Investigating staff knowledge of safeguarding and pressure ulcers in care homes.

Objective: To investigate whether nursing/care home staff regard pressure ulceration as a safeguarding issue; and to explore reporting mechanisms for pressure ulcers (PUs) in nursing/care homes.

Method: Within one clinical commissioning group, 65 staff members from 50 homes completed a questionnaire assessing their experiences of avoidable and unavoidable PUs, grading systems, and systems in place for referral to safeguarding teams. Understanding of safeguarding was assessed in depth by interviews with 11 staff members.

Eosinophilic fasciitis secondary to intravenous iron infusions.

A 43-year-old African-American female with anemia secondary to uterine leiomyomas and menorrhagia presented with induration and stiffness of the right arm and hand four weeks after receiving intravenous iron infusions at multiple infusion sites along the right proximal forearm. Multiple intravenous sites between her right antecubital fossa and wrist had to be used because developing pain necessitated the site changes. The iron infusions were performed because the patient had refused blood transfusions and her symptoms failed to resolve on oral iron supplementation.

Periocular granuloma annulare in four children.

Subcutaneous granuloma annulare is a skin condition that occurs on the lower extremities, hands, and scalp of healthy children. It rarely occurs in the periocular area, and when it does, the annular pattern is often absent. Histopathology is diagnostic and shows palisading histiocytes around areas of necrobiosis.

Accuracy of teledermatology for pigmented neoplasms.

Background: Accurate diagnosis and management of pigmented lesions is critical because of the morbidity and mortality associated with melanoma.

Objective: We sought to compare accuracy of store-and-forward teledermatology for pigmented neoplasms with standard, in-person clinic dermatology.

Methods: We conducted a repeated measures equivalence trial involving veterans with pigmented skin neoplasms.

Accuracy of teledermatology for nonpigmented neoplasms.

Background: Studies of teledermatology utilizing the standard reference of histopathology are lacking.

Objective: To compare accuracy of store-and-forward teledermatology for non-pigmented neoplasms with in-person dermatology.

Methods: This study was a repeated-measures equivalence trial involving veterans with non-pigmented skin neoplasms.

Experimental rationale for treatment of high-risk human melanoma with zinc chloride fixative paste. Increased resistance to tumor challenge in murine melanoma model.

Background: Fixed-tissue micrographic surgery (Mohs) of melanoma has been shown by retrospective analysis to improve 5-year survival.

Objectives: To determine whether zinc chloride fixative paste acts as an immune adjuvant to increase host resistance to melanoma.

Methods: We performed a murine study using the poorly immunogenic B16 melanoma of C57Bl6J mice, and the more immunogenic K1735p melanoma of C3H/HeN mice.

A reevaluation of the effect of occlusion on the trichloroacetic acid peel.

Background: Prior studies have demonstrated reduced wounding with trichloracetic acid (TCA) peels after tape occlusion. It is therefore reasonable to question whether or not other types of occlusion may have similar effects, particularly those used in routine postoperative care.

Objective: To reevaluate the effect of occlusion after TCA peels in multiple human models using various forms of dressings, at various times postoperatively, and to make recommendations regarding wound care that will not adversely affect the efficacy of the peel.

Unilateral linear lichenoid eruption after bone marrow transplantation: an unmasking of tolerance to an abnormal keratinocyte clone?

Chronic cutaneous graft-versus-host disease may appear clinically as a lichenoid eruption. We describe a 26-year-old man who developed a unilateral linear lichenoid eruption 7 months after allogeneic bone marrow transplantation. We believe this represents an unusual form of localized, chronic graft-versus-host disease.

Papillary adenoma of the nipple.

Papillary adenoma of the nipple is a benign condition of the nipple that can be confused clinically with adenocarcinoma metastatic to the skin or Paget's disease. Deep biopsy of the nipple is necessary to make a histologic diagnosis. Complete excision of the nipple and the subareolar tissue is sufficient to effect a cure.

Malignant melanoma with evidence of maturation arising from a giant congenital nevocellular nevus.

The association between melanoma and giant congenital nevocellular nevus has been well documented, although controversy still exists regarding the precise incidence. The following patient report illustrates the excision of malignant melanoma arising from a giant congenital nevocellular nevus in a 4-month-old infant. The child had malignant melanoma with deep dermal involvement diagnosed by incisional biopsy with positive margins.

Evaluation of spindle cell tumors.

The most important aspect of any evaluation of spindle cell tumors in the skin or superficial soft tissues is the clinical examination, as a great deal can be learned from the location, appearance, and size of the tumor in question. As recounted in this chapter, the histologic features of these tumors may also be distinctive; however, in some instances, histologic examination alone is insufficient for diagnosis. In such cases, electron microscopy holds considerable promise, but the technique is too dependent upon both the availability of adequately preserved tissues and access to the technique itself.

Cutaneous glomus tumor. A comparative immunohistochemical study with pseudoangiomatous intradermal melanocytic nevi.

Glomus tumor of the skin and subcutis is an uncommon neoplasm in which the histologic features can be mimicked by other dermal lesions of diverse types. The cell of origin is thought by most to be the pericyte, which has some of the ultrastructural features of smooth muscle. We examined six glomus tumors with a panel of antibodies including the myogenic markers, muscle-specific actin (HHF-35), and desmin; all tumors were immunoreactive for muscle-specific actin, but only two expressed desmin.

Spindle and epithelioid cell nevus (Spitz nevus). Natural history following biopsy.

A clinical follow-up study of 49 cases of spindle and epithelioid cell nevus is presented to address the question about the potential for local recurrence. Only 19 (39%) of the 49 lesions were initially excised en toto, and the remainder (30 cases) had positive margins; six of the latter spindle and epithelioid cell nevi were reexcised, and no evidence of a residual nevus was found in five of the six cases. There were no recurrences in the 49 patients during an average follow-up period of 5.

Geriatric urologic dermatology.

Most diseases involving the skin affect all age groups; however, some are more common in old age. The skin of the genital area may be involved as an isolated process or as part of more generalized disease. Clinical features and management of some of the more common dermatologic conditions affecting the genital area in the elderly are discussed.

Microcystic adnexal carcinoma. An immunohistochemical comparison with other cutaneous appendage tumors.

Since its initial description, microcystic adnexal carcinoma (MAC) of the skin has been controversial. In particular, it features keratin production of the type seen in some pilar neoplasms , and has been thought to pursue partial follicular differentiation. Diagnostically, MAC may be difficult to separate from desmoplastic trichoepithelioma (DTE) in superficial biopsy specimens.