P27 and mib1 expression in actinic keratosis, Bowen disease, and squamous cell carcinoma.

The histologic boundary between actinic keratosis, Bowen disease, and invasive squamous cell carcinoma is not clear in many cases. We determined nuclear expression of p27 (a protein associated with cellular quiescence) and Ki-67 (a marker of proliferation) immunohistochemically in actinic keratosis, Bowen disease, and squamous cell carcinoma to see if differential patterns of expression for p27 exist and how these might correlate with Ki-67 expression. We determined a labeling index for p27-stained nuclei and assessed the pattern of Ki-67 expression.

The incidence of nonattendance at an urgent care dermatology clinic.

Nonattendance in dermatology clinics remains a burden on clinic efficiency. Nonattendance rates have been measured in an urban university-based dermatology clinic and are significant. The nonattendance rate in a dermatology clinic dedicated primarily to new acute problems is not known.

A comparison of hourly block appointments with sequential patient scheduling in a dermatology practice.

Background: There is significant demand for dermatologic care, and manpower is limited. Increasing patient encounters stress office processes. Analyses of the effects of schedule manipulation in a high-volume dermatology office have not been described.

Expression of the cyclin-dependent kinase inhibitor p27 in keratoacanthoma.

Background: Keratoacanthomas are characterized by initial rapid enlargement followed by clinical regression. A series of cyclin and cyclin-dependent kinase complexes regulate cell cycle progression. p27(kip) inhibits a variety of cyclin-cyclin-dependent kinase complexes in vitro and may act to hold eukaryotic cells in a quiescent state (G0).

The incidence of cancellation and nonattendance at a dermatology clinic.

Background: Same-day cancellation of appointments and nonattendance by patients can disrupt management of certain aspects of medical delivery and lead to inefficient allocation of resources and lost revenue. The frequency of cancellation and nonattendance at dermatology clinics has not been well documented.

Objective: We measured same-day cancellation and nonattendance in a university dermatology clinic.

Profitability of a university-based clinic using benchmark time lengths for clinical encounters.

Reductions in reimbursement are applied to all physicians in a region equally. However, physicians do not practice in equivalent situations. For example, there are few fiscal allowances for academic functions associated with teaching and administration.

Log-in/log-out time: a quality factor for a reference laboratory--prolonged times for skin pathology processing in managed care-authorized laboratories.

Managed care organizations may divert skin biopsy specimens to commercial laboratories selected on a cost basis. Diversion to these laboratories could result in service of decreased quality for the patient and referring physician. Log-in/log-out dates were collected for all specimens submitted to managed care-authorized laboratories either from a university-based clinic or from a private practitioner's office for a period of 18 months and compared with data obtained from a local dermatopathology laboratory.

Focal adhesion kinase is expressed in acantholytic keratinocytes associated with pemphigus vulgaris and pemphigus foliaceus.

Focal adhesion kinase is a protein-tyrosine kinase that is found in cellular contact sites and is phosphorylated in response to cell attachment. It is possible that the immunohistochemical detection of this enzyme might be increased in keratinocytes involved in an acantholytic process. Normal skin, pemphigus vulgaris and foliaceus, Darier's disease, Hailey--Hailey disease, warty dyskeratoma, Grover's disease and spongiotic dermatitis were assayed for the immunohistochemical expression of focal adhesion kinase.

Quality assessment of skin biopsy specimens referred to anonymous consultants.

Background And Design: Managed care organizations may direct dermatopathologic specimens to anonymous consultants. I hypothesized that the quality of the consultation decreases when there is no incentive for an anonymous consultant to actively pursue the dermatologist/consumer. Therefore, I examined 364 consecutive specimens that had been directed to anonymous consultants.

Cutaneous eruption of lymphocyte recovery mimicking mycosis fungoides in a patient with acute myelocytic leukemia.

Eruption of lymphocyte recovery (ELR) develops in the setting of leukocyte reconstitution after iatrogenic marrow aplasia and displays a superficial perivascular lymphocytic infiltrate composed of CD3+/CD4+ cells. Epidermal changes are usually minimal to absent. We report a case of an ELR mimicking mycosis fungoides with the formation of CD4+ Pautrier-like microabscesses.

Analysis of the polymerase chain reaction in the detection of herpesvirus DNA from fixed and stained tissue sections.

Background And Design: The polymerase chain reaction (PCR) is a molecular diagnostic technique that has been applied to many infectious processes. Stained and unstained Tzanck smears, vesicle fluid swabs, and crusts have all been used as the source for template DNA for the PCR to document evidence of herpes simplex virus and varicella-zoster virus infection. Thirty-five cases with histologic evidence of acute herpesvirus infection were retrieved from archival tissue blocks that were up to 5 years old.

Expression of proliferating cell nuclear antigen in Spitz nevus.

Background: Epithelioid and spindle cell nevus (ESN; Spitz nevus) is a histologically well-described entity. We hypothesized that the features of ESN may reflect activation by a proliferative stimulus.

Objective: Nevocytes and keratinocytes in ESN and control specimens were examined for expression of the proliferation marker, proliferating cell nuclear antigen (PCNA).

Cystic clear cell acanthoma.

An histologically typical clear cell acanthoma was identified forming a cystic structure. The finding of clear cell acanthoma within a cyst is histologically unique.

Cutaneous histopathology of Conradi-Hunermann syndrome.

The histopathology of the skin in the ichthyosiform erythroderma associated with classical Conradi-Hunermann syndrome has been rarely described. Skin biopsies from 2 infants with the classical features of Conradi-Hunermann syndrome including ichthyosiform erythroderma contained hyperkeratosis, dilated ostia of pilosebaceous structures, and calcium salts in the stratum corneum detectable with special stains. An unusual feature of one case was dilatation of acrosyringeal structures.

Merkel cells in neurofibromas and neurilemomas.

Merkel cells are an integral component of the cutaneous nervous system. They are commonly associated with dermal nerves under normal physiological conditions. We postulated that Merkel cells may be present in increased numbers within the epidermis overlying benign peripheral nerve sheath tumours such as neurilemomas and neurofibromas.

Determining the processing cost of a skin biopsy specimen.

An integral part of directing a pathology laboratory is to understand the nature and behavior of relevant costs. Until recently, pathologists did not need to accurately know the specific costs assigned to various steps in the processing of tissue specimens. With the advent of a more competitive approach to the delivery of health care, laboratory directors must accurately cost their product in order to use competitive pricing strategies.