Merkel cell carcinoma (MCC) is an aggressive neuroendocrine skin cancer that carries a 5-year survival rate of 65%. Optimal management of MCC remains controversial. In this single-institution case series and literature-based meta-analysis, Gupta et al examine the impact of sentinel lymph node biopsy (SLNB) on staging and disease-free survival in MCC. In 122 patients with no nodal disease by clinical evaluation, SLNB revealed nodal involvement in 39 cases. These SLNB-positive patients would have been clinically and radiologically understaged without SLNB. Most important, these SLNB-positive patients might not have been otherwise offered adjuvant therapy, which was demonstrated to profoundly diminish their relapse rate at 1 year.
Coccidioidomycosis (CM) is endemic in arid and semi-arid regions of North and South America. Inhalation of the spores of any of the causative Coccidioides species may produce respiratory infection in both healthy and immunocompromised persons. Infections are typically mild or asymptomatic, although severe illness or death may rarely occur. In this case series, DiCaudo et al describe 3 patients with an acute reactive exanthema associated with pulmonary CM. Although erythema nodosum remains the most well-recognized reactive eruption associated with this infection, the presence of an acute generalized exanthem in the appropriate clinical setting should raise the clinical suspicion for pulmonary CM.
Light-skinned individuals are at higher risk for melanoma than those with darker pigmentation. Improved secondary prevention measures with earlier detection of thin, early-stage melanomas may account for the observed improvement in melanoma survival in white populations. Hispanics and blacks continue to have poorer survival rates. In this retrospective analysis of melanoma cases reported to the Florida Cancer Data System, Hu et al found that Hispanics and blacks residing in Miami-Dade County had a more advanced stage of melanoma at presentation than non-Hispanic whites. This racial disparity demonstrates the suboptimal secondary prevention efforts in minority populations, highlighting a significant public health concern for Hispanics, who are among the fastest growing minority groups in the United States.
Nonmelanoma skin cancer, including squamous cell carcinoma in situ (SCCis) is the most common skin cancer among whites, and the incidence continues to rise. Current therapeutic options, including cryotherapy, curettage, excision, and topical fluorouracil, are limited by pain, slow healing, prolonged treatment course, and local irritation. In this randomized, placebo-controlled study, Morton et al demonstrate that photodynamic therapy using topical methyl aminolevulinate is a simple, noninvasive procedure that is a well tolerated, effective treatment option for SCCis, with a favorable cosmetic outcome.
Tufted angioma (TA) is an uncommon, benign vascular tumor of infancy or early childhood. Most cases are sporadic, although familial cases have been reported. The Kasabach-Merritt phenomenon appears to be a rare complication of TA. In this case series, Browning et al describe 5 new cases of congenital TAs that spontaneously regressed. The authors suggest that regression may be a phenomenon more common to lesions that are present at birth and early infancy rather than with a later presentation. This observation should be considered for otherwise uncomplicated congenital or early infantile cases of TA prior to considering intervention.
This Month in Archives of Dermatology. Arch Dermatol. 2006;142(6):670. doi:10.1001/archderm.142.6.670