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Initial Lesions (initial + lesion)
Selected AbstractsThreading warts: a beauty parlor dermatosisJOURNAL OF COSMETIC DERMATOLOGY, Issue 4 2007Rajesh Kumar MD Summary Threading is a common beauty parlor procedure usually performed to shape the eyebrows and remove unwanted facial hair for cosmetic reasons. Appearance of warts at the site of threading is an unusual phenomenon. We report two such cases, first as koebnerization from the initial lesion elsewhere on the patient's body and second, possibly from the infected material at the beauty parlor. We emphasize the importance of identification of this condition and discuss its dermatological and cosmetological perspectives. [source] HER-2/neu expression in extramammary Paget disease: a clinicopathologic and immunohistochemistry study of 47 cases with and without underlying malignancyJOURNAL OF CUTANEOUS PATHOLOGY, Issue 7 2009Jose A. Plaza Extramammary Paget disease (EMPD) is an infrequent skin cancer sometimes representing a secondary event caused by extension of an underlying carcinoma. Her-2/neu overexpression in breast cancer is correlated with a more aggressive behavior, but anti-Her-2/neu therapy improves survival in these patients. We investigated Her-2/neu expression by immunohistochemistry in cases of EMPD with and without underlying malignancy to try to correlate with tumor recurrence, progression and possible targeted therapy. Forty-seven cases were analyzed (6 from the scrotum, 7 perianal region, 1 axilla and 33 vulva). Two cases had invasive EMPD (one from vulva and one from scrotum). The overall Her-2/neu expression was 31.9%. Of the noninvasive EMPD of the vulva (32 cases), Her-2/neu was shown in 38%. The case of invasive vulvar EMPD was negative. All six scrotal EMPD lacked Her2/neu expression. Her-2/neu was expressed in two of seven perianal cases (33.3%). The EMPD on the axilla (one case) was negative. Eighteen cases had recurrence, and of these, 44.4% expressed Her-2/neu in the initial lesion. A high proportion of EMPD showed Her-2/neu expression (31.9%), indicating that these patients may benefit from targeted therapy. The proportion of positive cases was higher in lesions that had recurred at last follow up (44.4%), suggesting a more aggressive behavior. [source] Follow-Up Recommendations for Benign Breast BiopsiesTHE BREAST JOURNAL, Issue 5 2006Susanna Shin MD Abstract: Histologically proven benign breast disease increases a woman's relative risk for subsequent cancer development. Yet follow-up guidelines for mammogram and clinical breast examination after a benign breast biopsy are lacking. Our objective was to determine if increased surveillance is indicated following a benign breast biopsy. Following institutional review board approval, a retrospective database review was conducted of prospectively gathered patients who had a benign breast biopsy (core or excisional) for an abnormality detected on mammogram, ultrasound, or clinical breast examination. Follow-up, for all subjects, was a clinical breast examination and mammogram or ultrasound at 6 months, 1 year, and 2 years after benign breast biopsy by a breast surgeon. End points were the need for additional biopsies or cancer detection. Statistical analysis was performed using chi-squared analysis. From January 2000 to July 2003, 156 patients age 18,86 years had a benign breast biopsy. During the 2 year follow-up, 20 patients (13%) required a subsequent biopsy. No significant difference was observed in mean age, race, menarche, menopause, parity, age at first live birth, use of oral contraceptives, history of prior biopsy, or the pathology of the initial lesion between those who needed a subsequent biopsy and those who did not. Seven excisional biopsies were performed (one at 6 months, four at 1 year, and two at 2 years follow-up) for growth of the benign breast biopsy lesion, and pathology remained concordant with the original diagnosis. Thirteen biopsies were done for new findings on mammogram or ultrasound. Three of these (1.9%) yielded a cancer diagnosis (one at 6 months, one at 1 year, and one at 2 years follow-up). No new lesions were identified on follow-up by clinical breast examination alone. Increased surveillance following a benign breast biopsy is necessary because of the increased need for subsequent biopsy or risk of cancer development. This should include imaging (mammography or ultrasound) and a clinical breast examination 6 months, 1 year, and 2 years after a benign breast biopsy. [source] Erythema multiforme-like lesions associated with lesional infiltration of tumor cells occurring with adult T-cell lymphoma/leukemiaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 4 2008Tomoyuki Ohtani MD A 66-year-old Japanese woman visited our hospital with a complaint of multiple papules on her trunk and extremities. She had a past medical history of appendicitis and blood transfusion 40 years earlier. For the last 10 years, she had noticed multiple, gradually enlarging papulonodular lesions with surrounding erythema on her trunk and extremities. ,Physical examination revealed multiple, violaceous papules or nodules, less than 10 mm in diameter, with surrounding erythema on her trunk and extremities (Fig. 1). The results of routine laboratory examinations, including blood count, liver function, renal function, serum calcium, and lactate dehydrogenase, were within the normal range. The peripheral blood picture showed a small population of atypical lymphocytes below 1% of the total white blood cells. Human T-cell lymphotropic virus type I (HTLV-I) serology was positive. A microscopic examination of a biopsy specimen from a nodule on the abdomen demonstrated diffuse infiltration of large pleomorphic T cells in the upper and middle dermis, although highly atypical lymphocytes, so-called flower cells, could not be recognized. Infiltrating lymphocytes were positive for CD2, CD3, CD4, CD5, CD7, and CD45, but negative for CD8 and CD20, immunohistologically. Bone marrow biopsy also demonstrated the infiltration of lymphocytes expressing CD2, CD3, CD4, CD5, and CD7, but not CD25. Southern blot analysis of the infiltrating cells in the skin revealed an integration of HTLV-I proviral DNA in T cells. Clonal T-cell receptor , gene rearrangement was detected in skin and bone marrow biopsies. No abnormal mass or bone defect was detected by chest or abdominal computed tomographic scanning, systemic gallium-67 citrate scintigraphy, or chest radiography. On the basis of these data, the patient was diagnosed with smouldering-type adult T-cell lymphoma/leukemia. Figure 1. Clinical features of adult T-cell lymphoma/leukemia (ATL) skin lesions. Crusted, target-like, dark-red plaques on the lower legs ,The patient was started on topical steroid and electron beam radiation therapy (27 Gy/14 days). Five days after the start of irradiation, she noticed multiple patches of edematous erythema appearing on the trunk and extremities (Fig. 2). As it was initially suspected that these newly emerging erythema multiforme or toxic eruptions were caused by irradiation, therapy was interrupted. Anti-herpes simplex virus antibody was not checked because no typical herpes simplex lesions were noticed. The patient was not taking any systemic drugs. A skin biopsy was taken from a representative lesion on the chest. The pathologic specimen showed epidermotropism, liquefaction degeneration in the basal layer, marked edema, and dense infiltration of mononuclear cells in the upper dermis. Infiltrating cells possessed abundant cytoplasm and large pleomorphic nuclei with distinct nucleoli (Fig. 3). These findings were consistent with the histopathologic findings of erythema multiforme, except for the atypical lymphoid cell infiltration. Immunohistochemical staining demonstrated that the phenotype of the skin-infiltrating cells was identical to that of the atypical cells in the initial lesions. As the eruptions did not disappear in spite of the interruption of radiation, total skin irradiation was restarted. After completion of therapy, both the erythema multiforme-like lesions and the initial adult T-cell lymphoma/leukemia nodules on the trunk and extremities had resolved, leaving brown pigmentation. The patient has been free of any recurrence of skin lesions or systemic symptoms for 6 years after the completion of total skin irradiation. Figure 2. Appearance of erythema multiforme (EM)-like lesions. Edematous red plaques involving the breast Figure 3. Microscopic examination of a biopsy specimen from (EM)-like lesions on the chest (hematoxylin and eosin staining). (a) Epidermotropism, liquefaction degeneration in the basal layer, and dense infiltration of mononuclear cells and severe edema in the upper dermis (×100). (b) High-power magnification revealed that the dermal infiltration included atypical lymphoid cells with abundant cytoplasm, convoluted large nuclei, and distinct nucleoli (×400) [source] A12. IPL therapy in the inflammatory stage of rosaceaJOURNAL OF COSMETIC DERMATOLOGY, Issue 2 2002M Rone The inflammatory stage of Rosacea iscommonly treated with topical or oral antibiotics. However, if additional erythema and telangiectasias are present, antibiotics are not successful. IPL (intense pulsed light) is mostly involved when only initial or residual telangiectasias are present. Application of IPL simultaneously with topical or oral medicine could be an effective form of treatment in the inflammatory stage of rosacea. This study was performed in order to detect the effect of IPL application with simultaneous topical antibiotics in inflammatory rosacea and to assess the efficacy of IPL therapy in routine treatment of rosacea. Twenty patients aged between 34 and 70 with papulopustular rosacea (14 female and 7 male) were included in the study. Ten patients (group I) were treated for 21 weeks with topical metronidazole. The other ten patients (group II) received an additional 3 sessions with IPL 515,755 nm Photoderm VL technology over 4 weeks. Treatment affectivity was recorded by digital visualisation and patient satisfaction scale before each IPL session. In all patients, significant reductions in papulopustular elements were observed. Eight out of 10 patients (group I) still showed permanent erythema and telangiectasias despite topical treatment. In 3/10 patients a few telangiectasias remained following the treatment in contrast to 5/10 satisfied group I patients. The most effective treatment was the application of 570 nm and 590 nm wavelength at a fluence of 25,55 J/cm2. Application of IPL in inflammatory rosacea is equally as safe and effective in residual or initial lesions. Moreover, in combination with antibiotics, it promotes reduction of all symptoms, is less time-consuming and is more successful for patients. The pathogenetic influence of IPL in rosacea seems not only to be limited to selective photothermolysis of dilated blood vessels, but may also have immunomodulatory effects on inflammatory processes and possibly on collagen remodelling. The combination of IPL and antibiotics from theoutset of rosacea therapy is considered to be highly effective. [source] Assessment of Dental Caries Predictors in a Seven-year Longitudinal StudyJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2006Elaine Pereira da Silva Tagliaferro DDS Abstract Objective: To identify, in a group of 6,8-year-old schoolchildren, risk factors for dental caries increment in permanent dentition. Methods: Two hundred and six children from three different schools in Piracicaba, Brazil, were examined at baseline and after 7 years by the same two calibrated dentists. Data on dental caries (dmfs, DMFS, presence of initial lesions), fluorosis, oral hygiene and presence of sealant were collected at the clinical examination that was performed in an outdoor setting, under natural light, using a dental mirror and probe following the WHO recommendations. Information on socioeconomic level, fluoride usage, dental service utilization, dietary and oral hygiene habits was also obtained at baseline in a semi-structured questionnaire sent to the parents. The dependent variable was the 7-year DMFS increment. A univariate analysis was performed to test the association of independent variables in caries increment. Then a logistic regression model was used to estimate the adjusted Odds Ratio for caries increment. Results: Clinical (dmfs, DMFS) and non-clinical variables (daily toothbrushing, use of preventive topical methods, parents' educational level) were entered in the multiple logistic regression analysis. The prediction model included the clinical and socioeconomic variables, DMFS, dmfs and mother's educational level. The best caries predictor was the dmfs variable. Conclusion: Caries experience and mother's educational level were predictors of caries increment in permanent dentition. [source] Atypical dermatitis herpetiformis: a Japanese case that presented with initial lesions mimicking prurigo pigmentosaCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 2 2006M. Saito No abstract is available for this article. [source] | ||||||||||