Leiomyosarcoma of the skin: review of the literature with an emphasis on prognosis and management

Leiomyosarcoma (LMS) of the skin is rare, and no management guideline currently exists. Although LMS is historically classified as either dermal (cutaneous) or subcutaneous, definition for its classfication is inconsistent in the literature. Studies on the managenent of LMS are scarce, and there is no consensus on the appropriate surgical margin for the treatment of LMS. While a 1 cm margin may be sufficient in cutaneous LMS, wider margins may be required for subcutaneous tumors. Mohs micrographic surgery is a promising surgical modality for the treatment of cutaneous LMS. In this review, current knowledge on LMS is summarized and a practical approach to the management of this rare neoplasm is proposed.     

Melanoma arising in a patient with ataxia-telangiectasia: A call for full skin examinations in this patient population

Ataxia-telangiectasia (A-T) is an autosomal recessive, multisystem disorder characterized by cerebellar ataxia and oculocutaneous telangiectasias that present in early childhood. Increased incidence of malignancy is also associated with A-T. Hematopoietic malignancies occur most commonly, with a majority being lymphoid cancers; however, there is a risk for other malignancies, such as breast, gastric, and other solid tumors. Herein, we report the case of a 28-year-old woman with A-T with melanoma.     

Men at risk for paradoxical adipose hyperplasia after cryolipolysis

Cryolipolysis, an aesthetic procedure that reduces adipose tissue by exposure to cold temperature, is generally well tolerated with mild side effects including temporary numbness, erythema, and tenderness. However, as cryolipolysis is gaining popularity and more treatments are being performed, reports of rare adverse events including delayed onset pain and paradoxical adipose hyperplasia (PAH) have been described. Recent studies have suggested that PAH can be more common than expected and have a predilection for males, as a disproportionate number of the cases reported in the literature have occurred in men despite the fact that fewer men are likely to be treated with cryolipolysis. Sexual dimorphism in adipose anatomy may provide insight into the increased susceptibility of men to PAH. Careful patient selection avoiding men with visceral abdominal adipose and firm, nondistensible, fibrous fat may be important to minimize the risk of PAH.     

'Pregnancy Tumour' of the Nasal Septum

Summary: The origins of pyogenic granulomas are subject to much debate. It is viewed as overexuberant growth of epithelium and capillary loops (i.e. granulation tissue) in response to trauma by some authorities, and is considered a capillary haemangioma with a unique lobular organization by others. Although the pathogenesis of the lesion is unclear, marked variation in sexual distribution suggests a hormonal factor, and the profound metabolic and endocrine changes in pregnancy seem to provide especially fertile soil for its growth. Its appearance and rapid rate of growth might easily lead the practitioner to mistake its identity for something more ominous.     

Meta‐Analysis of Randomized,Controlled Trials Comparing Particular Doses of Griseofulvin and Terbinafine for the Treatment of Tinea Capitis

Abstract: Two oral antifungal agents, griseofulvin and terbinafine, have regulatory approval in the United States, but it is unknown whether one has superior overall efficacy. Genus‐specific differences in efficacy are believed to exist for the two agents. It is not clear at what doses and durations of treatment these differences apply. The goals of this meta‐analysis were to determine whether a statistically significant difference in efficacy exists between these agents at a given dose and duration of each in tinea capitis infections overall and to determine whether a genus‐specific difference in efficacy exists for these two treatments at a given dose and duration of each. We performed a literature search for clinically and methodologically similar randomized controlled trials comparing 8 weeks of griseofulvin (6.25–12.5 mg/kg/day) to 4 weeks of terbinafine (3.125–6.25 mg/kg/day) in the treatment of tinea capitis. A meta‐analysis was performed using the Mantel–Haenszel method and random effects model; results were expressed as odds ratios with 95% confidence intervals. Meta‐analysis of randomized controlled trials did not show a significant difference in the overall efficacy of the two drugs at the doses specified, but specific efficacy differences were observed based on the infectious species. For tinea capitis caused by Microsporum spp., griseofulvin is superior (p = 0.04), whereas terbinafine is superior for Trichophyton spp. infection (p = 0.04). Our results support species‐specific differences in treatment efficacy between griseofulvin and terbinafine and provide a clinical context in which this knowledge may be applied.