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A rare cause of erythematous scaly patches
1858
1081
A rare cause of erythematous scaly patches Michael Lee, MD, Center for Clinical Studies, Webster, TX, United States; Stephen Tyring, MD, PhD, University of Texas Health Science Center, Houston, TX, United States Langerhans cell histiocytosis, or LCH, is a rare histiocytic disorder seen in an estimated 1-2 cases per million adults. A systemic disease, LCH commonly has dermatologic manifestations, usually seen as brown-purplish papules in children and an eczematous rash in adults. Herein we provide a case report of a 54-year-old female with previously unidentified LCH who was seen multiple times in our clinic for flare ups of erythematous scaly patches, initially diagnosed as atopic dermatitis. Her refractory condition persisted despite multiple topical corticosteroid therapies. Lymphadenopathy was found to be present at a recent clinic visit; biopsy of a right axillary lymph node revealed abundant and irregular Langerhans cells, consistent with LCH. While a link between LCH and atopic dermatitis has not been fully established, Langerhans cells have been thought to play a role in the pathogenesis of some inflammatory conditions. Recent studies have demonstrated increased numbers of CDa1+ cells within the dermis and epidermis of patients with atopic dermatitis, as well as a decrease in the number of these cells after clinically successful topical corticosteroid therapy. Furthermore, epidermal Langerhans cells have been shown to express a high affinity receptor for IgE. Based on these observations, our case may suggest that increased number of CDa1+ cells within the dermis and epidermis in LCH can lead to the clinical presentation of atopic dermatitis. Thus, LCH may be considered in cases of refractory atopic dermatitis, especially in the presence of other systemic symptoms.
A study of basal cell carcinoma in South Asians for risk factor and clinicopathological characterization: A hospital based study Sandeep Kaur, MBBS, MDGGS Medical College & Hospital, Faridkot, Punjab, India; Sumir Kumar, MBBS, MDGGS Medical College & Hospital, Faridkot, India; B.B. Mahajan, MBBS, MD, GGS Medical College & Hospital, Faridkot, Punjab, India
Commercial support: None identified.
Objectives: Basal cell carcinoma (BCC) is the commonest cutaneous malignancy worldwide. Although the incidence of skin cancers in India (part of South Asia) is low, the absolute number of cases may be significant due to large population. The existing literature on BCC in India is scant. So this study was done focusing on its epidemiology, risk factors and clinicopathological aspects. Methods: A hospital based study was conducted in Punjab, North India from 20112013. All patients visiting skin department with suspected lesions underwent history, examination and histopathologic confirmation. The results were analyzed using appropriate statistical tests. Results: Total of 36 confirmed cases were seen from 2011-2013. The disease had predilection for females (63.9%) and elderly (47.2% cases aged 61-80 years) with mean 6 S.D. age being 60.9 6 14.2 years (65.92 6 14.35 years for males and 57.96 6 13.54 years for females). Mean duration of disease was 4.7 years (range being 5 months to 15 years). Majority of patients were rural (69.4%) and illiterate (80.6%). Though there was statistically significant higher sun exposure in males compared to females (P ¼.000), BCC was commoner in females explainable by intermittent sun exposure (during household work in the open kitchens) in women. There was also seen a statistically significant association between long duration of disease and illiteracy (P ¼ .01) and also, duration with size of lesion (P ¼ .004). Majority of patients (88.9%) had a single lesion. Head and neck region was involved in 97.2% cases, nose being the commonest site (50%) with nodular/ noduloulcerative morphology in 77.8% cases. Pigmentation was evident in 22.2% cases clinically. Nodular variety was the commonest histopathologic variant (77.8%). Conclusions: This study highlights a paradoxically increasing trend of BCC with female preponderance, preferential involvement of nose and higher percentage of pigmentation in Indians. It is commoner in rural and agriculture based population. Major risk factors include intermittent rather than constant UV exposure, cultural and lifestyle changes, cosmetic indifference, arsenic and pesticides, improved clinical and diagnostic skills. The increasing cancer burden calls for the need of a national screening program. The data collected in this study would serve as a reference for future research and development of preventive strategies. Commercial support: None identified.
1220 A retrospective study on the long term efficacy of photodynamic therapy (PDT) treatment of nonmelanoma skin cancer Michal Wen Sheue Ong, MBBS, Jersey General Hospital, Jersey, Channel Islands, United Kingdom; Lynne Grieve, Jersey General Hospital, Jersey, Channel Islands, United Kingdom; Diane Rolland, Jersey General Hospital, Jersey, Channel Islands, United Kingdom; Mark Muhlemann, MBBS, Jersey General Hospital, Jersey, Channel Islands, United Kingdom Aim: (1) To retrospectively determine the rate of recurrence of basal cell carcinoma (BCC) and Bowen disease post methyl aminolaevulinate photodynamic therapy (MAL PDT) in Jersey, Channel Islands between year 2010 to 2013. (2) To compare the local recurrence rate with other centers. Methods: All MAL PDT cases for nonmelanoma skin cancer conducted in Jersey, Channel Islands were examined. Cases that met with the inclusion criteria were included in the study. Inclusion criteria: (1) all MAL PDT performed in Department of Dermatology, Jersey General Hospital between year 2010 to 2013; (2) all BCCs and Bowen’s Disease treated with MAL PDT; (3) all BCCs and Bowen disease diagnosed clinically and histologically; (4) all ages; and (5) same MAL PDT settings. Exclusion criteria: (1) incomplete data (eg, missing notes); and (2) cases that had no histologic report. Data collected: unique number; date of birth; presenting age; sex; diagnosis; number of lesion(s); site of lesion(s); biopsy date; histology report; number and dates of treatments; pain score; side effects; 4-month, 6-month, 12month, [ 12-month outcomes. Results: A total of 101 subjects met the inclusion and exclusion criteria. 87 subjects had BCC (male n ¼ 36, female n ¼ 51) and 14 subjects had Bowen disease (male n ¼ 11, female n ¼ 3). Mean ages of subjects were 60 years for BCC (range 32-89) and 75years for Bowen disease (range of 63-90). Total number of lesions treated with MAL PDT were: BCC, n ¼ 113; Bowen disease, n ¼ 14. Rate of recurrence for BCCs and Bowen disease were 19% (n ¼ 22) and 64% (n ¼ 9), respectively. Of the 22 lesions that recurred in BCC, most of the lesions (n ¼ 13) were picked up at 6-month follow-up, 4 lesions at 4-month follow-up; 4 lesions at 12-month follow-up and 1 lesion at [ 12/12 follow-up). Of the 9 lesions that recurred in Bowen disease, most of the lesions were picked up at 4-month follow-up (6 lesions); 1 lesion each was picked up at the 6-month, 12-month and post-12 month follow-up reviews, respectively. Of the 9 lesions that recurred in Bowen disease, 3 lesions were on the ear, 2 were on upper chest, 2 on thighs, 1 on the temple and 1 lesion on cheek. Conclusions: The rate of recurrence for BCCs after PDT treatment was 19%, similar to other centers (13%-22%); whereas the recurrence rate for Bowen disease after PDT treatment was 64%, much higher compared to other centers (0-40%). Commercial support: None identified.
MAY 2015
742 Assessment of predictive margins of biopsies of nonmelanoma skin cancer Brett Miller, MD, Drexel Dermatology, Philadelphia, PA, United States; Ellen Pritchett, MD, Drexel Dermatology, Philadelphia, PA, United States; Carrie Cusack, MD, Drexel Dermatology, Philadelphia, PA, United States; Mark Abdelmalek, MD, Drexel Dermatology, Philadelphia, PA, United States; Krister Jones, MD, Drexel Dermatology, Philadelphia, PA, United States The most widely used paradigm for the diagnosis and management of localized nonmelanoma skin cancer (NMSC) involves performing a biopsy on clinically concerning lesions to establish a diagnosis. Further treatment is decided based on clinical information, including location, size, patient immunosuppressive status and histopathology. Common treatments for NMSC include electrodessication and curettage, wide local excision, and Mohs surgery. Currently, there is no consensus as to whether tumor involvement at the margins of the initial diagnostic biopsy is predictive of residual tumor in vivo. Jackson et al recently reported that squamous cell carcinoma sites which had negative margins on initial biopsy were less likely to contain residual tumor on subsequent wide excision. However, this correlation did not exist for basal cell carcinomas. Additional research is needed to further understand the implications of margin status of NMSC biopsy specimens. We performed a retrospective analysis to compare the status of tumor histopathologic margins on diagnostic biopsies and the presence of residual tumor in subsequent wide local excision specimens. We reviewed the charts of all patients with a histopathologic diagnosis of basal cell carcinoma, squamous cell carcinoma, or squamous cell carcinoma in situ that later underwent wide local excision from 12/21/2006 to 07/31/2014. Examination of histopathology slides of both the diagnostic biopsy and the subsequent excision were performed to determine the presence of a correlation between biopsy margin status and the presence of tumor in the wide local excision specimen. Data collection is complete and statistical analysis using the two-sample t test is in progress. We hypothesize that negative biopsy margins will correlate with the absence of residual in vivo tumor for nonmelanoma skin cancers. Based on previous literature, we expect this correlation to be stronger for squamous cell carcinoma than for basal cell carcinoma. Commercial support: None identified.
J AM ACAD DERMATOL
AB179
1081
A rare cause of erythematous scaly patches Michael Lee, MD, Center for Clinical Studies, Webster, TX, United States; Stephen Tyring, MD, PhD, University of Texas Health Science Center, Houston, TX, United States Langerhans cell histiocytosis, or LCH, is a rare histiocytic disorder seen in an estimated 1-2 cases per million adults. A systemic disease, LCH commonly has dermatologic manifestations, usually seen as brown-purplish papules in children and an eczematous rash in adults. Herein we provide a case report of a 54-year-old female with previously unidentified LCH who was seen multiple times in our clinic for flare ups of erythematous scaly patches, initially diagnosed as atopic dermatitis. Her refractory condition persisted despite multiple topical corticosteroid therapies. Lymphadenopathy was found to be present at a recent clinic visit; biopsy of a right axillary lymph node revealed abundant and irregular Langerhans cells, consistent with LCH. While a link between LCH and atopic dermatitis has not been fully established, Langerhans cells have been thought to play a role in the pathogenesis of some inflammatory conditions. Recent studies have demonstrated increased numbers of CDa1+ cells within the dermis and epidermis of patients with atopic dermatitis, as well as a decrease in the number of these cells after clinically successful topical corticosteroid therapy. Furthermore, epidermal Langerhans cells have been shown to express a high affinity receptor for IgE. Based on these observations, our case may suggest that increased number of CDa1+ cells within the dermis and epidermis in LCH can lead to the clinical presentation of atopic dermatitis. Thus, LCH may be considered in cases of refractory atopic dermatitis, especially in the presence of other systemic symptoms.
A study of basal cell carcinoma in South Asians for risk factor and clinicopathological characterization: A hospital based study Sandeep Kaur, MBBS, MDGGS Medical College & Hospital, Faridkot, Punjab, India; Sumir Kumar, MBBS, MDGGS Medical College & Hospital, Faridkot, India; B.B. Mahajan, MBBS, MD, GGS Medical College & Hospital, Faridkot, Punjab, India
Commercial support: None identified.
Objectives: Basal cell carcinoma (BCC) is the commonest cutaneous malignancy worldwide. Although the incidence of skin cancers in India (part of South Asia) is low, the absolute number of cases may be significant due to large population. The existing literature on BCC in India is scant. So this study was done focusing on its epidemiology, risk factors and clinicopathological aspects. Methods: A hospital based study was conducted in Punjab, North India from 20112013. All patients visiting skin department with suspected lesions underwent history, examination and histopathologic confirmation. The results were analyzed using appropriate statistical tests. Results: Total of 36 confirmed cases were seen from 2011-2013. The disease had predilection for females (63.9%) and elderly (47.2% cases aged 61-80 years) with mean 6 S.D. age being 60.9 6 14.2 years (65.92 6 14.35 years for males and 57.96 6 13.54 years for females). Mean duration of disease was 4.7 years (range being 5 months to 15 years). Majority of patients were rural (69.4%) and illiterate (80.6%). Though there was statistically significant higher sun exposure in males compared to females (P ¼.000), BCC was commoner in females explainable by intermittent sun exposure (during household work in the open kitchens) in women. There was also seen a statistically significant association between long duration of disease and illiteracy (P ¼ .01) and also, duration with size of lesion (P ¼ .004). Majority of patients (88.9%) had a single lesion. Head and neck region was involved in 97.2% cases, nose being the commonest site (50%) with nodular/ noduloulcerative morphology in 77.8% cases. Pigmentation was evident in 22.2% cases clinically. Nodular variety was the commonest histopathologic variant (77.8%). Conclusions: This study highlights a paradoxically increasing trend of BCC with female preponderance, preferential involvement of nose and higher percentage of pigmentation in Indians. It is commoner in rural and agriculture based population. Major risk factors include intermittent rather than constant UV exposure, cultural and lifestyle changes, cosmetic indifference, arsenic and pesticides, improved clinical and diagnostic skills. The increasing cancer burden calls for the need of a national screening program. The data collected in this study would serve as a reference for future research and development of preventive strategies. Commercial support: None identified.
1220 A retrospective study on the long term efficacy of photodynamic therapy (PDT) treatment of nonmelanoma skin cancer Michal Wen Sheue Ong, MBBS, Jersey General Hospital, Jersey, Channel Islands, United Kingdom; Lynne Grieve, Jersey General Hospital, Jersey, Channel Islands, United Kingdom; Diane Rolland, Jersey General Hospital, Jersey, Channel Islands, United Kingdom; Mark Muhlemann, MBBS, Jersey General Hospital, Jersey, Channel Islands, United Kingdom Aim: (1) To retrospectively determine the rate of recurrence of basal cell carcinoma (BCC) and Bowen disease post methyl aminolaevulinate photodynamic therapy (MAL PDT) in Jersey, Channel Islands between year 2010 to 2013. (2) To compare the local recurrence rate with other centers. Methods: All MAL PDT cases for nonmelanoma skin cancer conducted in Jersey, Channel Islands were examined. Cases that met with the inclusion criteria were included in the study. Inclusion criteria: (1) all MAL PDT performed in Department of Dermatology, Jersey General Hospital between year 2010 to 2013; (2) all BCCs and Bowen’s Disease treated with MAL PDT; (3) all BCCs and Bowen disease diagnosed clinically and histologically; (4) all ages; and (5) same MAL PDT settings. Exclusion criteria: (1) incomplete data (eg, missing notes); and (2) cases that had no histologic report. Data collected: unique number; date of birth; presenting age; sex; diagnosis; number of lesion(s); site of lesion(s); biopsy date; histology report; number and dates of treatments; pain score; side effects; 4-month, 6-month, 12month, [ 12-month outcomes. Results: A total of 101 subjects met the inclusion and exclusion criteria. 87 subjects had BCC (male n ¼ 36, female n ¼ 51) and 14 subjects had Bowen disease (male n ¼ 11, female n ¼ 3). Mean ages of subjects were 60 years for BCC (range 32-89) and 75years for Bowen disease (range of 63-90). Total number of lesions treated with MAL PDT were: BCC, n ¼ 113; Bowen disease, n ¼ 14. Rate of recurrence for BCCs and Bowen disease were 19% (n ¼ 22) and 64% (n ¼ 9), respectively. Of the 22 lesions that recurred in BCC, most of the lesions (n ¼ 13) were picked up at 6-month follow-up, 4 lesions at 4-month follow-up; 4 lesions at 12-month follow-up and 1 lesion at [ 12/12 follow-up). Of the 9 lesions that recurred in Bowen disease, most of the lesions were picked up at 4-month follow-up (6 lesions); 1 lesion each was picked up at the 6-month, 12-month and post-12 month follow-up reviews, respectively. Of the 9 lesions that recurred in Bowen disease, 3 lesions were on the ear, 2 were on upper chest, 2 on thighs, 1 on the temple and 1 lesion on cheek. Conclusions: The rate of recurrence for BCCs after PDT treatment was 19%, similar to other centers (13%-22%); whereas the recurrence rate for Bowen disease after PDT treatment was 64%, much higher compared to other centers (0-40%). Commercial support: None identified.
MAY 2015
742 Assessment of predictive margins of biopsies of nonmelanoma skin cancer Brett Miller, MD, Drexel Dermatology, Philadelphia, PA, United States; Ellen Pritchett, MD, Drexel Dermatology, Philadelphia, PA, United States; Carrie Cusack, MD, Drexel Dermatology, Philadelphia, PA, United States; Mark Abdelmalek, MD, Drexel Dermatology, Philadelphia, PA, United States; Krister Jones, MD, Drexel Dermatology, Philadelphia, PA, United States The most widely used paradigm for the diagnosis and management of localized nonmelanoma skin cancer (NMSC) involves performing a biopsy on clinically concerning lesions to establish a diagnosis. Further treatment is decided based on clinical information, including location, size, patient immunosuppressive status and histopathology. Common treatments for NMSC include electrodessication and curettage, wide local excision, and Mohs surgery. Currently, there is no consensus as to whether tumor involvement at the margins of the initial diagnostic biopsy is predictive of residual tumor in vivo. Jackson et al recently reported that squamous cell carcinoma sites which had negative margins on initial biopsy were less likely to contain residual tumor on subsequent wide excision. However, this correlation did not exist for basal cell carcinomas. Additional research is needed to further understand the implications of margin status of NMSC biopsy specimens. We performed a retrospective analysis to compare the status of tumor histopathologic margins on diagnostic biopsies and the presence of residual tumor in subsequent wide local excision specimens. We reviewed the charts of all patients with a histopathologic diagnosis of basal cell carcinoma, squamous cell carcinoma, or squamous cell carcinoma in situ that later underwent wide local excision from 12/21/2006 to 07/31/2014. Examination of histopathology slides of both the diagnostic biopsy and the subsequent excision were performed to determine the presence of a correlation between biopsy margin status and the presence of tumor in the wide local excision specimen. Data collection is complete and statistical analysis using the two-sample t test is in progress. We hypothesize that negative biopsy margins will correlate with the absence of residual in vivo tumor for nonmelanoma skin cancers. Based on previous literature, we expect this correlation to be stronger for squamous cell carcinoma than for basal cell carcinoma. Commercial support: None identified.
J AM ACAD DERMATOL
AB179