Multiple Primary Acral Lentiginous Melanomas With BRCA1 Mutation

JAAD Case Reports · 2025-08-22

Peristomal verrucous plaque

JAAD Case Reports · 2023-05-18 · 1 citations

A 78-year-old male presented with an asymptomatic skin change around his urostomy stoma site present for 1 year. Six years prior to presentation, he had undergone a radical cystectomy and ileal conduit for bladder carcinoma. He was referred by his urologist out of concern for cutaneous malignancy. Review of systems was unremarkable, and the patient reported normal function of his urostomy. A computed tomography scan of his chest, abdomen, and pelvis revealed no evidence of metastatic disease. Physical exam revealed a macerated verrucous plaque on the superior aspect of the stoma (Fig 1). Question 1: What is the most likely diagnosis?A.Peristomal squamous cell carcinomaB.Pseudoverrucous irritant peristomal dermatitisC.Peristomal pyoderma gangrenosumD.Allergic contact dermatitisE.Cutaneous candidiasis Answers:A.Peristomal squamous cell carcinoma – Incorrect. Peristomal squamous cell carcinoma is a rare entity occurring in sites of chronic inflammation and presenting with an ulcerated, friable papulonodule. It has rarely been reported with urostomies.B.Pseudoverrucous irritant peristomal dermatitis – Correct. Pseudoverrucous irritant peristomal dermatitis (PIPD) is a subset of irritant dermatitis which presents as verrucous papules and plaques surrounding a stoma site. The proposed pathogenesis of urostomy-related PIPD begins with chronic exposure to alkaline urine leading to uric acid deposition in the peristomal skin. Chronic inflammation results in epidermal hyperplasia and hyperkeratosis that can clinicopathologically mimic verrucae.1Brogna L. Prevention and management of pseudoverrucous lesions: a review and case Scenarios.Adv Skin Wound Care. 2021; 34: 461-471https://doi.org/10.1097/01.ASW.0000758620.93518.39Crossref PubMed Scopus (0) Google ScholarC.Peristomal pyoderma gangrenosum – Incorrect. Peristomal pyoderma gangrenosum is often misdiagnosed as contact dermatitis, irritant dermatitis from leaking urine or feces, extension of underlying Crohn disease, or a wound infection.2Hughes A.P. Jackson J.M. Callen J.P. Clinical features and treatment of peristomal pyoderma gangrenosum.JAMA. 2000; 284: 1546-1548https://doi.org/10.1001/jama.284.12.1546Crossref PubMed Scopus (156) Google Scholar Primarily reported in patients with inflammatory bowel disease, it presents with painful, well-demarcated ulcers with erythematous to violaceous rolled borders with undermining.D.Allergic contact dermatitis – Incorrect. Allergic contact dermatitis (or ACD) is a type IV hypersensitivity reaction which manifests as pruritic, erythematous papules and plaques that can become edematous and vesiculobullous in severe cases. If ACD is suspected, topical corticosteroids can provide relief and patch testing should be performed to determine the cause.E.Cutaneous candidiasis – Incorrect. Peristomal skin is moist and warm, constituting an ideal environment for yeast proliferation. Stoma leakage can lead to maceration and an impaired epidermal barrier. Immunocompromised conditions will contribute to this complication.3Alvey B. Beck D.E. Peristomal dermatology.Clin Colon Rectal Surg. 2008; 21: 41-44https://doi.org/10.1055/s-2008-1055320Crossref PubMed Scopus (22) Google Scholar It often presents with thin erythematous plaques with satellite papulopustules. Question 2: Which histopathological findings are associated with this condition?A.Dense, neutrophil-predominant mixed inflammatory infiltrate with focal necrosis and hemorrhageB.Nodular or diffuse noncaseating granulomatous dermatitisC.Verrucous acanthotic hyperplasia, variable spongiosis, hyperkeratosis, and parakeratosisD.Nests of glassy, eosinophilic keratinocytes with hyperchromatic nuclei and squamous pearls extending into the dermisE.Regular acanthosis, confluent parakeratosis, intraepidermal collections of neutrophils, and thinning of suprapapillary plates Answers:A.Dense, neutrophil-predominant mixed inflammatory infiltrate with focal necrosis and hemorrhage – Incorrect. This description would be expected for pyoderma gangrenosum.B.Nodular or diffuse noncaseating granulomatous dermatitis – Incorrect. This is suggestive of cutaneous Crohn’s disease.4Emanuel P.O. Phelps R.G. Metastatic Crohn's disease: a histopathologic study of 12 cases.J Cutan Pathol. 2008; 35: 457-461https://doi.org/10.1111/j.1600-0560.2007.00849.xCrossref PubMed Scopus (66) Google ScholarC.Verrucous acanthotic hyperplasia, variable spongiosis, hyperkeratosis, and parakeratosis – Correct. These findings are suggestive of the patient’s diagnosis of PIPD (Fig 2).D.Nests of glassy, eosinophilic keratinocytes with hyperchromatic nuclei and squamous pearls extending into the dermis – Incorrect. This would be consistent with squamous cell carcinoma.E.Regular acanthosis, confluent parakeratosis, intraepidermal collections of neutrophils, and thinning of suprapapillary plates – Incorrect. These findings are consistent with psoriasis. Question 3: What would be the best first initial step in management?A.Applying topical steroids.B.Surgical excision of affected area.C.Treat with liquid nitrogen.D.Daily consumption of cranberry juice.E.Ensure a tight seal and refitting the appliance as needed.2Hughes A.P. Jackson J.M. Callen J.P. Clinical features and treatment of peristomal pyoderma gangrenosum.JAMA. 2000; 284: 1546-1548https://doi.org/10.1001/jama.284.12.1546Crossref PubMed Scopus (156) Google Scholar,5Colwell J.C. Ratliff C.R. Goldberg M. et al.MASD part 3: peristomal moisture- associated dermatitis and periwound moisture-associated dermatitis: a consensus.J Wound Ostomy Continence Nurs. 2011; 38 (quiz 554-5. https://doi.org/10.1097/WON.0b013e31822acd95): 541-553Crossref PubMed Scopus (76) Google Scholar Answers:A.Applying topical steroids – Incorrect. Topical steroids can be temporarily utilized for associated pruritus but would not be the first choice in management.B.Surgical excision of affected area – Incorrect. Excision of the affected area is usually reserved for severe cases that have not responded adequately to other forms of management.C.Treat with liquid nitrogen – Incorrect. A commonly used modality in the treatment of verruca vulgaris or warts, cryotherapy would not be effective in this case.D.Daily consumption of cranberry juice – Incorrect. This is a simple way for patients to neutralize alkalosis urine, as cranberry juice serves to both dilute the urine and to keep its pH at approximately 6. This can be done in addition to other primary interventions.E.Ensure a tight seal and refitting the appliance as needed – Correct. The best first step would be to closely evaluate the urostomy site and determine whether an adequate seal is present in multiple positions (such as upright, recumbent, and prone). An effective seal will prevent the urine from irritating the peristomal skin. In severe cases, topical corticosteroids can be useful along with acidic skin barriers and topical barrier films to further ensure a tight seal.2Hughes A.P. Jackson J.M. Callen J.P. Clinical features and treatment of peristomal pyoderma gangrenosum.JAMA. 2000; 284: 1546-1548https://doi.org/10.1001/jama.284.12.1546Crossref PubMed Scopus (156) Google Scholar,5Colwell J.C. Ratliff C.R. Goldberg M. et al.MASD part 3: peristomal moisture- associated dermatitis and periwound moisture-associated dermatitis: a consensus.J Wound Ostomy Continence Nurs. 2011; 38 (quiz 554-5. https://doi.org/10.1097/WON.0b013e31822acd95): 541-553Crossref PubMed Scopus (76) Google Scholar None disclosed.

Editorial Board

JAAD Case Reports · 2023-08-01

Editorial Board

JAAD Case Reports · 2023-05-01

Geospatial analysis of access to dermatology care in Los Angeles County: a cross sectional study

Dermatology Online Journal · 2023 · 3 citations

• Medicine
• Family medicine
• Dermatology

Geographic maldistribution of dermatologists contributes to disparities in access to dermatologic care. We aimed to investigate the geographic distribution of, and differences in wait times for medical dermatology services in Los Angeles County (LAC). We placed phone calls to 251 dermatology practices in LAC to ask for a new patient appointment for a changing mole. We found West LAC (Service Planning Area [SPA] 5) had the highest number of dermatologists and South LAC (SPA 6) had the lowest (26.1 versus 0 per 100,000 residents, P=0.01). Service Planning Area 6 has a higher non-White, uninsured, and impoverished population than SPA 5. Dermatology appointment wait times and Medicaid acceptance varied between SPAs but was not statistically significant (P=0.37 and P=0.20, respectively). Medicaid-accepting practices had a significantly longer mean wait time for an appointment than practices that did not accept Medicaid (26.1 versus 15.1 days, P=0.003). Regions with predominantly non-White, Spanish-speaking, and medically underinsured residents were found to be disproportionately lacking in dermatologists across LAC, which may contribute to impaired access to dermatology services in LAC.

Grover disease associated with docetaxel chemotherapy

JAAD Case Reports · 2022 · 2 citations

• Medicine
• Oncology
• Internal medicine

Grover disease (GD) is an acantholytic disorder that primarily affects middle-aged Caucasian men and causes erythematous skin eruptions in the form of papules or vesicle-papules on the upper portion of the trunk and proximal parts of extremities.1 The pathogenesis and etiology of GD, also commonly called transient acantholytic dermatosis, are poorly understood. In some cases, malignancy has been speculated to be a cause; however, most of these cases are rather associated with chemotherapy.2,3 Specifically, chemotherapeutic agents such as daunorubicin, cytarabine, idarubicin, and etoposide have been previously reported to be associated with GD.

Fixed erythrodysesthesia plaques at sites of intravenous docetaxel infusion: an unusual cutaneous reaction to chemotherapy

International Journal of Dermatology · 2021-08-05 · 1 citations

Warty papules on the nose

International Journal of Dermatology · 2021-11-23

A Case of Atypical Lymphocytic Lobular Panniculitis

Cureus · 2020-02-28 · 2 citations

Atypical lymphocytic lobular panniculitis (ALLP) is a rare T-cell dyscrasia of the subcutaneous fat. It typically presents with indurated erythematous nodules on the lower extremities and often will have a relapsing and remitting course. The cause is unknown, but clinically and histopathologically it shares similarities to lupus panniculitis (LP) and subcutaneous panniculitis-like T-cell lymphoma (SPTCL). It generally has an indolent course, and may best be treated like indolent versions of SPTCL with systemic steroids and immunosuppressive medications.

Painful plantar erosions

International Journal of Dermatology · 2020 · 2 citations

• Medicine
• Dermatology
• Gerontology