- Email: [email protected]
Anatomy of a skin biopsy: A retrospective analysis of outpatient biopsy results from 2000 to 2010
P7848
P8515
An unusual differential for nonmelanoma skin cancer on the dorsum of a hand: Superficial cutaneous actinomycosis Rhydian Davies, MBBS, Dermatology Department, Swansea, United Kingdom; Dafydd Roberts, MBBS, Dermatology department, Swansea, United Kingdom Introduction: Primary actinomycosis is a rare and difficult to recognize identity. Infection manifests slowly and systemic symptoms are uncommon. Usually associated with an oral, abdominal or uterine focal nidus, isolated primary infections are usually as a result of penetrating trauma. The causative bacteria are facultative intracellular anaerobic parasites that are difficult to culture. The detection of sulphur granules histologically is pathognomic. Case report: Our patient was a 78-year-old woman with type 2 diabetes. She was known to our department having previously had NMSCs treated on her legs. She presented with a 6-month history of a nonhealing erythematous plaque on the dorsum of her right hand. She did recall grazing the area on a rusty door lock some 6 months earlier. Incisional biopsy and histology was obtained which showed inflammatory change. There were no acid-fast bacilli nor fungal elements and sulphur granules were detected. Subsequent tissue culture was unsuccessful in detecting a causative organism and negative for actinomycosis cultures. Resolution of the lesion was achieved with 6 weeks empirical phenoxymethylpenicillin. Discussion: Actinomycoses was first isolated in 1885 by Israel, hence the name of the most virulent species in humans, Actinomyces israeli. Before the emergence of antibiotics, it was once a common clinical diagnosis. Today, outside of the developing world, primary actinomyces infection are rare. Infection of sites not related to the oral cavity or abdominal cavity are rarer still. Our case is a rare example where inoculation of subcutaneous tissue with a suspected actinomyces species has resulted in a chronic cutaneous infection and localised inflammatory response. Despite attempts to culture a causative organism, only skin commensal organisms were grown. Clinical diagnosis of actinomycosis requires a high degree of clinical suspicion. Tissue cultures can be unhelpful but fortunately resistance to beta lactam antibiotics is rare. Commercial support: None identified.
P8384 Anatomy of a skin biopsy: A retrospective analysis of outpatient biopsy results from 2000 to 2010 Charles Phillips, MD, Brody School of Medicine at East Carolina University, Greenville, NC, United States; Austin Newsome, MD, Hampton UniversitySkin of Color Institute, Hampton, VA, United States; Defazio Jennifer, MD, MD, Brody School of Medicine at East Carolina University, Greenville, NC, United States; Fix Lindsey, MS, Brody School of Medicine at East Carolina University, Greenville, NC, United States; Harris Green, MD, Dermatology Assoc-Tallahassee, Tallahassee, FL, United States; Tracy McLean, MD, Brody School of Medicine at East Carolina University, Greenville, NC, United States
Conclusions: This study highlights the interest, value and impact of a skincare product containing Ambophenol, Neurosensine, and La Roche-Posay thermal spring water formulated in a highly protective packaging in monotherapy or in combination with a therapeutic treatment in the management of patients suffering from rosacea.
Skin biopsies are frequently used in dermatology for diagnosis of and identification of malignant conditions. Although biopsies have been around as a standard tool in skin lesion analysis, little is known about the frequency of biopsies or the resulting ‘‘positive’’ yield. The purpose of this study was to evaluate clinical biopsy results from 2000 to 2010 to determine the characteristics of biopsy as a means for diagnosis of suspicious skin lesions. A retrospective analysis was conducted on all pathology results from skin biopsies performed between 2000 and 2010 in the Dermatology clinic at East Carolina University. Biopsy samples were taken from a diverse population of patients seen in an outpatient setting in Greenville, NC. The assessment of results was further stratified based on the reason for biopsy (inflammatory versus tumor; concern for a pigmented lesion) and the diagnoses of either basal cell carcinoma, squamous cell carcinoma, melanoma, ‘‘other cutaneous malignancy’’ and dysplastic nevus. From a sample size of approximately 67,000 office visits that occurred between 2000 and 2010, 20% of patient encounters resulted in skin biopsy. Of the biopsies, 87.9% were performed for suspected malignancy and 12.1% were performed for inflammatory conditions. Among the skin tumor biopsies, 27.5% were diagnosed as basal cell carcinoma, 19.2% were squamous cell carcinoma, 1.5% were melanoma, and 1% were other cutaneous malignancies. Of the biopsies to evaluate tumors, 29.5% were performed to further analyze a pigmented lesion; 5.1% were melanoma. Of the pigmented lesions, 16% were identified as dysplastic nevi with 45.1% had mild atypia, 18.4% moderate atypia, 9.9% severe atypia, and 26.6% uncategorized. Analysis of the total malignancies identified per patient over the 10-year period showed a vast majority of patient (98.5%) diagnosed with 10 malignancies or less. The remaining 2.5% of patients that exceeded 10 malignancies varied greatly with 7 patients having more than 35 skin cancers over the course of the decade. The primary reason for performing a biopsy is typically to identify or verify suspected malignancy. This study showed a 50% positive diagnostic rate for biopsies of lesions that were biopsied to identify skin cancer. A minority of skin biopsies are used to clarify the nature of a rash.
Commercial support: None identified.
Commercial support: None identified.
P7619 An observational study on the management of rosacea in private practice Sophie Seite, PhD, La Roche-Posay Dermatologic Laboratories, Asnieres Sur Seine, France Objective: This study investigates whether a skincare product containing Ambophenol, Neurosensine, and La Roche-Posay thermal spring water formulated in a highly protective packaging can have an impact in the management of rosaceaprone skin subjects as either monotherapy and/or adjunctive therapy. Methods: During this study, dermatologists practicing in Germany, Slovakia, and Canada were asked about their management of 614 patients suffering from rosacea (n ¼ 210, 247 and 157 respectively). A questionnaire, containing information about patient’s characteristics, severity of the pathology and the prescribed therapy was completed by dermatologists at baseline and 2 months later. Results: In monotherapy, there was significant efficacy of the test formula associated with excellent tolerance. Significant improvement of all the clinical signs and symptoms of rosacea and a reduction of the skin reactivity to ‘‘trigger factors’’ were shown as either monotherapy or adjunctive therapy.
AB36
J AM ACAD DERMATOL
MAY 2014
P8515
An unusual differential for nonmelanoma skin cancer on the dorsum of a hand: Superficial cutaneous actinomycosis Rhydian Davies, MBBS, Dermatology Department, Swansea, United Kingdom; Dafydd Roberts, MBBS, Dermatology department, Swansea, United Kingdom Introduction: Primary actinomycosis is a rare and difficult to recognize identity. Infection manifests slowly and systemic symptoms are uncommon. Usually associated with an oral, abdominal or uterine focal nidus, isolated primary infections are usually as a result of penetrating trauma. The causative bacteria are facultative intracellular anaerobic parasites that are difficult to culture. The detection of sulphur granules histologically is pathognomic. Case report: Our patient was a 78-year-old woman with type 2 diabetes. She was known to our department having previously had NMSCs treated on her legs. She presented with a 6-month history of a nonhealing erythematous plaque on the dorsum of her right hand. She did recall grazing the area on a rusty door lock some 6 months earlier. Incisional biopsy and histology was obtained which showed inflammatory change. There were no acid-fast bacilli nor fungal elements and sulphur granules were detected. Subsequent tissue culture was unsuccessful in detecting a causative organism and negative for actinomycosis cultures. Resolution of the lesion was achieved with 6 weeks empirical phenoxymethylpenicillin. Discussion: Actinomycoses was first isolated in 1885 by Israel, hence the name of the most virulent species in humans, Actinomyces israeli. Before the emergence of antibiotics, it was once a common clinical diagnosis. Today, outside of the developing world, primary actinomyces infection are rare. Infection of sites not related to the oral cavity or abdominal cavity are rarer still. Our case is a rare example where inoculation of subcutaneous tissue with a suspected actinomyces species has resulted in a chronic cutaneous infection and localised inflammatory response. Despite attempts to culture a causative organism, only skin commensal organisms were grown. Clinical diagnosis of actinomycosis requires a high degree of clinical suspicion. Tissue cultures can be unhelpful but fortunately resistance to beta lactam antibiotics is rare. Commercial support: None identified.
P8384 Anatomy of a skin biopsy: A retrospective analysis of outpatient biopsy results from 2000 to 2010 Charles Phillips, MD, Brody School of Medicine at East Carolina University, Greenville, NC, United States; Austin Newsome, MD, Hampton UniversitySkin of Color Institute, Hampton, VA, United States; Defazio Jennifer, MD, MD, Brody School of Medicine at East Carolina University, Greenville, NC, United States; Fix Lindsey, MS, Brody School of Medicine at East Carolina University, Greenville, NC, United States; Harris Green, MD, Dermatology Assoc-Tallahassee, Tallahassee, FL, United States; Tracy McLean, MD, Brody School of Medicine at East Carolina University, Greenville, NC, United States
Conclusions: This study highlights the interest, value and impact of a skincare product containing Ambophenol, Neurosensine, and La Roche-Posay thermal spring water formulated in a highly protective packaging in monotherapy or in combination with a therapeutic treatment in the management of patients suffering from rosacea.
Skin biopsies are frequently used in dermatology for diagnosis of and identification of malignant conditions. Although biopsies have been around as a standard tool in skin lesion analysis, little is known about the frequency of biopsies or the resulting ‘‘positive’’ yield. The purpose of this study was to evaluate clinical biopsy results from 2000 to 2010 to determine the characteristics of biopsy as a means for diagnosis of suspicious skin lesions. A retrospective analysis was conducted on all pathology results from skin biopsies performed between 2000 and 2010 in the Dermatology clinic at East Carolina University. Biopsy samples were taken from a diverse population of patients seen in an outpatient setting in Greenville, NC. The assessment of results was further stratified based on the reason for biopsy (inflammatory versus tumor; concern for a pigmented lesion) and the diagnoses of either basal cell carcinoma, squamous cell carcinoma, melanoma, ‘‘other cutaneous malignancy’’ and dysplastic nevus. From a sample size of approximately 67,000 office visits that occurred between 2000 and 2010, 20% of patient encounters resulted in skin biopsy. Of the biopsies, 87.9% were performed for suspected malignancy and 12.1% were performed for inflammatory conditions. Among the skin tumor biopsies, 27.5% were diagnosed as basal cell carcinoma, 19.2% were squamous cell carcinoma, 1.5% were melanoma, and 1% were other cutaneous malignancies. Of the biopsies to evaluate tumors, 29.5% were performed to further analyze a pigmented lesion; 5.1% were melanoma. Of the pigmented lesions, 16% were identified as dysplastic nevi with 45.1% had mild atypia, 18.4% moderate atypia, 9.9% severe atypia, and 26.6% uncategorized. Analysis of the total malignancies identified per patient over the 10-year period showed a vast majority of patient (98.5%) diagnosed with 10 malignancies or less. The remaining 2.5% of patients that exceeded 10 malignancies varied greatly with 7 patients having more than 35 skin cancers over the course of the decade. The primary reason for performing a biopsy is typically to identify or verify suspected malignancy. This study showed a 50% positive diagnostic rate for biopsies of lesions that were biopsied to identify skin cancer. A minority of skin biopsies are used to clarify the nature of a rash.
Commercial support: None identified.
Commercial support: None identified.
P7619 An observational study on the management of rosacea in private practice Sophie Seite, PhD, La Roche-Posay Dermatologic Laboratories, Asnieres Sur Seine, France Objective: This study investigates whether a skincare product containing Ambophenol, Neurosensine, and La Roche-Posay thermal spring water formulated in a highly protective packaging can have an impact in the management of rosaceaprone skin subjects as either monotherapy and/or adjunctive therapy. Methods: During this study, dermatologists practicing in Germany, Slovakia, and Canada were asked about their management of 614 patients suffering from rosacea (n ¼ 210, 247 and 157 respectively). A questionnaire, containing information about patient’s characteristics, severity of the pathology and the prescribed therapy was completed by dermatologists at baseline and 2 months later. Results: In monotherapy, there was significant efficacy of the test formula associated with excellent tolerance. Significant improvement of all the clinical signs and symptoms of rosacea and a reduction of the skin reactivity to ‘‘trigger factors’’ were shown as either monotherapy or adjunctive therapy.
AB36
J AM ACAD DERMATOL
MAY 2014