Publications by authors named "Tracey N Liebman"

37 Publications

Melanoma surveillance for high-risk patients via telemedicine: Examination of real-world data from an integrated store-and-forward total body photography and dermoscopy service.

J Am Acad Dermatol 2021 Jan 27. Epub 2021 Jan 27.

The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York 10016. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2021.01.055DOI Listing
January 2021

Dermoscopy Proficiency Expectations for US Dermatology Resident Physicians: Results of a Modified Delphi Survey of Pigmented Lesion Experts.

JAMA Dermatol 2021 Feb;157(2):189-197

The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York.

Importance: Dermoscopy education in US dermatology residency programs varies widely, and there is currently no existing expert consensus identifying what is most important for resident physicians to know.

Objectives: To identify consensus-based learning constructs representing an appropriate foundational proficiency in dermoscopic image interpretation for dermatology resident physicians, including dermoscopic diagnoses, associated features, and representative teaching images. Defining these foundational proficiency learning constructs will facilitate further skill development in dermoscopic image interpretation to help residents achieve clinical proficiency.

Design, Setting, And Participants: A 2-phase modified Delphi surveying technique was used to identify resident learning constructs in 3 sequential sets of surveys-diagnoses, features, and images. Expert panelists were recruited through an email distributed to the 32 members of the Pigmented Lesion Subcommittee of the Melanoma Prevention Working Group. Twenty-six (81%) opted to participate. Surveys were distributed using RedCAP software.

Main Outcomes And Measures: Consensus on diagnoses, associated dermoscopic features, and representative teaching images reflective of a foundational proficiency in dermoscopic image interpretation for US dermatology resident physicians.

Results: Twenty-six pigmented lesion and dermoscopy specialists completed 8 rounds of surveys, with 100% (26/26) response rate in all rounds. A final list of 32 diagnoses and 116 associated dermoscopic features was generated. Three hundred seventy-eight representative teaching images reached consensus with panelists.

Conclusions And Relevance: Consensus achieved in this modified Delphi process identified common dermoscopic diagnoses, associated features, and representative teaching images reflective of a foundational proficiency in dermoscopic image interpretation for dermatology residency training. This list of validated objectives provides a consensus-based foundation of key learning points in dermoscopy to help resident physicians achieve clinical proficiency in dermoscopic image interpretation.
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http://dx.doi.org/10.1001/jamadermatol.2020.5213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788510PMC
February 2021

A case of recalcitrant lichen planus pigmentosus treated by oral isotretinoin.

JAAD Case Rep 2020 Sep 8;6(9):812-814. Epub 2020 Jul 8.

The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2020.06.037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452212PMC
September 2020

Utility of confocal microscopy in the management of lentigo maligna and lentigo maligna melanoma.

J Am Acad Dermatol 2020 Aug 29. Epub 2020 Aug 29.

The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine New York, New York 10016. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.08.101DOI Listing
August 2020

Technological advances for the detection of melanoma: Advances in molecular techniques.

J Am Acad Dermatol 2020 Oct 29;83(4):996-1004. Epub 2020 Apr 29.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York. Electronic address:

The growth of molecular technologies analyzing skin cells and inherited genetic variations has the potential to address current gaps in both diagnostic accuracy and prognostication in patients with melanoma or in individuals who are at risk for developing melanoma. In the second article in this continuing medical education series, novel molecular technologies are reviewed. These have been developed as adjunct tools for melanoma management and include the Pigmented Lesion Assay, myPath Melanoma, and DecisionDx-Melanoma tests, and genetic testing in patients with a strong familial melanoma history. These tests are commercially available and marketed as ancillary tools for clinical decision-making, diagnosis, and prognosis. We review fundamental principles behind each test, discuss peer-reviewed literature assessing their performance, and highlight the utility and limitations of each assay. The goal of this article is to provide a comprehensive, evidence-based foundation for clinicians regarding the management of patients with difficult pigmented lesions.
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http://dx.doi.org/10.1016/j.jaad.2020.03.122DOI Listing
October 2020

Technological advances for the detection of melanoma: Advances in diagnostic techniques.

J Am Acad Dermatol 2020 Oct 26;83(4):983-992. Epub 2020 Apr 26.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York. Electronic address:

Managing the balance between accurately identifying early stage melanomas while avoiding obtaining biopsy specimens of benign lesions (ie, overbiopsy) is the major challenge of melanoma detection. Decision making can be especially difficult in patients with extensive atypical nevi. Recognizing that the primary screening modality for melanoma is subjective examination, studies have shown a tendency toward overbiopsy. Even low-risk routine surgical procedures are associated with morbidity, mounting health care costs, and patient anxiety. Recent advancements in noninvasive diagnostic modalities have helped improve diagnostic accuracy, especially when managing melanocytic lesions of uncertain diagnosis. Breakthroughs in artificial intelligence have also shown exciting potential in changing the landscape of melanoma detection. In the first article in this continuing medical education series, we review novel diagnostic technologies, such as automated 2- and 3-dimensional total body imaging with sequential digital dermoscopic imaging, reflectance confocal microscopy, and electrical impedance spectroscopy, and we explore the logistics and implications of potentially integrating artificial intelligence into existing melanoma management paradigms.
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http://dx.doi.org/10.1016/j.jaad.2020.03.121DOI Listing
October 2020

Calciphylaxis in Association with Alcoholic Cirrhosis and Hepatorenal Syndrome.

Skinmed 2020 1;18(1):46-49. Epub 2020 Jan 1.

Department of Dermatology, Hofstra Northwell School of Medicine, Manhasset, NY;

A 45-year-old woman with cirrhosis secondary to alcohol abuse was transferred from an outside hospital for management of a painful cutaneous eruption, progressively worsening over 2 weeks. On examination, the patient was a middle-aged white woman lying in bed in no acute distress, with jaundice and a protuberant abdomen consistent with ascites. The patient was afebrile (98.2°F), heart rate of 79 beats per minute, blood pressure of 105/61 mmHg, respiratory rate of 18 breaths per minute, and oxygen saturation of 93% on room air. She had multiple large stellate lesions of retiform purpura with central hemorrhagic necrosis on both thighs, with surrounding induration (Figures 1 and 2). These purpuric plaques and perilesional skin were exquisitely painful to palpation.
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December 2020

Real-world outcomes of melanoma surveillance using the MoleMap NZ telemedicine platform.

J Am Acad Dermatol 2020 Feb 28. Epub 2020 Feb 28.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York. Electronic address:

Background: MoleMap NZ is a novel New Zealand-based store-and-forward telemedicine service to detect melanoma. It uses expert review of total body photography and close-up and dermoscopic images of skin lesions that are suspicious for malignancy.

Objective: The purpose of this study was to assess the effectiveness of MoleMap NZ as a melanoma early detection program.

Methods: We conducted a review of 2108 melanocytic lesions recommended for biopsy/excision by MoleMap NZ dermoscopists between January 2015 and December 2016.

Results: Pathologic diagnoses were available for 1571 lesions. Of these, 1303 (83%) lesions were benign and 260 (17%) lesions were diagnosed as melanoma, for a melanoma-specific benign:malignant ratio of 5.0:1. The number needed to biopsy to obtain 1 melanoma was 6. Among melanomas with available tumor thickness data (n = 137), 92% were <0.8 mm (range in situ to 3.1 mm), with in situ melanomas comprising 74%.

Limitations: Only lesions recommended for excision were analyzed. Pathology results were available for 75% of these cases. Tumor thickness data were available for 53% of melanomas diagnosed.

Conclusions: This real-world study of MoleMap NZ, a community-based teledermoscopy program, suggests that it has the potential to increase patients' access to specialist expertise via telemedicine. Additional studies are needed to more accurately define its efficacy.
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http://dx.doi.org/10.1016/j.jaad.2020.02.057DOI Listing
February 2020

Acquired Ichthyosis in the Setting of Active Pulmonary Tuberculosis.

J Clin Aesthet Dermatol 2019 Jun 1;12(6):42-44. Epub 2019 Jun 1.

Dr. Liang and Dr. Liebman are with the Ronald O. Perelman Department of Dermatology at the New York University School of Medicine in New York, New York.

Acquired ichthyosis is an uncommon disorder of cornification. It characteristically presents as symmetric scaling of the skin on the trunk and extensor surfaces of the extremities. It is clinically and histologically similar to ichthyosis vulgaris; however, acquired ichthyosis develops later in life and has been associated with various malignancies, infections, medications, autoimmune diseases, metabolic disorders, and malnutrition. We describe a case of a 35-year-old woman with active pulmonary tuberculosis and a history of breast cancer who presented with a several-month history of a widespread, scaly, pruritic skin eruption. Physical examination revealed fine, scaly patches on the extremities with relative sparing of the flexures and larger, scaly, ichthyosiform patches on the chest and back. Skin biopsy revealed orthokeratotic hyperkeratosis and a diminished granular layer, consistent with a diagnosis of acquired ichthyosis. Further evaluation, including positron-emission tomography/computed tomography scan, revealed hypermetabolic infiltrates and cavitation in the lungs, consistent with active pulmonary tuberculosis; there was no evidence of new or recurrent malignancy. The patient was treated with antituberculosis drugs and topical ammonium lactate cream. With incident cases rarely reported in the literature, this case of new-onset ichthyosis in the setting of active pulmonary tuberculosis highlights the distinctive clinical and histologic features of acquired ichthyosis and emphasizes the relationship of acquired ichthyosis with underlying systemic disease, particularly infection.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6624008PMC
June 2019

A 68-Year-Old Man on Azathioprine With New Systemic Symptoms and Widespread Skin Eruption.

Clin Infect Dis 2019 04;68(8):1427-1430

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine.

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http://dx.doi.org/10.1093/cid/ciy440DOI Listing
April 2019

Botulinum toxin for treatment of Raynaud phenomenon in CREST syndrome.

Dermatol Online J 2018 Dec 15;24(12). Epub 2018 Dec 15.

The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York Yale University School of Medicine, New Haven, Connecticut.

Calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome is a form of a rare, clinical subtype of systemic sclerosis, known as limited systemic sclerosis. Limited systemic sclerosis, including CREST syndrome, manifests as fibrotic skin changes restricted to the hands and face, with vascular, musculoskeletal, and visceral involvement. We present a case of a 75-year-old woman with a longstanding history of CREST syndrome complicated by a digital ulceration and persistent pain associated with recalcitrant Raynaud phenomenon. After failing a number of first-line pharmacologic therapies such as diltiazem, sildenafil, and topical nitropaste, the patient was started on a trial of botulinum toxin for the left second digit, with 10 unit injections into both webspaces for a total of 20 units. Following injection, the patient reported no further baseline pain in the affected finger and an over fifty-percent improvement in discomfort with manipulation of the digit at a follow-up time of one week. The ulceration started healing within the following three weeks. This result was maintained at a follow-up time of six weeks.
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December 2018

Folliculotropic mycosis fungoides.

Dermatol Online J 2018 Dec 15;24(12). Epub 2018 Dec 15.

The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York.

Folliculotropic mycosis fungoides (MF) is a distinct subset of cutaneous T cell lymphoma (CTCL). The disease is typically marked by an aggressive course and is often recalcitrant to skin-direct therapy. We report a case of an 83-year-old woman with folliculotropic MF characterized by erythematous, scaly plaques on the forehead along with poliosis and alopecia of the right medial eyebrow.
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December 2018

Acral Melanoma: A Patient's Experience and Physician's Commentary.

Dermatol Ther (Heidelb) 2018 Dec 18;8(4):503-507. Epub 2018 Sep 18.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA.

This article, co-authored by a patient diagnosed with acral melanoma, discusses the patient's experience of being diagnosed with and treated with surgery for this disease. The physician discusses the epidemiology, genetics, diagnosis, treatment, and prognosis of acral melanoma. Follow-up care plans are also discussed.
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http://dx.doi.org/10.1007/s13555-018-0260-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6261119PMC
December 2018

Recurrent Palisaded Neutrophilic and Granulomatous Dermatitis in the Setting of Systemic Lupus Erythematosus.

Skinmed 2018;16(4):281-284. Epub 2018 Jul 1.

Department of Dermatology, State University of New York Downstate, Brooklyn, NY.

We present the case of a 66-year-old woman with a history of systemic lupus erythematosus, who presented with tender nodules on the forearms. The patient reported an 8-year history of pink bumps on the extensor surfaces of the forearms bilaterally that would arise episodically for a few weeks and subsequently resolve with no intervention. Her systemic lupus erythematosus was under good control with oral prednisone 10 mg daily, and the development of these lesions was not associated with concomitant flares of the systemic lupus erythematosus.
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October 2019

Mycoplasma pneumoniae, more than a lung disease.

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

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

Mycoplasma pneumoniae-induced rash and mucositis (MIRM) is a recently described clinical entity and should be considered in children who present with oral (94% of patients), ocular (82% of patients), and urogenital lesions (63% of patients). MIRM was first described as a distinct clinical entity from Stevens Johnson syndrome/Toxic epidermal necrolysis (SJS)/(TEN) in 2015 [1]. As a new, uncommon diagnosis it frequently poses a diagnostic and therapeutic challenge for pediatricians and dermatologists. We report a case of MIRM in a previously healthy 15-year-old boy.
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June 2018

Melanoma risk after in vitro fertilization: A review of the literature.

J Am Acad Dermatol 2018 Dec 25;79(6):1133-1140.e3. Epub 2018 Jul 25.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York. Electronic address:

Background: The role of female sex hormones in the pathogenesis of malignant melanoma (MM) remains controversial. Although melanocytes appear to be hormonally responsive, the effect of estrogen on MM cells is less clear. Available clinical data does not consistently demonstrate that increased endogenous hormones from pregnancy or increased exogenous hormones from oral contraceptive pills and hormone replacement affect MM prevalence and outcome.

Objective: We sought to examine potential associations between in vitro fertilization (IVF) and melanoma.

Methods: A literature review was conducted. Primary outcomes were reported as associations between IVF and melanoma risk compared with the general population. Secondary outcomes included associations stratified by type of IVF regimen and subgroup, such as parous versus nulliparous patients.

Results: Eleven studies met our inclusion criteria. Five studies found no increased risk for MM among IVF users compared with the general population. Two studies found an increase in MM in clomiphene users, and 4 studies found an increase in MM among patients who were gravid or parous either before or after IVF.

Conclusion: The reviewed studies do not reveal consistent patterns of association between IVF and MM among all infertile women. However, the data indicates a potential increased risk for MM in ever-parous patients treated with IVF. High-quality studies including a large number of MM cases that control for well-established MM risk factors are needed to adequately assess the relationship between IVF and MM, particularly among ever-parous women.
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http://dx.doi.org/10.1016/j.jaad.2018.07.022DOI Listing
December 2018

Severe Oral Mucositis: A Rare Adverse Event of Pembrolizumab.

J Drugs Dermatol 2018 Jul;17(7):807-809

Treatment of malignancy with anti-programmed cell death 1 (PD-1) immune checkpoint inhibitors can cause mucocutaneous side effects resulting from T cell activation. Due to their recent development, the full side effect profile remains to be fully elucidated, however dermatologic adverse events are most common. The main oral toxicities of these immune checkpoint inhibitors include: xerostomia, dysgeusia, and lichenoid reactions. Oral mucositis occurs more rarely in the setting of PD-1 inhibition, and few other reports of a Grade 3 or higher, severe, stomatitis have been reported in the literature. We present a case of a 78-year-old woman with Grade 3 ulcerative oral mucositis that occurred 13 months after initiation of PD-1 inhibitor, pembrolizumab, for the treatment for lung adenocarcinoma. She was successfully treated with prednisone, and pembrolizumab was temporarily held by her oncologist. Physicians should be aware of the possibility of severe mucositis in the setting of PD-1 inhibitors, as well as the management. J Drugs Dermatol. 2018;17(7):807-809.
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July 2018

Pregnancy and Melanoma: Recommendations for Clinical Scenarios.

Int J Womens Dermatol 2018 Jun 1;4(2):113-115. Epub 2018 Mar 1.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY.

Managing pregnant patients with a history of melanoma or with a melanoma diagnosis can be daunting and confusing for dermatologists. We present three clinical scenarios that raise questions about the safety of pregnancy in patients with a history of melanoma, skin biopsies during pregnancy, and excisions and sentinel lymph node biopsies during pregnancy. Our recommendations incorporate the most up-to-date clinical data to help guide clinicians when faced with pigmented lesions and melanoma in a pregnant patient.
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http://dx.doi.org/10.1016/j.ijwd.2017.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986258PMC
June 2018

Comment on "Prognostic value of sentinel lymph node biopsy according to Breslow thickness for cutaneous melanoma".

J Am Acad Dermatol 2018 09 19;79(3):e53-e54. Epub 2018 May 19.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2018.04.056DOI Listing
September 2018

Cold panniculitis: Adverse cutaneous effect of whole-body cryotherapy.

JAAD Case Rep 2018 May 1;4(4):344-345. Epub 2018 Apr 1.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2018.02.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911975PMC
May 2018

Violaceous papules on the legs of an elderly Mediterranean man.

Eur J Intern Med 2018 09 8;55:e3-e4. Epub 2018 Mar 8.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, United States. Electronic address:

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http://dx.doi.org/10.1016/j.ejim.2018.02.025DOI Listing
September 2018

Generalized eruptive syringomas.

Dermatol Online J 2017 Sep 15;23(9). Epub 2017 Sep 15.

Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, New York.

Eruptive syringoma is a rare variant of syringoma, benign neoplasms of the eccrine sweat ducts that appear on the face, neck, chest, and axillae of predominately Asian and African American women before or during puberty [1, 2]. Lesions appear as small skin-colored or slightly pigmented, flat-topped papules [2]. The condition can be cosmetically disfiguring and difficult to treat, especially in dark-skinned patients. The investigators report a 52-year old Guyanese woman who presented with widespread, chronic, non-pruritic and nontender, skin-colored papules that arose approximately 20 years earlier. A punch biopsy of affected skin was obtained and the histological diagnosis was eruptive syringoma. The patient pursued no further treatment, after discussion of costs and risks.
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September 2017

Acquired elastoma in a subungual location.

Dermatol Online J 2017 Sep 15;23(9). Epub 2017 Sep 15.

Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York.

Elastomas are connective tissue nevi or hamartomas. They may occur in isolation or can be associated with familial syndromes such as Buschke-Ollendorff syndrome. Elastomas typically present in childhood as small ivory papules or firm skin-colored nodules that can coalesce into larger yellow plaques. These lesions are typically distributed over the extremities, abdomen, and back. Herein, we report an unusual case of a renal transplant recipient who presented with an acquired subungual papule with associated koilonychia and distal nail plate dystrophy. Histopathologic findings were consistent with subungual elastoma.
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September 2017

An immunosuppressed man with an isolated necrotic plaque on the chest.

JAAD Case Rep 2018 Mar 12;4(2):114-116. Epub 2018 Jan 12.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2017.02.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767909PMC
March 2018

Dihydroxyacetone and sunless tanning: Knowledge, myths, and current understanding.

J Am Acad Dermatol 2017 11;77(5):991-992

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2017.04.1117DOI Listing
November 2017

Dermoscopic Findings of an Unusual Acral Nevus on the Hand of a Child.

Pediatr Dermatol 2017 May 20;34(3):e137-e139. Epub 2017 Mar 20.

Department of Dermatology, Downstate Medical Center, State University of New York, Brooklyn, New York.

Distinguishing benign acral nevi from small early acral melanomas may be challenging in certain cases. Dermoscopy is a noninvasive imaging technique that can help clinicians better visualize deeper lesion structures and thus more easily differentiate benign nevi from melanoma. We report the case of a 13-year-old girl with a changing dark brown to black macule with a central papular component on the volar surface of the right third finger. Dermoscopy revealed asymmetrically distributed irregular black blotches on a bluish-black background. Histopathology revealed a traumatized compound melanocytic nevus. Certain melanocytic nevi, although histologically benign, may not conform to the limited selection of reassuring benign dermoscopic patterns. Nevi in children are often dynamic and have a high likelihood of dermoscopic change.
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http://dx.doi.org/10.1111/pde.13105DOI Listing
May 2017

Pemphigus foliaceus exacerbated by radiation, in association with myasthenia gravis.

Dermatol Online J 2016 Mar 16;22(3). Epub 2016 Mar 16.

State University of New York Downstate Medical Center.

Pemphigus foliaceus (PF) is a sporadic autoimmune blistering disease of unknown etiology. The production of immunoglobulin G4 antibodies against desmoglein-1 is responsible for the clinical manifestation of PF. We present a case of a woman with a recent diagnosis of myasthenia gravis (MG), who was also recently treated with radiation therapy for breast cancer. The clinical exam, supported by biopsy and direct immunofluorescence, were consistent with PF. We present this case to increase the awareness of the potential exacerbation or induction of PF with radiation, and of the association of PF and myasthenia gravis. Only five prior cases of radiation-exacerbated or radiation-induced PF have been reported in the literature to date. Furthermore, the co-existence of the autoimmune entities of myasthenia gravis and PF has been reported in the literature in only 9 cases and was also noted in this patient.
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March 2016

Growth-Curve Modeling of Nevi With a Peripheral Globular Pattern.

JAMA Dermatol 2015 Dec;151(12):1338-1345

Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.

Importance: Although nevi with a peripheral rim of globules (peripheral globular nevi [PGN]) observed with dermoscopy are associated with enlarging melanocytic nevi, their actual growth dynamics remain unknown. Because change is a sensitive but nonspecific marker for melanoma, beginning to understand the growth patterns of nevi may improve the ability of physicians to differentiate normal from abnormal growth and reduce unnecessary biopsies.

Objective: To study the growth dynamics and morphologic evolution of PGN on dermoscopy.

Design, Setting, And Participants: A total of 84 participants with 121 PGN from September 1, 1999, through May 1, 2013, were identified retrospectively. Cohorts were recruited from the Memorial Sloan Kettering Cancer Center; Melanoma Unit of the Hospital Clinic, University of Barcelona; and Study of Nevi in Children. All 3 cohorts underwent longitudinal monitoring with serial dermoscopic imaging of their PGN. Data analysis was performed from May 1, 2014, through April 1, 2015.

Main Outcomes And Measures: Establishment of the natural growth curve of PGN. The secondary aim was to establish the median time to growth cessation in those PGN for which the size eventually stabilized and/or had begun to decrease during the study period.

Results: The median duration of follow-up was 25.1 (range, 2.0-114.4) months. Most of the nevi (116 [95.9%]) enlarged at some point during sequential monitoring. The rate of increase in the surface area of PGN varied among cohorts and ranged from -0.47 to 2.26 mm2/mo (mean rate, 0.25 [95% CI, 0.14-0.36] mm2/mo). The median time to growth cessation in the 26 PGN that stabilized or decreased in size (21.5%) was 58.6 months. All lesions changed in a symmetric manner and 91 (75.2%) displayed a decrease in the density of peripheral globules over time.

Conclusions And Relevance: Nevi displaying a peripheral globular pattern enlarged symmetrically with apparent growth cessation occurring during a span of 4 to 5 years. Our results reiterate the important concept that not all growth is associated with malignancy.
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http://dx.doi.org/10.1001/jamadermatol.2015.2231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483973PMC
December 2015

TNF-inhibitor induced lupus in a patient treated with adalimumab for rheumatoid arthritis.

Dermatol Online J 2014 Dec 13;21(2). Epub 2014 Dec 13.

SUNY Downstate Medical Center.

Anti-tumor necrosis factor induced lupus (ATIL) is a rare side effect reported in patients treated with anti-tumor necrosis factor medications such as infliximab, etanercept and adalimumab. Of the three, this condition has been least commonly reported secondary to adalimumab. In this report, we present a case of ATIL in a patient treated for rheumatoid arthritis (RA) with adalimumab. This report will increase physician awareness of the warning signs, diagnostic options and potential complications of ATIL. In this patient, adalimumab was discontinued and treatment was started, leading to improvement in the patient's status.
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December 2014