Evaluation of cytodiagnosis of cutaneous basal cell carcinoma

Cytologic and histopathologic diagnoses were assessed independently without clinical details in 150 lesions from 112 consecutive patients. Nine of the lesions (6%) could not be evaluated cytologically because of unsatisfactory smears. Correct cytodiagnosis was obtained in 125 of 141 (89%) evaluable lesions. A solar keratosis with prominent basal cell hyperplasia was incorrectly assessed as a basal cell carcinoma (BCC). Five BCCs were misdiagnosed as squamous atypia, either because the smears were not representative or from inability to distinguish between pleomorphic BCC and severe squamous atypia. An incorrect cytologic diagnosis was thus made in 4% of lesions. Smears from ten lesions (7%) were reported as nondiagnostic for the same reasons. Cytologic diagnosis is simple, rapid, and accurate and is of value in the management of suspected cutaneous BCC.     

Evaluating the impact of WaterCell® Technology on pressure redistribution and comfort/discomfort of adults with limited mobility

Aim of the study

The aim of the study was to evaluate the effect of WaterCell^® Technology on pressure redistribution and self-reported comfort and discomfort scores of adults with mobility problems who remain seated for extended periods of time.

Contact dermatitis in a spinal injuries centre

A routine patch testing survey carried out on 122 patients in the National Spinal Injuries Centre at Stoke Mandeville Hospital showed that 40.1% of the patients studied gave positive patch test results to medicaments and other topical applications. The incidence of positive results was higher in patients with a history of pressure sores (45.1%) than in those who had never had sores (33.3%). The significance of these results is discussed.     

Epidemiology of the herpes simplex viruses

The two types of herpes simplex virus—HSV-1 and HS V-2—are morphologically indistinguishable and consist of 150-mm particles with a DNA-containing core that is enclosed in an envelope. The two virus types can be distinguished by biologic, biochemical, and antigenic properties; however, the typical clinical lesions associated with infections by the two viruses are very similar. Generally, HSV-1 has been isolated from oral-facial lesions, as well as from cases of herpetic keratoconjunctivitis and encephalitis, while HSV-2 has been recovered from genital lesions, infants with neonatal systemic herpes, and cases of herpetic meningitis.¹ These associations of virus types with clinical diseases are not absolute.HSV-1 or HSV-2 may produce a number of clinically distinguishable illnesses. Each of these illnesses has certain epidemic-logic features that are unique. For example, Kaposi's varicelliform eruption represents a generalized cutaneous infection occurring primarily among persons suffering from atopic eczema^2–4 or Darier's disease.⁵ Herpetic whitlow occurs commonly among physicians, dentists, and nurses who occupations require manual contact with individuals who may be shedding virus.^6–8 A form of cutaneous herpes has been described among wrestlers and has been called herpes gladiatorium.^9,10 Anorectal herpes has been reported with increasing frequency, and the majority of cases reported have occurred in homosexual men.^11,12 Aseptic meningitis is an occasional complication of genital herpetic infections and occurs mostly in young adults.^13–15 The vast majority of illness, however, results from infections initiated in the oral cavity or the genital tract, and these will be considered in more detail.Our knowledge of the epidemiology of HSV-1 and HSV-2 comes from studies that have varied considerably in design and in the populations examined. The epidemiology of clinical illnesses has been delineated primarily by periodically examining patients in described populations or from questionnaire surveys. Information about the occurrence of infections, many of which are asymptomatic, has come from serologic surveys or from surveys of virus shedding. Each method has limitations and the conclusions drawn from these different approaches have not always been similar. In this review, the conclusions drawn are those that are most consistent with the data available.     

Epidemiology of HPV infections

Since the infectivity of various HPVs cannot be studied otherwise, the only available information about this important question is provided by clinical and epidemiologic observations of warts.     

An Unusual Form of Skin Tuberculosis Following B.C.G. Vaccination

A 25-year-old female has had brown to erythematous telangiectatic patches and grouped papules on her face, neck, arm, and trunk since childhood following B.C.G. vaccination. Histopathologically, the lesions consisted of hyperkeratosis, slight acanthosis, tuberculoid granulomas with some Langerhans type giant cells in the mid-dermis. Although various forms of cutaneous tuberculosis after B.C.G. vaccination have been reported, it was difficult for us to assign the patient's skin lesion to any specific disease entity. Remission of her cutaneous lesions occurred clinically and histopathologically after treatment with isoniazid and rifampin.     

Immunoperoxidase examination of cutaneous infiltrates of mycosis fungoides and large-plaque atrophic parapsoriasis with OKT10

A monoclonal antibody (OKT10), which was developed recently, reacts with pro-thymocytes, T cell acute lymphoblastic leukemia (ALL) cells, cells in normal bone marrow (including plasma cells), and activated T cells. Tissues from patients with cutaneous T cell lymphoma were studied for the presence of OKT10-reactive cells with the use of an indirect immunoperoxidase technic. OKT10-reactive cells were identified in three of eight cases of mycosis fungoides, one of two cases of Sézary syndrome, with an equivocal reaction in one of ten cases of large-plaque parapsoriasis and in one of seven positive patch tests (allergic contact dermatitis). The biologic and possible clinical implications are discussed.     

L.E.A.P.ing into the cosmetic consult

Establishing good rapport with patients is important during the initial consult, especially in aesthetic medicine. While experienced physicians develop expertise in cultivating a positive patient experience, younger physicians may benefit from some guidance. We describe the L.E.A.P (Listen, Educate and Empower, Align, Perform) method which may help guide young physicians through a successful cosmetic consult. In addition we will review the B.L.A.S.T (Believe, Listen, Apologize, Satisfy, Thank) method for dealing with unhappy patients.     

The edema of fiddler's neck.

Fiddler's neck is a dermatosis of violinists and violists. It characteristically presents as focal lichenification and pigmentation on the left side of the neck. Edema may also occur in the same area and lead to cosmetic concern or fear of malignancy. The edema apparently results from pressure on the patient's neck by the base of the violin or viola and is worsened by holding the instrument in a drooping position.