3 families with JEB-PA: 2 splice-site and one insertion mutation. Two families with lethal phenotypes (EB-050 and EB-049) were due to combinations of premature termination codons and missense mutations (658delCIR252C and 3903dupC/G273D, respectively). The third family EB-013 has 2 JEB affected siblings; a brother with PA and a sister without PA. Both were homozygous for ITGB4 264G>A/3111-1G>A. Two cases had no gastrointestinal symptoms or signs of PA. PA is an inconstant feature of the subtype of epidermolysis bullosa known as JEB-PA. It is most likely that multiple factors influence the development of PA and its presence is not predictive of a poor outcome. It is possible that institutions that do not routinely screen immunofluorescence mapping for integrin α6β4 staining in the absence of PA are missing this form of epidermolysis bullosa. [ABSTRACT FROM AUTHOR]