Search Our Scientific Publications & Authors

Am Surg 2019 Mar;85(3):e115-e117

J Cutan Pathol 2019 Mar 20. Epub 2019 Mar 20.

Bey Dermatology and Cosmetic Surgery, Spring Hill, FL.

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). Read More

Dermatol Ther (Heidelb) 2019 Feb 21. Epub 2019 Feb 21.

Department of Dermatology, Saint-Louis Hospital, AP-HP, INSERM U976, University of Paris 7 Paris Diderot, Paris, France.

Introduction: Keratoacanthomas (KA) are common cutaneous skin tumors originating from the hair follicles. Unlike squamous cell carcinoma, KA can regress spontaneously and have a benign evolution. Solitary KA is the most common form but familial multiple KA (Ferguson-Smith type), genetically predisposed KA (such as in xeroderma pigmentosum, or Muir-Torre syndrome), or sporadic multiple eruptive KA (Grzybowski type) have been described. Read More

Australas J Dermatol 2019 Jan 22. Epub 2019 Jan 22.

St Vincent's Hospital, Sydney, New South Wales, Australia.

Muir Torre syndrome is an autosomal dominant disorder characterised by germline mutations in mismatch repair genes involved in DNA repair, leading to microsatellite instability and a propensity to tumour formation. We report a case of a 67-year-old gentleman who underwent biopsy of a smooth nodular lesion on the nasal tip, histopathologically consistent with sebaceous adenoma. Immunohistochemistry suggested a loss of MSH6. Read More

Acta Derm Venereol 2019 Apr;99(4):360-369

Department of Dermatology and Allergy Centre, Odense University Hospital, DK-5000 Odense, Denmark.

Skin cancer has become the most common type of cancer worldwide as a result of environmental exposure and medical treatments. A small group of patients are genetically predisposed to skin cancer and this article is intended as a diagnostic tool when encountering patients with multiple skin cancer lesions. The disorders are described with clinical characteristics, genetics and management. Read More

Fam Cancer 2019 Apr;18(2):193-196

Department of Dermatology, Academic Medical Centre, Amsterdam, The Netherlands.

Lynch syndrome (LS) is an autosomal-dominant inherited disorder characterized by a predisposition to colorectal cancer and extracolonic cancers (particularly endometrium, ovary, stomach, small bowel, hepatobiliary tract, pancreas, urothelial tract, brain, and skin). Muir-Torre syndrome (MTS) is considered a phenotypical variant of LS, where patients develop sebaceous neoplasms and keratoacanthomas. Currently, only few studies and case reports suggest an association between LS and other skin cancers, such as Bowens' disease, melanoma and squamous cell carcinoma (SCC). Read More

Australas J Dermatol 2018 Dec 2. Epub 2018 Dec 2.

Department of Clinical Pathology, Colorectal Oncogenomics Group, The University of Melbourne, Parkville, Victoria, Australia.

Background/objectives: Loss of expression of mismatch repair (MMR) proteins is frequently observed in sebaceous skin lesions and can be a herald for Lynch syndrome. The aim of this study was to identify clinico-pathological predictors of MMR deficiency in sebaceous neoplasia that could aid dermatologists and pathologists in determining which sebaceous lesions should undergo MMR immunohistochemistry (IHC).

Methods: An audit of sebaceous skin lesions (excluding hyperplasia) where pathologist-initiated MMR IHC was performed between January 2009 to December 2016 was undertaken from a single pathology practice identifying 928 lesions from 882 individuals. Read More

Int J Gynecol Pathol 2018 Dec 3. Epub 2018 Dec 3.

Department of Pathology, Wuhan University Zhongnan Hospital, and Wuhan University Center for Pathology and Molecular Diagnostics (Q.C., Z.X., S.T., S.X.) Department of Pathology, Hubei Cancer Hospital (Manxiang W., S.J., Mingwei W.), Wuhan, Hubei Province, China Department of Pathology, University of Chicago, Chicago, Illinois (S.X.).

Muir-Torre syndrome is a rare subtype of Lynch syndrome characterized by coincidence of skin neoplasm and visceral malignancies. Here, we report a case of this rare disease, whose diagnosis of the syndrome was first suspected by the pathologist. This was a 60-yr-old woman who presented with an axillary skin nodule, which was diagnosed as basal cell carcinoma. Read More

Clin Exp Dermatol 2018 Nov 14. Epub 2018 Nov 14.

Department of Dermatology, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain.

Background: Sebaceous neoplasms (SN) may appear sporadically in the general population but may also be part of the Muir-Torre variant of Lynch syndrome (MT-LS). There are few studies in southern Europe on the incidence of MT-LS in the population of patients with SN.

Aim: To retrospectively review patients with SN and to analyse their clinical features and the incidence of MT-LS. Read More

Gynecol Oncol Rep 2018 Nov 29;26:37-40. Epub 2018 Aug 29.

Department of Pathology, Cedars-Sinai Medical Center, United States.

Sebaceous carcinomas are rare tumors, with the majority of described cases occurring within the eyelid. To date, there are nine documented reports of sebaceous carcinoma arising within a mature cystic teratoma of the ovary. Although the majority of cases originate from idiopathic mutations, there exists a strong association between this rare tumor and hereditary syndromes of DNA mismatch repair deficiency, such as Lynch syndrome and the lesser-known Muir-Torre syndrome. Read More

S D Med 2018 Aug;71(8):350-353

Department of Pathology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.

Sebaceous carcinoma in situ is a poorly understood and ill-defined entity. In situ sebaceous carcinoma exhibits a similar location pattern to its invasive counterpart in that most commonly has a periorbital distribution. Review of the literature found only seven cases of extraocular sebaceous carcinoma in situ. Read More

J Gynecol Oncol 2018 09;29(5):e84

Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.

Ugeskr Laeger 2018 Jul;180(27)

Muir-Torre syndrome (MTS) is an autosomal dominant disease with approximately 200 reported cases worldwide, which is characterised by multiple neoplasms of the skin and internal organs. This is a case report of a 57-year-old woman with MTS, who was referred to a plastic surgery department from a gastroenterology department due to a neoplasm of the skin. After treatment, she was referred to a dermatology department for follow-up. Read More

Am J Dermatopathol 2019 Jan;41(1):55-59

Departments of Dermatology, and.

We report a case of a 68-year-old white woman presenting with 5 sebaceous neoplasms, ranging from sebaceous adenoma to sebaceoma on histopathology. Despite the lack of a personal cancer history, her multiple sebaceous neoplasms and a paternal history of colon cancer prompted testing her sebaceous adenomas for microsatellite instability (MSI) by immunohistochemistry. The results showed retained nuclear expressions of MLH1 and PMS2 while MSH2 and MSH6 proteins were absent. Read More

Am J Dermatopathol 2018 Jul;40(7):479-485

Department of Pathology, Charles University in Prague, Faculty of Medicine in Pilsen, Pilsen, Czech Republic.

Sebaceous neoplasms with an organoid pattern (rippled, labyrinthine/sinusoidal, carcinoid-like, and petaloid) are rare. Previous studies suggested that the above patterns likely represent variations along a morphological continuum. The objectives of this study were to (1) validate this proposition by studying a large number of cases, (2) determine whether there are specific associations with clinical features, (3) establish their frequency, and (4) determine whether they have any association with Muir-Torre syndrome. Read More

Case Rep Pathol 2018 24;2018:5947870. Epub 2018 Apr 24.

Department of Pathology, UAB, Birmingham, AL, USA.

Hereditary nonpolyposis colorectal carcinoma (HNPCC) is an autosomal dominant genetic disorder characterized by a predisposition towards colorectal carcinoma and other extracolonic neoplasms. Histiocytic sarcoma (HS) is a very rare hematologic neoplasm characterized by a malignant proliferation of cells with histiocytic differentiation. We present the case of a 62-year-old male with previous diagnosis of MTS who presented with metastatic colorectal adenocarcinoma, bilateral papillary renal cell carcinoma, and a new squamous cell carcinoma of the scalp, treated with resection and adjuvant radiation therapy. Read More

Rev Clin Esp 2019 Jan - Feb;219(1):51-52. Epub 2018 May 19.

Servicio de Dermatología, Hospital Clínico Universitario de Valladolid, Valladolid, España.

Jpn J Clin Oncol 2018 Jun;48(6):514-521

Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University.

Background: Muir-Torre syndrome (MTS) is currently considered as a clinical variant of Lynch syndrome (LS). The clinical significance of the screening of patients with MTS-associated cutaneous tumors for the identification of LS has not yet been established. In addition, the prevalence and molecular characteristics of mismatch repair (MMR) protein deficiency in such tumors has scarcely been investigated in the Japanese population. Read More

Dermatol Surg 2019 01;45(1):148-149

Department of Dermatology Case Western Reserve University School of Medicine, Cleveland, Ohio Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.

APMIS 2018 Apr;126(4):353-356

Department of Pathology, Chicago Medical School, North Chicago, IL, USA.

Sebaceous carcinoma of the breast (SCB) is a rare variant of ductal carcinoma arising within the mammary gland and containing at least 50% of malignant cells with sebaceous differentiation. Only 11 cases that adjust to the criteria delineated in the WHO classification have been published in the English literature, to the best of our knowledge. Here, we present the first SCB arising in the context of a deleterious BRCA2 mutation, focusing on the histopathologic and immunohistochemical features of this exceedingly rare tumor. Read More

Dermatol Online J 2017 Nov 15;23(11). Epub 2017 Nov 15.

Albert Einstein College of Medicine, Bronx, New York.

Hereditary Nonpolyposis Colorectal Cancer (HNPCC), also known as Lynch Syndrome, is an autosomal dominant, tumor predisposing disorder usuallycaused by germline mutations in mismatch repair (MMR) genes. A subset of HNPCC, Muir-Torre Syndrome (MTS) also involves MMR gene defects and is generally accepted as a variant of HNPCC. MTS is typicallycharacterized by at least one visceral malignancy and one cutaneous neoplasm of sebaceous differentiation, with or without keratoacanthomas. Read More

Mol Clin Oncol 2018 Feb 8;8(2):306-309. Epub 2017 Dec 8.

Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35233, USA.

Muir-Torre Syndrome (MTS) is a rare hereditary autosomal dominant cancer syndrome and is linked to hereditary non-polyposis colorectal carcinoma (Lynch Syndrome). Individuals develop various skin neoplasms in addition to colorectal, endometrial and upper gastrointestinal malignancies. Therapy-associated myelodysplastic syndrome (T-MDS) is an aggressive hematologic malignancy and is considered a pre-leukemic phase. Read More

Clin Exp Dermatol 2018 Jun 14;43(4):410-415. Epub 2018 Jan 14.

East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

Background: Muir-Torre syndrome (MTS) is a subtype of Lynch syndrome, which encompasses the combination of sebaceous skin tumours or keratoacanthomas and internal malignancy, due to mutations in DNA mismatch repair genes. Sebaceous neoplasms (SNs) may occur before other malignancies, and may lead to the diagnosis, which allows testing of other family members, cancer surveillance, risk-reducing surgery or prevention therapies.

Aim: To evaluate the efficacy of universal immunohistochemistry (IHC) screening of SNs in a service setting. Read More

Gut 2018 11 15;67(11):1957. Epub 2017 Dec 15.

Department of Dermatology Venerology and Allergology, University Hospital Essen, Essen, Germany.

CLINICAL PRESENTATION: A 77-year-old man presented to our skin cancer centre with various cutaneous tumours occurring in 2006-2017. Histopathology showed a 'hidradenocarcinoma' on the left upper back (2006) and a sebaceous adenoma (figure 1) on the left shoulder (2011). In 2017, he developed a sebaceous carcinoma on the middle upper back, which manifested as a slowly enlarging, asymptomatic nodule. Read More

Clin Med (Lond) 2017 Dec;17(6):562-567

Institute of Genetic Medicine, Centre for Life, Newcastle upon Tyne, UK.

This article provides an overview of selected genetic skin conditions where multiple inherited cutaneous tumours are a central feature. Skin tumours that arise from skin structures such as hair, sweat glands and sebaceous glands are called skin appendage tumours. These tumours are uncommon, but can have important implications for patient care. Read More

Pathology 2017 Dec 25;49(7):688-697. Epub 2017 Oct 25.

Dermatopathology Group, Department of Anatomical Pathology, PathWest, Perth, Australia; School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia. Electronic address:

Sebaceous differentiation is commonly seen in cutaneous neoplasms, both in the context of lesions showing predominantly sebaceous differentiation (e.g., sebaceous adenoma, sebaceoma and sebaceous carcinoma), or as more focal sebaceous components in neoplasms with other primary lines of differentiation. Read More

Acta Dermatovenerol Alp Pannonica Adriat 2017 09;26(3):63-66

Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.

Superficial epithelioma with sebaceous differentiation is the original name for a rare benign tumor that lacks consensus in the literature, both in nomenclature and in diagnostic criteria. We report the case of a 68-year-old male with a white papule on the left lower eyelid, fully excised. On histology, the lesion was a superficial, lobulated, plate-like epithelial proliferation, with small mature clusters of sebocytes and ductal structures. Read More

Skinmed 2017 1;15(4):259-264. Epub 2017 Aug 1.

Department of Dermatology, Walter Reed National Military Medical Center, Bethesda MD.

Muir-Torre syndrome is a rare genodermatosis inherited most frequently in an autosomal dominant fashion. Current criteria for its diagnosis include at least one sebaceous tumor and an underlying visceral malignancy. Muir-Torre syndrome is strongly associated with a germline mutation in DNA mismatch repair genes. Read More

JAAD Case Rep 2017 Jul 20;3(4):358-361. Epub 2017 Jul 20.

Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas.

J Cutan Pathol 2017 Nov 29;44(11):931-937. Epub 2017 Aug 29.

Departments of Dermatology and Pathology, Saint Louis University School of Medicine, St. Louis, Missouri.

Muir-Torre syndrome is a clinical variant of Lynch syndrome defined by the synchronous or metachronous occurrence of at least one sebaceous neoplasm and at least one Lynch syndrome-related internal cancer. Although screening guidelines for patients with colorectal carcinomas have been established, screening guidelines for cutaneous Muir-Torre associated neoplasms are not currently available. As such, we reviewed the current evidence for the use of MLH1, MSH2, MSH6 and PMS2 immunohistochemistry when cutaneous Muir-Torre associated neoplasms are encountered. Read More

Rom J Morphol Embryol 2017 ;58(2):599-601

Servicio de Anatomia Patologica, Hospital El Bierzo, Ponferrada, Spain;

Sebaceoma associated with seborrheic keratosis has only been described once in the literature. Herein, we present an additional case in a 69-year-old woman who complained of a multicolored plaque on the left breast. Dermatoscopy showed a central orange lesion with orange globules suggestive of dilated glands. Read More

Curr Treat Options Oncol 2017 08;18(8):47

Department of Dermatology, Columbia University Medical Center, New York, NY, 10032, USA.

Opinion Statement: Sebaceous carcinoma is a rare and potentially aggressive cutaneous malignancy. Commonly reported in the periocular area and the head and neck region, sebaceous carcinoma can arise from any sebaceous gland in the skin. The clinical presentation may be nonspecific, and a biopsy is important to establish a diagnosis and to differentiate from mimickers including benign sebaceous neoplasms, other adnexal tumors, and basal cell carcinoma. Read More

Virchows Arch 2017 09;471(3):435

Department of Pathology and Laboratory Medicine, University of Vermont Medical Center/University of Vermont College of Medicine, Burlington, VT, USA.

Pathol Res Pract 2017 Jun 1;213(6):654-658. Epub 2017 Mar 1.

Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do 431-070, Republic of Korea.

Sebaceous carcinoma (SC) represents a rare, aggressive eyelid malignancy with poor prognosis and is a possible component of Muir-Torre syndrome. However, genetic features as driver mutations or potential therapeutic targets are not fully elucidated. Recent a few studies have shown that SCs have concurrently multiple mutations including RAS/RAF/MAPK and PI3K/Akt pathways via next-generation sequencing in western population. Read More

Surg Case Rep 2017 Dec 23;3(1):71. Epub 2017 May 23.

Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.

Background: Muir-Torre syndrome (MTS) is a rare autosomal dominant genodermatosis caused by mutations in mismatch repair genes. It is characterized by the presence of at least one sebaceous skin tumor associated with internal malignancies. Whether positron emission tomography/computed tomography (PET/CT) is useful for the detection of malignancies in patients with MTS has not been determined. Read More

Hered Cancer Clin Pract 2017 12;15. Epub 2017 May 12.

Department of Genetics, Hôpital Nord, CHU Saint Etienne, 42055 Saint-Etienne Cedex 2, France.

Background: The tumor spectrum in the Lynch syndrome is well defined, comprising an increased risk of developing colonic and extracolonic malignancies. Muir-Torre syndrome is a variant with a higher risk of skin disease. Patients have been described carrying mutations in the mismatch repair genes and presenting tumors with unusual histology or affected organ not part of the Lynch syndrome spectrum. Read More

Virchows Arch 2017 07 13;471(1):129-132. Epub 2017 May 13.

Department of Pathology and Laboratory Medicine, University of Vermont Medical Center/University of Vermont College of Medicine, Burlington, VT, USA.

Surg Pathol Clin 2017 Jun;10(2):367-382

Department of Dermatology, University of Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany; Labor für Dermatohistologie und Oralpathologie, Bayerstrasse 69, 80335 München, Munich, Germany. Electronic address:

Sebaceous skin tumors are classified into sebaceous adenoma, sebaceoma, and sebaceous carcinoma. An additional group of cystic sebaceous tumors indicate the Muir-Torre syndrome (MTS). Cystic sebaceous tumors are considered as morphologic variants of the 3 main categories. Read More

Acta Derm Venereol 2017 Aug;97(8):959-961

Department of Dermatology and Venereology, Université Paris 7, Saint Louis Hospital, FR-75010 Paris, France.

Am J Dermatopathol 2017 Apr;39(4):239-249

Dermatopathology Section Chief, Dermatopathology Section, Department of Pathology and Laboratory Medicine (113), VA Consolidated Laboratories, West Roxbury, MA.

Sebaceous neoplasms such as adenoma, sebaceoma, and carcinoma, although sporadic in their occurrence, are clinically significant because of their association with Muir-Torre syndrome (MTS). MTS is a rare autosomal dominant genodermatosis characterized by the occurrence of sebaceous neoplasms and/or keratoacanthomas and visceral malignancies. MTS is usually the result of germline mutations in the DNA mismatch repair genes MSH2 and, albeit less commonly, MLH1. Read More

Chirurg 2017 08;88(8):699-701

Zentrum für Allgemein-, Viszeral- und Gefäßchirurgie, Klinikum Wolfsburg, Sauerbruchstrasse 7, 38440, Wolfsburg, Deutschland.

Ann Dermatol Venereol 2017 Aug - Sep;144(8-9):525-529. Epub 2017 Feb 27.

Clinique dermatologique, hôpitaux universitaires de Strasbourg, université de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.

Introduction: Lynch syndrome (LS) is a syndrome that carries a genetic predisposition to certain cancers associating, either in a single individual or in a family, a visceral tumour, mainly colorectal, with a high risk of other synchronous or metachronous cancers. LS is linked with mutations in the genes coding for proteins in the DNA repair system. Phenotypic variants of SL exist, including Muir-Torre syndrome (MTS) and Turcot syndrome (TS), both of which predispose to colorectal cancer. Read More

Cesk Patol Winter 2017;53(1):35-37

We report the case of a 44-year-old female with sebaceous adenoma arising in mature cystic teratoma of the ovary. The patient had a tumor in the left ovary; 125 x 90 x 70 mm. Microscopically, the tumor consisted of structures typical of dermoid cysts. Read More

Int J Dermatol 2017 Jul 8;56(7):746-749. Epub 2017 Feb 8.

Mayo Clinic Arizona, Scottsdale, AZ, USA.

Background: Though a rare tumor, sebaceous carcinoma is relatively well-described in immunocompetent patients, in whom it often occurs in a periorbital distribution where it has an overall poor prognosis with a high metastasis rate. The effect of transplant-related immunosuppression on the development of sebaceous carcinoma and its outcomes has not been characterized.

Methods: We collected 9 cases from a single institution of patients developing sebaceous carcinoma after solid organ transplantation. Read More

Dermatol Surg 2017 Feb;43(2):281-286

*Department of Dermatology, Roswell Park Cancer Institute, Buffalo, New York;†Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri.

Background: Sebaceous carcinoma is a rare and potentially aggressive adnexal neoplasm with historic data indicating high rates of recurrence, metastasis, and cancer-specific mortality.

Objective: To evaluate the incidence of local recurrence, metastasis, disease-specific mortality, and all-cause mortality and to identify work-up approaches.

Patients And Methods/materials: Retrospective review of patients with sebaceous carcinoma treated with Mohs micrographic surgery between 2001 and 2013 at one institution. Read More

Eur J Dermatol 2017 Feb;27(1):54-58

Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan.

Background: Muir-Torre syndrome (MTS) is characterized by sebaceous neoplasms with internal malignancies and regarded as a variant of hereditary nonpolyposis colorectal cancer (HNPCC). Pathogenic variations of MTS have been identified in the MSH2, MLH1, and MSH6 genes, with the majority of variations located in MSH2.

Objectives: To present an MTS patient who was the only individual with skin malignancies within a cancer-prone pedigree and to show the usefulness of RNA-based genetic analysis in the investigation of MTS. Read More

Head Neck Pathol 2017 Sep 21;11(3):364-376. Epub 2017 Jan 21.

Department of Histopathology, King's College Hospital, London, SE5 9R, UK.

Several autosomal dominant inherited tumour syndromes demonstrate prominent features in the oral and maxillofacial region. Although multiple organ systems are frequently involved, the target organs more frequently affected are the skin (nevoid basal cell carcinoma syndrome, Brooke-Spiegler syndrome, Birt-Hogg-Dube syndrome and Muir-Torre syndrome), gastrointestinal tract (Peutz-Jegher syndrome and Gardner syndrome) or endocrine system (multiple endocrine neoplasia type 2b and hyperparathyroidism-jaw tumour syndrome). In some syndromes, the disease is multisystem with skin index lesions presenting in the head and neck (Cowden syndrome and tuberous sclerosis complex). Read More

Am J Dermatopathol 2016 Dec;38(12):915-923

*Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Prague, Czech Republic; †Bioptical Laboratory, Pilsen, Czech Republic; and ‡Department of Dermatology, Regional Hospital, Sumperk, Czech Republic.

A 76-year-old white male with a history of adenocarcinoma of the rectosigmoideum and multiple colonic polyps removed at the age of 38 and 39 years by an abdominoperitoneal amputation and total colectomy, respectively, presented with multiple whitish and yellowish papules on the face and a verrucous lesion on the trunk. The lesions were surgically removed during the next 3 years and a total of 13 lesions were investigated histologically. The diagnoses included 11 sebaceous adenomas, 1 low-grade sebaceous carcinoma, and 1 squamous cell carcinoma. Read More

Int J Dermatol 2017 Feb 21;56(2):e26-e27. Epub 2016 Nov 21.

Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, USA.