Reinhart, Jacob P.

Locally advanced basal cell carcinoma (BCC) is an uncommon and complex presentation of BCC. These tumors can present as extensive nonhealing ulcers and require skin biopsy to rule out other causes, including malignant, infectious, and inflammatory etiologies. In this case report, a 57-year-old female without significant past medical history presented with a 5-year history of a chronic progressive ulcer involving the neck and back. Histopathological study of the tissue identified nodular and infiltrative BCC, prompting further multidisciplinary treatment and management with vismodegib, radiation, and surgery.

Background Dermatofibrosarcoma protuberans (DFSP) arising in the vulvar and perivulvar region poses unique challenges to the dermatologic surgeon. The potential for broad subclinical extension and involvement of deeper and high-risk functional structures requires a strong knowledge of relevant anatomy. Careful considerations are required for preoperative arrangements, surgical day preparations, and postoperative surveillance to improve treatment outcomes and patient experiences. Objective The authors aim to provide a practical guide for the dermatologic surgeon, which outlines surgical planning and management recommendations for vulvar DFSP. Emphasis on pelvic anatomy through cadaveric and patient images as well as anatomical illustrations will be included. Materials and Methods A literature review was performed to identify evidence-based management recommendations for vulvar DFSP. Authors share anecdotal perioperative recommendations for optimizing the patient experience. A detailed pelvic dissection of a female cadaver was performed for anatomical depiction of relevant high-risk structures. Illustrations of sensory nerve distributions were created for reference. Conclusion Vulvar DFSP is a challenging cutaneous tumor in a sensitive anatomical location. As Mohs surgery offers clear advantages over wide local excision, the authors provide dermatologic surgeons with detailed anatomy review resources as well as recommendations and considerations for management and perioperative planning for this specialized site.

AbstractBackgroundTechnology has revolutionized not only direct patient care but also diagnostic care processes. This study evaluates the transition from glass‐slide microscopy to digital pathology (DP) at a multisite academic institution, using mixed methods to understand user perceptions of digitization and key productivity metrics of practice change.MethodsParticipants included dermatopathologists, pathology reporting specialists, and clinicians. Electronic surveys and individual or group interviews included questions related to technology comfort, trust in DP, and rationale for DP adoption. Case volumes and turnaround times were abstracted from the electronic health record from Qtr 4 2020 to Qtr 1 2023 (inclusive). Data were analyzed descriptively, while interviews were analyzed using methods of content analysis.ResultsThirty‐four staff completed surveys and 22 participated in an interview. Case volumes and diagnostic turnaround time did not differ across the institution during or after implementation timelines (p = 0.084; p = 0.133, respectively). 82.5% (28/34) of staff agreed that DP improved the sign‐out experience, with accessibility, ergonomics, and annotation features described as key factors. Clinicians reported positive perspectives of DP impact on patient safety and interdisciplinary collaboration.ConclusionsOur study demonstrates that DP has a high acceptance rate, does not adversely impact productivity, and may improve patient safety and care collaboration.

AbstractBackgroundBier anemic spots, cyanosis with urticaria‐like eruption (BASCULE) syndrome is a recently described entity with episodic urticarial lesions and white anemic halos on a background of erythrocyanosis, commonly affecting the lower extremities. Possible association with autonomic dysfunction remains poorly understood. Existing publications are limited, but the condition is suggested as highly underrecognized.ObjectiveTo further characterize clinical and epidemiologic data for BASCULE syndrome.MethodsWe performed an IRB‐approved retrospective chart review on patients with BASCULE syndrome evaluated at Mayo Clinic from April 2021 to November 2022.ResultsA total of 17 patients were identified (13 female, 4 male). Median age of onset was 12 years (range 9–17). Lower extremities were involved in all patients (17). Most patients were symptomatic with pruritus (8) or burning pain (8); three were asymptomatic. Triggers were standing (11), hot showers or hot environments (7), or no clear trigger (4). Autonomic dysfunction was present in 10 patients. Treatment responses were observed from propranolol (3) and high‐dose cetirizine (1).ConclusionNovel epidemiologic data from 17 pediatric and young adult patients with BASCULE syndrome further supports an association with autonomic dysfunction and suggests a higher prevalence than previously acknowledged.

BACKGROUND AND OBJECTIVE Primary cutaneous melanoma incidence is increasing in elderly individuals. This population-based cohort examines incidence and mortality rates among adults aged 61 years and older with cutaneous melanoma. MATERIALS AND METHODS Using the Rochester Epidemiology Project, patients aged 61 years of age or older with a first lifetime diagnosis of cutaneous melanoma between January 1, 1970 and December 31, 2020 were identified. RESULTS The age- and sex-adjusted incidence rate increased from 16.4 (95% CI, 8.2–24.6) per 100,000 person-years in 1970 to 1979 to 201.5 (95% CI, 185.1–217.8) per 100,000 person-years in 2011 to 2020 (12.3-fold increase). There was a 16.0x increase in males and an 8.5× increase in females. Melanoma incidence has stabilized in males (1.2-fold increase, p = .11) and continues to significantly increase in females (2.7-fold increase, p < .001). Older age at diagnosis was significantly associated with an increased risk of death (HR 1.23 per 5-year increase in age at diagnosis, 95% CI, 1.02–1.47). CONCLUSION Melanoma incidence continues to increase since 1970. The incidence has risen in elderly females, but has stabilized in males. Mortality has decreased throughout this period.

AbstractTumor necrosis factor‐alpha inhibitor therapy for inflammatory bowel disease may be associated with paradoxical cutaneous adverse events, most commonly psoriasiform eruptions. We present the case of a pediatric female patient with Crohn's disease who developed multiple concurrent cutaneous eruptions while on infliximab treatment, including morphea, psoriasiform dermatitis, and genital lichen sclerosus. Although refractory to skin‐directed treatments, all three conditions resolved upon discontinuation of infliximab, supporting their development as a paradoxical reaction to infliximab therapy.