Publications by authors named "Jason B Lee"

92 Publications

Rutoside and Ascorbic Acid in the Treatment of Schamberg Pigmented Purpuric Dermatosis.

Cureus 2021 Apr 20;13(4):e14592. Epub 2021 Apr 20.

Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, USA.

Schamberg disease is a type of pigmented purpuric dermatosis (PPD), which is a benign cutaneous capillaritis characterized by macules and patches most commonly found on the lower extremities. Rutoside and ascorbic acid have been shown in previous cases to be efficacious in the treatment of PPD lesions due to their free radical scavenging effect on capillaries. We present the case of a 19-year-old woman with Schamberg disease who achieved complete clearance of lesions within four months of daily rutoside and ascorbic acid treatment. The goal of this case report is to further demonstrate the effectiveness of this treatment and to call for investigation of its use as a standard of care in PPD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.14592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136452PMC
April 2021

Expression of p40 in Primary Cutaneous Mucinous Carcinoma Versus Primary Mucinous Carcinomas of the Breast and Colon.

Am J Dermatopathol 2021 May 11. Epub 2021 May 11.

Department of Dermatology, Oregon Health and Science University, Portland, OR; J. Chung's work was performed while at Thomas Jefferson University Hospital, Philadelphia, PA; and Departments of Pathology, Anatomy, and Cell Biology, and Dermatology and Cutaneous Biology, Thomas Jefferson University Hospital, Philadelphia, PA.

Background: The transcription factor p63 is a homolog of p53, expressed in basal layers of epithelia and myoepithelial cells. Some studies have suggested that p63 may provide utility in differentiating primary versus metastatic mucinous carcinoma of the skin, given its preferential expression in primary adnexal neoplasms. There have been few studies investigating the expression patterns of p40, an isoform of p63, in primary cutaneous mucinous carcinomas.

Methods: An immunohistochemical panel including p40, CK7, CK20, estrogen receptor, and progesterone receptor was applied to primary mucinous carcinomas of the skin, breast, and colon.

Results: Only a small subset (25%) of primary cutaneous mucinous carcinomas displayed focal positive staining with p40, similar to what has been reported in the literature for p63. All primary mucinous carcinomas of skin and breast labeled positively with CK7, estrogen receptor, and progesterone receptor. Primary colon mucinous carcinomas were only positive for CK20.

Conclusions: Based on these results, p40 seems to be an insufficient marker for distinguishing primary versus metastatic mucinous carcinoma due to its low rate of positivity in primary cutaneous mucinous carcinomas.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/DAD.0000000000001973DOI Listing
May 2021

Hypergranulotic Dyskeratotic Acanthoma: Another Histologically Distinctive Acanthoma.

Am J Dermatopathol 2021 May 5. Epub 2021 May 5.

Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, Korea; Institute for Dermatopathology, Newtown Square, PA; Department of Dermatology and Cutaneous Biology, Thomas Jefferson University Hospital, Philadelphia, PA; and Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.

Abstract: Various acanthomas have been named based on their distinctive histopathologic patterns. Hypergranulotic dyskeratotic acanthoma represents another acanthoma with a distinctive histopathologic pattern that has been rarely reported. In this article, clinical and histological features of hypergranulotic dyskeratotic acanthoma are delineated. A retrospective analysis was performed of cases with diagnosis or suggested diagnosis of hypergranulotic dyskeratotic acanthoma between 2012 and 2017 from 2 dermatopathology laboratories. Forty-eight potentials were identified, of which 18 cases met the inclusion histologic criteria. Most cases came from women (78%) with a mean age of 53 years, and the thigh was the most common site involved. All cases had the following histopathological findings: (1) verrucous or digitated epidermal hyperplasia, (2) hyperkeratosis dominated by basketweave or compact orthokeratosis, (3) hypergranulosis involving the breadth of the lesion, and (4) presence of enlarged, often indistinctly bordered, keratinocytes with cytoplasm characterized by a blue-gray granular peripheral zone sometimes showing outstretched desmosomes and central perinuclear eosinophilic zones, a combination of findings representing slowly evolving dyskeratosis. Retrospective nature and a small sample size are the major limitations of the study. In sum, hypergranulotic dyskeratotic acanthoma can be easily distinguished from other acanthomas based on their repeatable histopathological findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/DAD.0000000000001966DOI Listing
May 2021

Generalized Multinucleate Cell Angiohistiocytoma: Histopathological and Immunohistochemical Analyses of 10 Lesions.

Am J Dermatopathol 2021 Apr 21. Epub 2021 Apr 21.

Department of Dermatology and Cutaneous Biology, Thomas Jefferson University Hospital, Philadelphia, PA; and Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.

Abstract: Multinucleate cell angiohistiocytoma (MCAH) is an uncommon fibrohistiocytic disorder that usually presents as a localized solitary papule or multiple grouped papules. Generalized presentation is very rare with less than 20 cases reported in the literature. In this article, we present histopathological and immunohistochemical studies of 10 lesions from a patient with generalized MCAH. In all lesions, the histopathological changes were confined to a discrete zone of the superficial dermis that consisted of (1) an increase in the number of capillary-sized vessels with thickened walls, (2) presence of oval to dendritic spindle cells and stellate hyperchromatic multinucleated cells, (3) fibrosis marked by compact collagen, (4) hypertrophy and hyperplasia of small nerve fibers, and (5) a moderately dense lymphocytic infiltrate. The entire population of the cellular component including the multinucleated cells stained for CD10, whereas a subpopulation of the mononuclear spindle cells stained for factor XIIIa and CD68. CD34 highlighted only the blood vessels. The results confirm that the multinucleated cells lack expression of CD68 and factor XIIIa and that CD10 may be used to highlight the entire cellular component. The rarely reported hypertrophy and hyperplasia of nerve fibers in MCAH may be a common finding as it was observed in all 10 lesions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/DAD.0000000000001954DOI Listing
April 2021

Evolution of a melanoma in situ to a sarcomatoid dedifferentiated melanoma.

J Cutan Pathol 2021 Jul 16;48(7):943-947. Epub 2021 Mar 16.

Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

Sarcomatoid dedifferentiated melanoma (SDDM) is a recently recognized subtype of melanoma that stains diffusely for CD10 and lacks the expression of the usual melanocytic markers including S100, SOX10, MITF, and Melan A. Advances in next-generation DNA sequencing technology have facilitated the increased recognition of this rare, aggressive spindle cell melanoma. Herein, a case of relatively early lesion of SDDM arising in association with melanoma in situ is highlighted. A 72-year-old man with a history of previously treated melanoma in situ on the face five years prior presented with a new rapidly growing lesion within the scar of the treated site. A shave biopsy of the lesion revealed a centrally located 1.8-mm deep, poorly differentiated spindle cell neoplasm in association with an adjacent recurrent melanoma in situ. The spindle cell component stained diffusely for CD10, but failed to stain for S100, SOX10, and Melan-A while the melanoma in situ expressed all three melanocytic markers. Next-generation DNA sequencing assay revealed mutations in NF1, CDKN2A, TP53, and TSC1. A diagnosis of stage 2B SDDM arising in association with melanoma in situ was established based on the clinical context and genomic assay results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cup.14003DOI Listing
July 2021

PD1 inhibitor induced inverse lichenoid eruption: a case series.

Dermatol Online J 2020 Dec 15;26(12). Epub 2020 Dec 15.

Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA.

The increased use of monoclonal antibodies that target the immune checkpoint T cell receptor programmed death-1 (PD1) to treat numerous solid tumors has led to several reports describing associated cutaneous adverse events. Although lichenoid reactions have been well described, we propose that PD1 inhibitor-induced inverse lichenoid eruption (PILE) is a distinct variant. We describe two patients who presented with nearly identical deeply erythematous, malodorous, eroded anogenital plaques with focal crusting. Diagnosis of PILE was established given the biopsy findings and temporal association with PD1 inhibitor therapy. Treatment with clobetasol ointment was successful without necessitating discontinuation of immunotherapy. The findings were consistent with the only other previously published case of inverse lichenoid eruption in the groin secondary to PD1 inhibitors.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2020

Artificial intelligence in dermatopathology: Diagnosis, education, and research.

J Cutan Pathol 2021 Jan 9. Epub 2021 Jan 9.

Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.

Artificial intelligence (AI) utilizes computer algorithms to carry out tasks with human-like intelligence. Convolutional neural networks, a type of deep learning AI, can classify basal cell carcinoma, seborrheic keratosis, and conventional nevi, highlighting the potential for deep learning algorithms to improve diagnostic workflow in dermatopathology of highly routine diagnoses. Additionally, convolutional neural networks can support the diagnosis of melanoma and may help predict disease outcomes. Capabilities of machine learning in dermatopathology can extend beyond clinical diagnosis to education and research. Intelligent tutoring systems can teach visual diagnoses in inflammatory dermatoses, with measurable cognitive effects on learners. Natural language interfaces can instruct dermatopathology trainees to produce diagnostic reports that capture relevant detail for diagnosis in compliance with guidelines. Furthermore, deep learning can power computation- and population-based research. However, there are many limitations of deep learning that need to be addressed before broad incorporation into clinical practice. The current potential of AI in dermatopathology is to supplement diagnosis, and dermatopathologist guidance is essential for the development of useful deep learning algorithms. Herein, the recent progress of AI in dermatopathology is reviewed with emphasis on how deep learning can influence diagnosis, education, and research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cup.13954DOI Listing
January 2021

Subungual blue nevus.

J Cutan Pathol 2020 Dec;47(12):1111-1114

Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cup.13781DOI Listing
December 2020

Toxic erythema of chemotherapy secondary to gemcitabine and paclitaxel.

Dermatol Online J 2020 Sep 15;26(9). Epub 2020 Sep 15.

Department of Dermatology, Lewis Katz School of Medicine, Philadelphia, PA.

Toxic erythema of chemotherapy (TEC) is an infrequently reported cutaneous condition, with diagnosis predominately based on clinical presentation, histologic findings, and known reported associations. Therefore, it is important to both recognize common presentations of TEC and be mindful of chemotherapeutic agents associated with this cutaneous side effect to prevent misdiagnosis and prolonged time to treatment. Herein, we present a patient with TEC occurring in intertriginous skin (malignant intertrigo) with classic clinical and histologic findings. In our patient this was associated with a combination neoadjuvant gemcitabine and paclitaxel therapy, a relationship that, to our knowledge, has yet to be reported in the literature.
View Article and Find Full Text PDF

Download full-text PDF

Source
September 2020

Mobile Encapsulated Fat Necrosis.

Dermatol Surg 2021 Jun;47(6):880-882

Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/DSS.0000000000002738DOI Listing
June 2021

Clinical and histopathological features of pagetoid Spitz nevi of the thigh.

J Cutan Pathol 2020 Dec 8;47(12):1143-1149. Epub 2020 Sep 8.

Department of Dermatology and Cutaneous Biology, Sydney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

Background: Pagetoid Spitz nevus is a rare subtype of Spitz nevus usually found on the lower extremities, particularly on the thigh of women. As a rare and under-recognized entity that can be misdiagnosed as melanoma, further characterization of clinical and histopathological features is needed to improve its recognition.

Methods: A retrospective analysis of all melanocytic neoplasms from the thigh diagnosed over a 3-year period.

Results: Fifty-five (15.4%) of the 357 melanocytic neoplasms on the thigh were Spitz nevi, the majority of them occurring in women (87.3%). Of the 55 Spitz nevi, 33 (60.0%) were pagetoid Spitz nevi, 14 (25.5%) were Reed nevi, and eight (14.5%) were conventional Spitz nevi. The mean age of patients with pagetoid Spitz nevi was 47.2, the majority being women (84.9%). Pagetoid Spitz nevi were small, with a mean histopathologic diameter of 4 mm, and often junctional (63.6%). Compared to Clark nevi of the thigh, pagetoid Spitz nevi comprised significantly more solitary melanocytes with a greater degree of scatter.

Conclusions: These results suggest that Spitz nevi and, in particular, pagetoid Spitz nevi constitute a significant percentage of nevi on the thigh. Previously reported benign clinical and histopathological features of pagetoid Spitz nevi are confirmed in this study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cup.13854DOI Listing
December 2020

Skin-Colored Nodule on the Cutaneous Lip: Answer.

Am J Dermatopathol 2020 May;42(5):378

Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA; and.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/DAD.0000000000001365DOI Listing
May 2020

Linear basal cell nevus with a novel mosaic PTCH1 mutation.

Exp Dermatol 2020 06 14;29(6):531-534. Epub 2020 May 14.

Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA.

The patched tumor suppressor gene (PTCH1) encodes a receptor, which is a key component of the hedgehog signalling pathway. Mutations in PTCH1 are implicated in the development of sporadic basal cell carcinomas (BCC), as well as those in Gorlin Syndrome. Rarely, BCCs may develop in a linear pattern along lines of Blaschko due to cutaneous mosaicism. In cases in which there are other features of Gorlin syndrome, genomic analysis has demonstrated lesional mutations in the Hedgehog signalling pathway. Causative mutations, however, have not been firmly demonstrated in the cases of linear and segmental BCCs in otherwise healthy individuals. Herein, we report a case of a 31 year-old Caucasian woman with linear development of multiple superficial BCCs in a Blaschkoid distribution without other characteristic findings of Gorlin syndrome. Genomic analysis of lesional skin by whole-exome sequencing identified a novel heterozygous mutation PTCH1: NM_000264.3, Exon 15, c.2336-2337insGGTAGGA, p.Asp779Glufs*13 in PTCH1, shared by two discrete samples within the lesion, while no mutations were found in the non-lesional skin or peripheral blood. Given the young age of our patient and linear distribution of BCCs on non-sun exposed skin, our findings suggest segmental mosaicism. The patient was treated with topical 5% imiquimod with histologically confirmed clearance of BCCs in 2 months.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/exd.14101DOI Listing
June 2020

Guttate leukoderma and acrokeratosis verruciformis of Hopf: a rare combination in Darier disease.

Dermatol Online J 2020 Jan 15;26(1). Epub 2020 Jan 15.

Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.

A distinct Darier phenotype presenting with confetti-like hypopigmented macules was first described in 1965. Designated as "guttate leukoderma," this skin finding is a rarely-reported presentation of Darier disease. It has been theorized that the mutation in ATP2A2 causes defective E-cadherin, which in turn disrupts the adhesion of melanocytes to keratinocytes, thus leading to impaired dendrite formation, hindered melanin transfer, and ultimately to melanocyte apoptosis. Herein, we contribute a case of a 56-year old woman who presented with the rarely-described guttate leukoderma of Darier disease and acrokeratosis verruciformis of Hopf.
View Article and Find Full Text PDF

Download full-text PDF

Source
January 2020

Diagnosis and treatment of low-risk superficial basal cell carcinoma in a single visit.

J Dermatolog Treat 2020 Mar 11:1-4. Epub 2020 Mar 11.

Department of Dermatology and Cutaneous Biology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

Surgical excision remains the most commonly utilized treatment for superficial basal cell carcinoma (sBCC). In the era of cost containment of healthcare, the rising incidence of BCC and the high cost of excision require a continuous search for efficient and cost-effective management. Examine the feasibility of the diagnosis and treatment of low-risk sBCC in a single visit. Retrospective chart review of sBCCs diagnosed and treated in a single visit. The study identified 151 histologically confirmed sBCCs in 86 patients over a 5-year period, 93 (61.6%) cases of which were diagnosed as low-risk sBCC and treated in a single appointment. The majority of the cases ( = 86) were treated with curettage alone and the rest ( = 7) with a shave removal technique. The average size of the lesion was 0.82 cm located primarily on the trunk and extremities (95.7%). One recurrence on the trunk was observed in the single appointment group. Overall, diagnostic sensitivity was 95.4% and specificity was 92.0%. Diagnosis and treatment of sBCC in a single visit is an efficient and cost-effective management option for those who are proficient in identifying low-risk sBCC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09546634.2020.1737637DOI Listing
March 2020

Tailored for Real-World: A Whole Slide Image Classification System Validated on Uncurated Multi-Site Data Emulating the Prospective Pathology Workload.

Sci Rep 2020 02 21;10(1):3217. Epub 2020 Feb 21.

Departments of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

Standard of care diagnostic procedure for suspected skin cancer is microscopic examination of hematoxylin & eosin stained tissue by a pathologist. Areas of high inter-pathologist discordance and rising biopsy rates necessitate higher efficiency and diagnostic reproducibility. We present and validate a deep learning system which classifies digitized dermatopathology slides into 4 categories. The system is developed using 5,070 images from a single lab, and tested on an uncurated set of 13,537 images from 3 test labs, using whole slide scanners manufactured by 3 different vendors. The system's use of deep-learning-based confidence scoring as a criterion to consider the result as accurate yields an accuracy of up to 98%, and makes it adoptable in a real-world setting. Without confidence scoring, the system achieved an accuracy of 78%. We anticipate that our deep learning system will serve as a foundation enabling faster diagnosis of skin cancer, identification of cases for specialist review, and targeted diagnostic classifications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-59985-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035316PMC
February 2020

Molluscum contagiosum infection with features of primary cutaneous anaplastic large cell lymphoma.

Dermatol Online J 2019 Nov 15;25(11). Epub 2019 Nov 15.

Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA.

CD30+ T cell pseudolymphomas (CD30+ PSL) are a group of benign inflammatory cutaneous disorders that can develop in settings of viral infections or drug reactions. Owing to their histological similarities to malignant lymphomas, these benign infiltrates are occasionally misdiagnosed as malignant, causing significant concerns for patients and physicians. Herein, we report a patient with CD30+ PSL associated with molluscum contagiosum whose initial biopsy revealed atypical large CD30-expressing cells, leading to a misdiagnosis of primary cutaneous anaplastic large cell lymphoma and referral to our cutaneous lymphoma clinic. We report this case to demonstrate that reactive CD30+ infiltrate associated with molluscum contagiosum can be mistaken for T-cell lymphomas and patients should be reassured in these cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
November 2019

Spitz nevi in older adults: Correlation of histopathology with results of a gene expression profiling assay.

J Am Acad Dermatol 2020 Apr 20;82(4):1021-1023. Epub 2019 Dec 20.

Department of Dermatology & Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaad.2019.12.029DOI Listing
April 2020

Eosinophilic dermatosis of hematologic malignancy responding to dupilumab in a patient with chronic lymphocytic leukemia.

JAAD Case Rep 2019 Sep 30;5(9):815-817. Epub 2019 Aug 30.

Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jdcr.2019.07.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6726863PMC
September 2019

Lymphoplasmacellular mucositis ameliorated by α4β7 integrin inhibitor vedolizumab in a patient with ulcerative colitis.

JAAD Case Rep 2019 Aug 31;5(8):663-665. Epub 2019 Jul 31.

Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jdcr.2019.06.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677862PMC
August 2019

Selection Criteria of Program Directors for Dermatopathology Fellows.

Am J Dermatopathol 2019 Aug;41(8):585-586

Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA.

Dermatopathology represents a unique field at the intersection of dermatology and pathology. Although programs are approved by the ACGME, there is neither uniformity in application materials, timetables, and deadlines, nor a centralized application process. Despite the competitive nature of dermatopathology fellowships, no formal studies have thoroughly examined the selection criteria by program directors. Our study fills this gap in the literature and evaluates the impact of selection criteria for dermatopathology fellows. Applicants can now gain insight into the most important and meaningful aspects of their application.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/DAD.0000000000001306DOI Listing
August 2019

Eccrine porocarcinoma presenting as a recurrent wart.

Cutis 2019 Mar;103(3):166-168

Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

Eccrine porocarcinoma (EPC) is an exceedingly rare sweat gland tumor most commonly seen in older patients. Diagnosis of EPC is rare, representing a small percentage of cutaneous malignancies. In the absence of established guidelines, wide local excision (WLE) has traditionally been considered the standard treatment. However, there is growing evidence of increased local recurrence and nodal metastasis associated with WLE. More recently, Mohs micrographic surgery (MMS) is emerging as an effective treatment method with higher cure rates. We report a case of EPC presenting as a recurrent wart in a 36-year-old man that was successfully treated with MMS.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2019

Muir-Torre syndrome appropriate use criteria: Effect of patient age on appropriate use scores.

J Cutan Pathol 2019 Jul 26;46(7):484-489. Epub 2019 Apr 26.

Division of Dermatopathology, Bay Dermatology and Cosmetic Surgery, Spring Hill, Florida.

Background: Muir-Torre syndrome (MTS) is a rare inherited syndrome, with an increased risk of sebaceous and visceral malignancy. Prior reports suggest screening for mismatch repair (MMR) deficiency may be warranted in patients <50 years and when sebaceous neoplasms are located on a non-head and neck location. Previously, appropriate use criteria (AUC) were developed for clinical scenarios in patients >60 years concerning the use of MMR protein immunohistochemistry (MMRP-IHC). This analysis explores the appropriateness of testing in patients ≤60 years.

Methods: Panel raters from the AUC Task Force rated the use of MMRP-IHC testing for MTS for previously rated scenarios with the only difference being age.

Results: Results verify the previously developed AUC for the use of MMRP-IHC in neoplasms associated with MTS in patients >60 years. Results also show that in patients ≤60 years with a single sebaceous tumor on a non-head and neck site, MMRP-IHC testing should be considered. Testing can also be considered with a 2-antibody panel on periocular sebaceous carcinoma in younger patients.

Conclusions: Our findings align with known evidence supporting the need to incorporate clinical parameters in identifying patients at risk for MTS, with age being a factor when considering MMRP-IHC testing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cup.13459DOI Listing
July 2019

Skin-Colored Nodule on the Cutaneous Lip: Challenge.

Am J Dermatopathol 2020 May;42(5):e55-e56

Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA; and.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/DAD.0000000000001364DOI Listing
May 2020

Genetic Testing in Dermatology: Bioethics and Health Policy Implications.

Skinmed 2018;16(5):356-358. Epub 2018 Nov 9.

Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA;

View Article and Find Full Text PDF

Download full-text PDF

Source
October 2019

Atrophodermalike guttate morphea.

Cutis 2018 08;102(2):E7-E10

Department of Dermatology and Cutaneous Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
August 2018

Reticular Telangiectatic Erythema: A Chronic Hematoma Subsequent to Hip Replacement as an Underlying Cause.

Skinmed 2018;16(3):199-200. Epub 2018 Jun 1.

Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA;

A 78-year-old woman with a history of bilateral hip replacements presented with an ill-defined erythematous plaque with foci of reticulated and indurated areas on the left thigh. Initially, a few weeks after her surgery, a small area of erythema appeared overlying the incision site. Over a 6-month period, the erythema slowly expanded before stabilizing in size (Figure 1). There was no pruritus, pain, or warmth. Orthopedic evaluation found no evidence of infection or malfunction of the hip prosthesis. A skin biopsy revealed telangiectasia of the superficial vessels. Based on the clinical and histopathologic findings, a diagnosis of reticular telangiectatic erythema (RTE) was established. An ultrasound scan revealed a greater trochanteric bursa distended by a chronic, organized hematoma measuring 12 cm at greatest dimension, secondary to a full-thickness tear of the left gluteus minimus (Figure 2), establishing the underlying cause of the RTE in this patient.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2019

Asymptomatic subcutaneous nodule on the cheek.

Cutis 2018 Mar;101(3):170;183;184

Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
March 2018

Invasive trichosporonosis treated with voriconazole.

JAAD Case Rep 2018 May 4;4(4):362-364. Epub 2018 Apr 4.

Department of Dermatology and Cutaneous Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jdcr.2017.11.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911819PMC
May 2018

Appropriate use criteria in dermatopathology: Initial recommendations from the American Society of Dermatopathology.

J Am Acad Dermatol 2019 Jan 22;80(1):189-207.e11. Epub 2018 Apr 22.

Departments of Pathology, Dermatology, and Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.

Background: Appropriate use criteria (AUC) provide physicians guidance in test selection, and can affect health care delivery, reimbursement policy, and physician decision-making.

Objectives: The American Society of Dermatopathology, with input from the American Academy of Dermatology and the College of American Pathologists, sought to develop AUC in dermatopathology.

Methods: The RAND/UCLA appropriateness methodology, which combines evidence-based medicine, clinical experience, and expert judgment, was used to develop AUC in dermatopathology.

Results: With the number of ratings predetermined at 3, AUC were developed for 211 clinical scenarios involving 12 ancillary studies. Consensus was reached for 188 (89%) clinical scenarios, with 93 (44%) considered "usually appropriate" and 52 (25%) "rarely appropriate" and 43 (20%) having "uncertain appropriateness."

Limitations: The methodology requires a focus on appropriateness without comparison between tests and irrespective of cost.

Conclusions: The ultimate decision to order specific tests rests with the physician and is one where the expected benefit exceeds the negative consequences. This publication outlines the recommendations of appropriateness-the AUC for 12 tests used in dermatopathology. Importantly, these recommendations may change considering new evidence. Results deemed "uncertain appropriateness" and where consensus was not reached may benefit from further research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaad.2018.04.033DOI Listing
January 2019