Publications by authors named "Sirunya Silapunt"

67 Publications

Analysis of adverse events with sclerosants reported to the United States Food and Drug Administration.

Phlebology 2022 Apr 20:2683555221088373. Epub 2022 Apr 20.

Department of Dermatology, 12339UTHealth McGovern Medical School, Houston, TX, USA.

Objectives: To analyze adverse events (AEs) related to sclerosants reported through the Federal Adverse Event Reporting System (FAERS).

Methods: We queried the FAERS database for all cases associated with sclerosants. Reports were analyzed and stratified based on severity of cases and patient death.

Results: A total of 1215 cases with 3124 reactions were identified among 4 sclerosants. "General disorder and administration site conditions" reaction group was prevalent in all sclerosants. For polidocanol, deep vein thrombosis and pulmonary embolism were the most common severe reactions while cardiac arrest was frequent in death cases. Anaphylaxis was common in fatalities of sodium tetradecyl sulfate. Ethanolamine oleate was associated with procedural errors, while morrhuate sodium resulted in few cases.

Conclusion: Our analysis supports previous studies concerning common local symptoms, but also reveals serious and death associated reaction profiles specific to individual sclerosants. Practitioners should be knowledgeable on both non-lethal and fatal AEs for each sclerosant. The multitude of reports concerning serious reactions and deaths we report herein provide a cautionary reminder to venous practitioners and patients that sclerotherapy is not a trivial procedure.
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http://dx.doi.org/10.1177/02683555221088373DOI Listing
April 2022

Use of PD-1 Inhibitors in the Treatment of Advanced Basal Cell Carcinoma.

Dermatol Surg 2021 11;47(11):1511-1512

Departments of Dermatology and Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, Texas.

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http://dx.doi.org/10.1097/DSS.0000000000003207DOI Listing
November 2021

PD-1 inhibitors for cutaneous squamous cell carcinoma: A meta-analysis.

Australas J Dermatol 2022 Feb 26;63(1):36-42. Epub 2021 Oct 26.

Departments of Dermatology and Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

PD-1 inhibitors are immunotherapeutic agents used in the treatment of advanced cutaneous squamous cell carcinoma (cSCC). This study aimed to determine the pooled objective response and disease control rates of patients with advanced cSCC treated with PD-1 inhibitors. Pubmed, Cochrane Library and EMBASE databases were searched up to 1 January 2021 to include eligible articles. Objective response rate (ORR) and disease control rate (DCR) were pooled and analysed. Subgroup analysis of the odds ratio (OR) for ORR for patients by PD-L1 tumour proportion score (TPS) was performed. Seven articles including a total of 453 patients were identified and included. Pooled estimate of ORR was 44% (95% CI: 39-49%, I  = 23.7%) and of DCR was 66% (95% CI: 57-74%, I  = 68.2%). Pooled odds ratio of ORR for patients by PD-L1 TPS was 2.81 (95% CI: 1.22-6.51, I  = 0.0%). These results were derived from single-arm studies, some of which were retrospective. No head-to-head trials comparing PD-1 inhibitors have been reported. We present aggregate estimates of ORR and DCR for patients with advanced cSCC treated with PD-1 inhibitors, as well as subgroup analysis for ORR for patients by PD-L1 TPS.
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http://dx.doi.org/10.1111/ajd.13733DOI Listing
February 2022

Switching Hedgehog inhibitors and other strategies to address resistance when treating advanced basal cell carcinoma.

Oncotarget 2021 Sep 28;12(20):2089-2100. Epub 2021 Sep 28.

Department of Dermatology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Although basal cell carcinoma (BCC) is often managed successfully with surgery, patients with locally advanced BCC (laBCC) or metastatic BCC (mBCC) who are not candidates for surgery or radiotherapy have limited treatment options. Most BCCs result from aberrant Hedgehog pathway activation in keratinocyte tumor cells, caused by sporadic or inherited mutations. Mutations in the patched homologue 1 gene that remove its inhibitory regulation of Smoothened homologue (SMO) or mutations in that make it constitutively active, lead to Hedgehog pathway dysregulation and downstream activation of GLI1/2 transcription factors, promoting cell differentiation and proliferation. Hedgehog inhibitors (HHIs) block overactive signaling of this pathway by inhibiting SMO and are currently the only approved treatments for advanced BCC. Two small-molecule SMO inhibitors, vismodegib and sonidegib, have shown efficacy and safety in clinical trials of advanced BCC patients. Although these agents are effective and tolerable for many patients, HHI resistance occurs in some patients. Mechanisms of resistance include mutations in SMO, noncanonical cell identity switching leading to tumor cell resistance, and non-canonical pathway crosstalk causing Hedgehog pathway activation. Approaches to managing HHI resistance include switching HHIs, HHI and radiotherapy combination therapy, photodynamic therapy, and targeting Hedgehog pathway downstream effectors. Increasing understanding of the control of downstream effectors has identified new therapy targets and potential agents for evaluation in BCC. Identification of biomarkers of resistance or response is needed to optimize HHI use in patients with advanced BCC. This review examines HHI resistance, its underlying mechanisms, and methods of management for patients with advanced BCC.
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http://dx.doi.org/10.18632/oncotarget.28080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8487719PMC
September 2021

Treatment of advanced cutaneous squamous cell carcinoma: a Mohs surgery and dermatologic oncology perspective.

Future Oncol 2021 Dec 5;17(35):4971-4982. Epub 2021 Oct 5.

Departments of Dermatology & Head & Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Locally advanced or metastatic cutaneous squamous cell carcinoma no longer amenable to surgical resection or primary radiation therapy requires an alternative approach to treatment. Until 2018, management consisted of limited systemic chemotherapies, which carried marginal clinical benefit. The introduction of immunotherapy with anti-PD-1 antibodies resulted in alternative treatment options for advanced cutaneous squamous cell carcinoma with substantial antitumor activity, durable response and acceptable safety profile. The field of immunotherapeutics continues to expand with adjuvant, neoadjuvant and intralesional studies currently in progress. Herein, the authors discuss their approach for the treatment of advanced cutaneous squamous cell carcinoma from the perspective of a Mohs surgeon and a dermatologic oncologist.
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http://dx.doi.org/10.2217/fon-2021-0901DOI Listing
December 2021

Intracavitary Foam Sclerotherapy in Dissecting Cellulitis of the Scalp.

Dermatol Surg 2021 09;47(9):1317-1319

Texas Surgical Dermatology PA, Spring, Texas.

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http://dx.doi.org/10.1097/DSS.0000000000003035DOI Listing
September 2021

A review of emerging and non-US FDA-approved topical agents for the treatment of basal cell carcinoma.

Future Oncol 2021 Aug 22;17(23):3111-3132. Epub 2021 Jun 22.

Department of Dermatology, University of Texas McGovern Medical School at Houston, Houston, TX 77030, USA.

Although surgical therapy continues to be the gold standard for the treatment of basal cell carcinoma given high cure rates and the ability to histologically confirm tumor clearance, there are a number of nonsurgical treatment options that may be considered based on individual tumor characteristics, functional and cosmetic considerations, patient comorbidities and patient preference. Topical 5-fluorouracil 5% cream and imiquimod 5% cream have been US FDA-approved for the treatment of superficial basal cell carcinoma. Additionally, a number of new and emerging topical agents and techniques have been described for the treatment of basal cell carcinoma and will be reviewed herein.
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http://dx.doi.org/10.2217/fon-2020-1147DOI Listing
August 2021

Linear lichen planus pigmentosus of the face with histological findings of lichen planopilaris - an uncommon variant of lichen planus.

Dermatol Online J 2021 Apr 15;27(4). Epub 2021 Apr 15.

Department of Dermatology, University of Texas McGovern Medical School at Houston, Houston, TX.

Lichen planus pigmentosus and lichen planopilaris are two clinically and histologically distinct forms of lichen planus. Lichen planus pigmentosus presents with sudden onset hyperpigmented macules and patches, predominantly in darker skin phototypes. On the other hand, lichen planopilaris is a scarring follicular variant of lichen planus that presents with progressive, permanent patches of alopecia. It is not uncommon for different variants of lichen planus to clinically coexist with each other. However, to our knowledge, there has been no previous reporting of linear lichen planus pigmentosus of the face with histological features of lichen planopilaris. We herein present a hybrid case of these two entities.
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April 2021

Exercise-Induced Vasculitis in a Patient With Negative Ultrasound Venous Reflux Study: A Mimic of Stasis Dermatitis.

Cutis 2021 Feb;107(2):E10-E11

Drs. Sundaresan and Silapunt are from the University of Texas McGovern Medical School, Houston. Dr. Silapunt is from the Department of Dermatology. Dr. Migden is from the Departments of Dermatology and Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston.

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http://dx.doi.org/10.12788/cutis.0186DOI Listing
February 2021

Muir-Torre Syndrome.

Skinmed 2020 1;18(6):382-384. Epub 2020 Dec 1.

Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL.

A 64-year-old man was referred to our dermatology clinic with a diagnosis of Muir-Torre syndrome (MTS), he had a history of multiple sebaceous carcinomas and sebaceous adenomas removed over the years. The patient has also had visceral cancer and had undergone a colon resection 17 years before to treat colon cancer and was recently diagnosed with invasive high-grade urothelial carcinoma of the right ureter. In addition, the patient has an extensive family history of cancer; a pedigree was constructed to document this history (Figure 1). Of note is that the patient's mother and father were second cousins. The patient's father was diagnosed with lung cancer at age 57 and died of colon cancer at the age of 72. The patient's mother died of colon cancer at age 74. The patient has three siblings: a sister and two brothers. The sister died of bone cancer at age 42. One brother had a number of cancers including colon, kidney, and skin cancers and died at age 53. His other brother is alive and has a history of colon cancer, kidney cancer, and ureteral cancer. The patient has five children. He has a 40-year-old son who, at the age of 30, was diagnosed with testicular cancer. His daughters are 47, 44, 39, and 34, with no history of malignancy to date. The patient had three maternal aunts, all of whom succumbed to colon cancer, as well as two paternal uncles who died of lung cancer. The patient's maternal grandfather was a smoker and he also died of lung cancer.
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http://dx.doi.org/DOI Listing
September 2021

Cutaneous Lesions of Multiple Myeloma of the Lower Extremity Masquerading as Squamous Cell Carcinoma.

Cureus 2020 Nov 3;12(11):e11313. Epub 2020 Nov 3.

Dermatology, University of Texas McGovern Medical School at Houston, Houston, USA.

Cutaneous involvement in multiple myeloma (MM) is a rare manifestation, being more prevalent in patients with aggressive subtypes, and refractory to standard therapies. Due to the rarity of this diagnosis, the reported clinical characteristics have been protean and relatively non-specific. Lower extremity involvement of cutaneous MM is an uncommon anatomical location for this diagnosis. We present a patient with refractory IgG lambda MM, and a past medical history of squamous cell carcinoma of the lower extremities who developed cutaneous MM in his lower leg. At the time of initial evaluation, the lesions mimicked squamous cell carcinoma, posing a diagnostic challenge. Histopathological and immunohistochemical studies confirmed cutaneous involvement by multiple myeloma. There needs to be a high clinical suspicion for cutaneous MM in patients with MM presenting with new skin lesions.
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http://dx.doi.org/10.7759/cureus.11313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714738PMC
November 2020

Eccrine Hidrocystoma of the Central Chest and Dermoscopic Findings.

Cureus 2020 May 7;12(5):e8012. Epub 2020 May 7.

Dermatology, University of Texas McGovern Medical School, Houston, USA.

Eccrine hidrocystomas are benign, cystic tumors that are most commonly found on the central face in middle-aged females. Their dermoscopic findings are rarely described in the literature, with only seven cases currently reported to date. We present the case of an elderly man with an unusual location of an eccrine hidrocystoma of the central chest and its associated dermoscopic findings. Characterizing the dermoscopic features of eccrine hidrocystomas may allow for better differentiation of these lesions from cutaneous malignancies and may minimize unnecessary biopsies, treatment, and scarring.
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http://dx.doi.org/10.7759/cureus.8012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279684PMC
May 2020

Severe pretibial myxedema refractory to systemic immunosuppressants.

Cutis 2019 Sep;104(3):E1-E3

University of Texas MD Anderson Cancer Center, Houston, USA.

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September 2019

Review of systemic agents in the treatment of advanced cutaneous squamous cell carcinoma.

Future Oncol 2019 Sep 6;15(27):3171-3184. Epub 2019 Aug 6.

University of Texas MD Anderson Cancer Center, Department of Dermatology, Mohs and Dermasurgery Unit, Houston, TX 77030, USA.

Advanced cutaneous squamous cell carcinoma (cSCC) accounts for only 5% of all cases of cSCC but up to 60% of disease related deaths. Historically, this disease has lacked effective treatment options due to a combination of poor response rate, poor response durability and significant treatment-associated morbidity. Autumn of 2018 marked the first time ever that an agent received US FDA approval for advanced cSCC and the future is looking much brighter for this previously neglected patient population. The purpose of this article is to review the various systemic treatment options for advanced cSCC moving from the past to the present, highlighting their relative merits and shortcomings, and to briefly speculate on future developments in the field of advanced cSCC.
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http://dx.doi.org/10.2217/fon-2019-0158DOI Listing
September 2019

Treatment of Leg Veins for Restless Leg Syndrome: A Retrospective Review.

Cureus 2019 Apr 2;11(4):e4368. Epub 2019 Apr 2.

Dermatology, University of Texas McGovern Medical School, Houston, USA.

Background: Restless leg syndrome (RLS) and chronic venous insufficiency (CVI) share similar circadian timings and epidemiological characteristics.

Objective: The objective of the study was to investigate whether treating superficial venous reflux (SVR) improves the RLS severity in patients with CVI and whether there is an association of the RLS severity with the number of refluxed veins.

Materials And Methods: Patients with RLS and duplex ultrasound-proven SVR were identified from a database of 134 patients. All patients underwent endovenous radiofrequency ablation and ultrasound-guided foam sclerotherapy. International RLS (IRLS) rating scale questionnaires were reviewed to assess pre- and post-intervention RLS status.

Results: Thirty-five patients were identified. The average baseline IRLS score was 19.83 (moderate RLS) and improved to 7.89 (mild RLS) after treatment (p < .0001), corresponding to 63% decrease in symptoms. Ten patients (29%) had a follow-up score of 0, indicating complete relief of RLS symptoms. Twenty patients (57%) had decreased IRLS scores of 10 points or more (i.e. 1 grade level of severity). Six patients had no improvement. There was no association of the RLS severity with the number of refluxed veins.

Conclusion: The study found that correcting SVR improves RLS symptoms, suggesting an association between CVI and RLS. Venous ultrasound study and intervention should be considered for potential patients.
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http://dx.doi.org/10.7759/cureus.4368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6551200PMC
April 2019

A Rare Variant of Penile Squamous Cell Carcinoma in a Man with Paraplegia.

Cureus 2018 Sep 3;10(9):e3244. Epub 2018 Sep 3.

Dermatology, University of Texas Mcgovern Medical School at Houston, Houston, USA.

Verrucous carcinoma (VC) is a rare variant of squamous cell carcinoma (SCC). It is described as a low grade, slow growing, locally infiltrative neoplasm that accounts for 3%-8% of penile SCCs. Here we report a case of destructive VC of the glans penis in a paraplegic man resulting in a hypospadias from the tip of the glans to the corona. Histology demonstrated exophytic squamous epithelial proliferation with characteristic round, pushing borders. In situ hybridization was positive for both low-risk and high-risk strains of human papillomavirus.
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http://dx.doi.org/10.7759/cureus.3244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6217864PMC
September 2018

Atrophic dermatofibroma in an elderly male - a rarely described variant of a common lesion.

Dermatol Online J 2018 Jun 15;24(6). Epub 2018 Jun 15.

University of Texas McGovern Medical School at Houston, Houston, Texas.

Dermatofibroma frequently presents as a red-brown nodule on the extremities of the middle aged. Atrophic dermatofibroma is a rare variant that has been most commonly described as an atrophic depressed, erythematous lesion in females. The correct diagnosis of atrophic dermatofibroma is often hindered by its infrequent presentation. It has a female preponderance with an occurrence ratio of 10:1. We describe a case of an atrophic dermatofibroma on the back of an elderly man. Skin biopsy demonstrated a spindle cell proliferation in a storiform pattern, loss of elastic fibers, and substantial atrophy of both the underlying dermis and subcutaneous tissue. An aggregation of elastic fibers was found in the periphery of the tumor. These histologic features supported the diagnosis of atrophic dermatofibroma. The dermal and adipocyte atrophy was likely responsible for the retracted appearance of the lesion.
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June 2018

Recognizing Skin Popping Scars: A Complication of Illicit Drug Use.

Cureus 2018 Jun 1;10(6):e2726. Epub 2018 Jun 1.

Dermatology, University of Texas Mcgovern Medical School at Houston, Houston, USA.

"Skin popping" is a method of injecting illicit drugs into the skin. There are numerous acute and chronic complications associated with skin popping. We present a case of a 48-year-old, African-American female patient with 40 - 60 hyperpigmented, fibrotic, depressed, round papules and plaques on the extremities, which were incidentally noticed during a clinic visit for her acne vulgaris. Skin popping scars are important clues for possible drug abuse. Healthcare practitioners should be aware of and recognize the lesions associated with this practice so further testing can be performed if clinically indicated. Recognition of the lesions and thus earlier treatment of the complications could prevent the complications of skin popping in the skin and other organs.
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http://dx.doi.org/10.7759/cureus.2726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6070054PMC
June 2018

The Development of Psoriasis Over a Silicone Granuloma: Case Report and Postulated Mechanism of Pathogenesis.

Cureus 2018 May 24;10(5):e2684. Epub 2018 May 24.

Dermatologist, San Diego Family Dermatology, National City, USA.

Liquid silicone injections are used for soft tissue augmentation and have the potential to cause adverse effects. A 60-year-old woman who developed a psoriatic lesion over a silicone granuloma is reported. The clinical, dermatoscopic, and histological findings were characteristic of psoriasis. The patient was started on hydroxychloroquine for the treatment of the granuloma without any subsequent development of new psoriatic lesions. The presentation of psoriasis associated with a silicone granuloma in an immunocompetent patient is unique. The sequence of events is another example of a dermatosis occurring in an immunocompromised cutaneous district.
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http://dx.doi.org/10.7759/cureus.2684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6059527PMC
May 2018

Emerging Nonsurgical Therapies for Locally Advanced and Metastatic Nonmelanoma Skin Cancer.

Dermatol Surg 2019 01;45(1):1-16

Departments of Dermatology and Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.

Background: Locally advanced and metastatic nonmelanoma skin cancer (NMSC) not amenable to surgical resection requires a different approach to therapy.

Objective: To review the efficacy and adverse effects of emerging treatment options for locally advanced and metastatic NMSC.

Materials And Methods: A comprehensive search on PubMed was conducted to identify relevant literature investigating the role of program cell death 1 (PD-1) inhibitor, cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) inhibitor, epidermal growth factor receptor (EGFR) inhibitor, and Hedgehog pathway inhibitors in the treatment of NMSC.

Results: PD-1 inhibitor and CTLA-4 inhibitor have shown promising efficacy with tolerable side-effect profiles in the treatment of NMSC, although the number of cases reported is limited. Currently, 3 larger-scale clinical trials are investigating PD-1 inhibitor therapy for NMSC. Similarly, EGFR inhibitor demonstrated marginal success in unresectable cutaneous squamous cell carcinomas. Hedgehog pathway inhibitors were approved by the US FDA for treatment of locally advanced and metastatic basal cell carcinomas and have shown favorable efficacy. Common adverse effects included muscle spasm, alopecia, and dysgeusia.

Conclusion: Systemic therapies including PD-1 inhibitors and CTLA-4 inhibitors have demonstrated early promising results for difficult-to-treat NMSC. Future studies are necessary to optimize treatment outcome.
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http://dx.doi.org/10.1097/DSS.0000000000001601DOI Listing
January 2019

Erythema Ab Igne from Heating Pad Use: A Report of Three Clinical Cases and a Differential Diagnosis.

Cureus 2018 May 16;10(5):e2635. Epub 2018 May 16.

Dermatology, University of Texas Mcgovern Medical School at Houston, Houston, USA.

Erythema ab igne is an asymptomatic cutaneous disorder characterized by erythematous reticulated hyperpigmentation resulting from chronic exposure to infrared radiation in the form of heat. We report three cases of erythema ab igne from chronic heating pad use over a duration of six months to three years. The lesions were asymptomatic in all three patients and were incidental skin findings in two patients, unrelated to their chief complaints. This illustrates the importance of recognizing the morphology and distribution of erythema ab igne. Additionally, knowledge of similarly presenting cutaneous diseases is important to distinguish erythema ab igne from other more worrisome entities that would require further evaluation. Our patients were informed of the benign nature of this condition and were told that cessation of heating pad use would likely result in the resolution of their lesions.
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http://dx.doi.org/10.7759/cureus.2635DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047836PMC
May 2018

A Vascular-appearing Spindle Cell Xanthogranuloma in a Child.

Cureus 2018 May 8;10(5):e2595. Epub 2018 May 8.

Dermatology, University of Texas Mcgovern Medical School at Houston, Houston, USA.

Spindle cell xanthogranuloma is a rare variant of juvenile xanthogranuloma that most commonly presents in adults as papulonodules. We describe a vascular-appearing case of spindle cell xanthogranuloma on the nose of a 10-year-old boy. The lesion was a dark red, well-demarcated, dome-shaped papule. Histopathology revealed spindle-shaped histiocytes in a storiform pattern that stained positive for cluster of differentiation 68 (CD68) and the nuclear antigen Ki-67. No vascular features were found. To our knowledge, this is the first reported spindle cell xanthogranuloma to mimic an angiomatous lesion.
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http://dx.doi.org/10.7759/cureus.2595DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6037337PMC
May 2018

Rapidly growing nodule in an adolescent girl.

Pediatr Dermatol 2018 Jul;35(4):513-514

Department of Dermatology, McGovern Medical School, University of Texas at Houston, Houston, TX, USA.

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http://dx.doi.org/10.1111/pde.13461DOI Listing
July 2018

A Nodular Hidradenoma of Atypical Location in Pregnancy.

Acta Derm Venereol 2018 Oct;98(9):908-909

University of Texas McGovern Medical School at Houston, , 77030 Houston, TX, USA.

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http://dx.doi.org/10.2340/00015555-2983DOI Listing
October 2018

Utility of a High-Resolution Superficial Diagnostic Ultrasound System for Assessing Skin Thickness: A Cross-Sectional Study.

Dermatol Surg 2018 Jun;44(6):855-864

Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

Background: Compared with other imaging modalities, ultrasound is relatively deeply penetrating and can be used to evaluate deep dermal and subcutaneous structures.

Objective: Image skin thickness of the face and neck using high-frequency diagnostic ultrasound devices.

Materials And Methods: Skin overlying 20 different predesignated face and neck anatomic sites in 32 individuals was imaged using 2 commercially available high-frequency diagnostic ultrasound devices, a dedicated imaging device and a diagnostic device bundled with a therapeutic device. At each site, the subcutaneous and combined epidermal and dermal layer thicknesses were assessed by blinded expert raters.

Results: Similar skin thickness measurements were obtained. Notably, subcutaneous fat depth was measured to be 0.2 cm at the forehead; 0.5 cm at the mental eminence; and 0.6 cm at the submental, supraglenoid, and temporal regions. The combined epidermal and dermal thickness was approximately 0.1 cm at the zygomatic process, suborbital area, inferior malar region, gonion, supraglenoid area, and nasolabial-buccal, and nasolabial fold regions.

Conclusion: This is the first study using high-resolution superficial diagnostic ultrasound to map skin thickness of the face and neck at standard anatomic locations. Ultrasound is an inexpensive, noninvasive, and convenient means to monitor dermatologic conditions and guide their treatment.
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http://dx.doi.org/10.1097/DSS.0000000000001445DOI Listing
June 2018

A Supernumerary Nipple-Like Clinical Presentation of Lymphangioma Circumscriptum.

Case Rep Dermatol Med 2018 11;2018:6925105. Epub 2018 Feb 11.

Department of Dermatology, University of Texas McGovern Medical School, Houston, TX, USA.

Lymphangioma circumscriptum is a superficially localized variant of lymphangioma. The characteristic clinical presentation is a "frogspawn" grouping of vesicles or papulovesicles on the proximal limb or limb girdle areas. Though most lymphangiomas develop congenitally, the lymphangioma circumscriptum subtype is known to present in adults. We report a case of lymphangioma circumscriptum on the left inframammary area of an African American female with an unusual supernumerary nipple-like clinical presentation. Our patient presented with a firm, smooth, hypopigmented papule, and the clinical diagnosis of keloid was made initially. However, she returned reporting growth of the lesion and was noted to have a firm, exophytic, lobulated, pink to skin-colored nodule. Histopathological examination demonstrated dilated lymphatic vessels, consistent with the diagnosis of lymphangioma. The presentation as a firm, hypopigmented papule and later exophytic, lobulated, skin-colored nodule in our case represents a clinical presentation of lymphangioma circumscriptum not previously described in the literature. Correct diagnosis in lymphangioma circumscriptum is vital, as recurrence following surgical resection and secondary development of lymphangiosarcoma and squamous cell carcinoma following treatment with radiation have been reported. Thus, it is important to consider lymphangioma circumscriptum in the differential of similar lesions in the future to allow appropriate diagnosis, treatment, and monitoring.
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http://dx.doi.org/10.1155/2018/6925105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896405PMC
February 2018

Linear terra firma-forme dermatosis of the midline back.

Cutis 2018 Mar;101(3):205-206

Department of Dermatology, McGovern Medical School, University of Texas, Houston, USA.

Terra firma-forme dermatosis (TFFD) is a benign and likely underdiagnosed disorder with relatively few reports in the literature. A 46-year-old woman presented to our clinic with a 3-year history of linear TFFD extending from the upper sacrum to the midline upper back. It initially was thought to be acanthosis nigricans or lichen simplex chronicus, and a topical steroid cream was applied without success. The lesion ultimately was removed by rubbing with isopropyl alcohol, which confirmed a diagnosis of TFFD. Due to its ability to mimic other skin diseases, TFFD should be considered when patients present with hyperkeratotic hyperpigmented lesions.
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March 2018

Multiple eccrine spiradenomas in a zosteriform pattern.

Dermatol Online J 2017 Aug 15;23(8). Epub 2017 Aug 15.

Department of Dermatology, University of Texas McGovern Medical School at Houston, Houston, Texas,.

Eccrine spiradenoma (ES) typically presents as a solitary tender lesion. Multiple ES is a rare variant of ES and can present in a segmental, linear, blaschkoid, or zosteriform pattern. The etiology of multiple ES is unknown, but several theories have been suggested including a multipotent stem cell origin. We report the case of a 30-year-old woman with multiple painful ES in a zosteriform pattern on the mid-back and abdomen. Skin biopsy of a representative lesion demonstrated a circumscribed tumor nodule encapsulated by a fibrous capsule with diffuse dense basophilic proliferation located in the dermis. The lesions were then excised on two separate sessions without recurrence.
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August 2017

Treatment of advanced basal cell carcinoma with sonidegib: perspective from the 30-month update of the BOLT trial.

Future Oncol 2018 Mar 9;14(6):515-525. Epub 2017 Nov 9.

Departments of Dermatology & Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Sonidegib, a hedgehog pathway inhibitor, was approved by the US FDA for the treatment of locally advanced basal cell carcinoma which cannot be readily treated with surgery or radiotherapy. The pharmacology and pharmacokinetics of sonidegib will be discussed in this review. Additionally, an in-depth analysis of the BOLT trial and data from the 30-month update will be included. This will serve as an update to a previously published article which reported the 12-month update of the BOLT trial.
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http://dx.doi.org/10.2217/fon-2017-0457DOI Listing
March 2018

Venous Treatment of Lipodermatosclerosis to Improve Ambulatory Function.

Dermatol Surg 2018 May;44(5):749-752

University of Texas McGovern Medical School at Houston, Houston, Texas Departments of Dermatology and Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas Department of Dermatology, University of Texas McGovern Medical School at Houston, Houston, Texas.

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http://dx.doi.org/10.1097/DSS.0000000000001314DOI Listing
May 2018
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