Dissociating Fibroepithelioma of Pinkus From Internal Malignancy: A Single-Center Retrospective Study

Fibroepithelioma of Pinkus (FeP) is a rare skin tumor with a clinical presentation similar to benign neoplasms such as acrochordons and seborrheic keratoses. Our study analyzed if there is an association between FeP and internal tumors, specifically gastrointestinal tract tumors. We retrospectively reviewed the medical records of patients with FeP for other tumors throughout their lives until 2020. Although the quality of documentation for each patient may have differed, this study suggests that the presence of FeP does not indicate the presence of gastrointestinal tract tumors, and there is no need for altered cancer screening recommendations for those with FeP.

Fingernail Abnormalities After a Systemic Illness

Examining a patient's nails and understanding nail growth mechanics can provide helpful clues to help treat past injuries or underlying diseases.

Laptop computer-induced hyperpigmentation

A 25-year-old afebrile man presented with one year of worsening non-pruritic hyperpigmented non-blanchable reticulated patches and one erosion on his abdomen. He denied trauma, contact with new detergents, and recent travel. He was not taking medications and denied ever having similar skin findings. Further questioning revealed that he positioned his laptop computer directly on his abdomen for several hours every night. His progressive skin findings characterize erythema ab igne, which occurs after repetitive prolonged exposure to temperatures between 43 to 47 degrees Celsius. The hyperpigmentation can occur anywhere on unprotected skin and is an ongoing clinical problem in all demographics as heat sources evolve. Guided questioning of an unsuspecting patient can expedite diagnosis and prevent the development of erosions and ulcers, permanent skin discoloration, and even skin cancers.

Local and distal involution of recalcitrant warts after a single intralesional dose of measles, mumps, and rubella vaccine

Verruca vulgaris is a prevalent childhood condition, but treatments are often poorly tolerated. Early treatment is preferable because delays increase the probability of pain, disfigurement, and failed eradication. However, typical treatments require multiple sessions without promising cure. We describe the use of a single intralesional treatment with the measles, mumps, and rubella (MMR) vaccine to successfully eliminate both local and distant recalcitrant warts as well as the proposed mechanism of this method. There are no other known reports of complete wart regression at distant untreated sites after a single intralesional MMR treatment.

Skin-Colored Papules on the Chest

An otherwise healthy male presents with multiple smooth uniform painless cystic papules scattered across his central chest.

Rapidly fatal metastatic cutaneous angiosarcoma initially mimicking a furuncle in a middle-aged male

Cutaneous angiosarcomas are rare but typically occur in three distinct clinical settings and are most commonly found on the scalp or face of elderly men. Positive prognostic factors include tumor size less than 5 cm, primary tumor location below the head, negative margins after excision, resectability, and younger age. Metastases drastically reduce survival and the most common metastatic site is lung. We present a 43-year-old man who had primary cutaneous angiosarcoma that initially mimicked a furuncle and eventuated in multiple metastases. The metastatic disease included brain involvement, which has rarely been reported, especially in a relatively young person without known predisposing conditions. This unique case also highlights the need for early diagnosis followed by advanced imaging, given the limitations of current therapies and high metastatic potential of angiosarcoma.

Intra-lesional injection of the novel PKC activator EBC-46 rapidly ablates tumors in mouse models

Intra-lesional chemotherapy for treatment of cutaneous malignancies has been used for many decades, allowing higher local drug concentrations and less toxicity than systemic agents. Here we describe a novel diterpene ester, EBC-46, and provide preclinical data supporting its use as an intra-lesional treatment. A single injection of EBC-46 caused rapid inflammation and influx of blood, followed by eschar formation and rapid tumor ablation in a range of syngeneic and xenograft models. EBC-46 induced oxidative burst from purified human polymorphonuclear cells, which was prevented by the Protein Kinase C inhibitor bisindolylmaleimide-1. EBC-46 activated a more specific subset of PKC isoforms (PKC-βI, -βII, -α and -γ) compared to the structurally related phorbol 12-myristate 13-acetate (PMA). Although EBC-46 showed threefold less potency for inhibiting cell growth than PMA in vitro, it was more effective for cure of tumors in vivo. No viable tumor cells were evident four hours after injection by ex vivo culture. Pharmacokinetic profiles from treated mice indicated that EBC-46 was retained preferentially within the tumor, and resulted in significantly greater local responses (erythema, oedema) following intra-lesional injection compared with injection into normal skin. The efficacy of EBC-46 was reduced by co-injection with bisindolylmaleimide-1. Loss of vascular integrity following treatment was demonstrated by an increased permeability of endothelial cell monolayers in vitro and by CD31 immunostaining of treated tumors in vivo. Our results demonstrate that a single intra-lesional injection of EBC-46 causes PKC-dependent hemorrhagic necrosis, rapid tumor cell death and ultimate cure of solid tumors in pre-clinical models of cancer.

A principal case of multiple lymphoid collision tumors involving both B-cell chronic lymphocytic leukemia and metastatic malignant melanoma

B-cell chronic lymphocytic leukemia/small lymphocytic B-cell lymphoma (CLL/B-SLL) is a neoplasm of B-cell lymphocytes that occurs frequently in the older population as an asymptomatic elevation of the white blood cell count (WBC) and has a good overall prognosis. Malignant melanoma of the skin is a neoplasm derived from cutaneous melanocytes that frequently arises among the elderly and, depending on certain histopathologic features, may metastasize loco-regionally or distally. However, only one report describes synchronous presentation of these two malignancies within the same lymph node. In this report, we present the unique case of an 87-year-old male with a presumed history of indolent CLL/B-SLL, in which metastatic malignant melanoma and CLL/B-SLL both involved 112 of 145 dissected regional lymph nodes. Possible explanations regarding the mechanisms that can lead to this rare presentation of both CLL/B-SLL and melanoma in the same lymph nodes are discussed.

Drug and excipient diffusion and solubility in acrylate adhesives measured by infrared-attenuated total reflectance (IR-ATR) spectroscopy

Infrared-attenuated total reflectance (IR-ATR) was used to measure drug and excipient diffusion in acrylate pressure-sensitive adhesives. The first part describes diffusion of drug and excipient from one adhesive layer to another. The IR-ATR spectrometer is used to continuously monitor the rate at which drug and excipient diffuse into the 'receptor' adhesive layer. In this way, the ability of the drug and/or excipient to leave an adhesive can be determined without any influence of receptor fluids or skin membranes. Data is reported here for terpineol and testosterone diffusion in isooctyl acrylate (IOA) and IOA-acrylic acid (AA) adhesives. It is shown that the diffusion rate is much higher in IOA adhesive than in IOA-AA adhesive. The second part describes the use of IR-ATR to measure the solubility of liquids in adhesives. In this method, a liquid excipient is placed in direct contact with an adhesive layer containing no excipient. The IR-ATR spectrometer is used to continuously monitor the rate at which excipient diffuses into the 'receptor' adhesive layer. At equilibrium, the IR spectrum can be compared to both the pure adhesive spectrum and the pure excipient spectrum to determine the solubility of the excipient in the adhesive. Data are reported here for terpineol in an IOA adhesive and for several liquids in an IOA-vinyl acetate adhesive.