Shave Biopsy Research Articles

Cutaneous Atypical Fibroxanthoma With Osteoclast-Like Giant Cell: A Rare but Diagnostic Pitfall.

Atypical fibroxanthoma (AFX) is a dermal-based, low-grade neoplasm with no specific lineage of differentiation. The occurrence of AFX with osteoclast-like giant cells is exceptionally rare. Less than 20 cases have been reported in the literature. A 77-year-old man with a medical history of multiple basal and squamous cell carcinomas of the skin, presented with a progressively growing erythematous nodule on the sun-damaged right central parietal scalp. A shave biopsy showed a dermal spindle cell proliferation accompanied by numerous osteoclast-like multinucleated giant cells and predominant atypical mitotic figures. The immunohistochemical staining showed a diffuse positive staining for CD68 and SMA, patchy staining for CD10, and negative staining for SOX-10, pan-cytokeratin, CK5/6, S100, CD34, and desmin. The tumor was completely excised with negative margins. A subsequent follow-up over a period of 13 months showed no recurrence. Distinguishing AFX with osteoclast-like giant cells from both malignant and benign skin lesions with osteoclast-like giant cells is crucial. Although AFX tumors display worrisome malignant histologic features, most cases have a favorable prognosis with a local recurrence rate below 5% and exceedingly rare metastasis.

Delayed Nipple-Areola Complex Radiotherapy after Nipple Sparing Mastectomy and Immediate Reconstruction for Invasive Breast Cancer or DCIS: Long-Term Results of a Phase I Study

To report long-term outcomes of a novel nipple-sparing approach in patients with DCIS or early-stage breast cancer that would not be eligible for nipple sparing mastectomy due to multifocality/multicentricity or tumor less than 2 cm from the nipple-areola complex (NAC). We conducted a phase I pilot study approved by Institutional IRB. Eligible patients had a biopsy confirming DCIS or invasive breast cancer, and a surgical recommendation for mastectomy due to extent of disease, with tumor at least 1 cm from the NAC. Nipple sparing mastectomy (NSM) was performed after negative shave biopsy behind the nipple was obtained at time of surgery, followed by immediate reconstruction per plastic surgeon's preference. NAC RT was administered 5 to 8 weeks postoperative. A 3+3 dose-escalation design was used to test RT doses of 25, 30, 35 Gy in 10 fractions, given BID, 6 hours apart with electrons. Dose-limiting toxicity (DLT) was specified as RT-related NAC loss or any grade 4/5 AE up to 1-month from end of RT. Adverse events were assessed using CTCAE. v 4.0. Patients completed cosmesis and satisfaction assessment at standard follow up visits. From 2010-2017, 18 women were treated on the study, 6 per dose level. Median age was 45.5 (range 30-63). 100% of patients were White, of those 44.5% were Hispanic. 17% had DCIS and 83% had invasive breast cancer (all ER+, 14 pStage T1N0, 1 pStage T1N1mi). Endocrine therapy was given to all ER+ invasive breast cancer patients. With a median F/U of 80.5 months, there was no RT-related DLT or grade 4/5 AEs (73 G1, 15 G2, 6 G3). All grade 3 AEs were related to the surgery (infection, pain, allergy to tape). There was no local recurrence in the NAC, with 100% of nipple preservation with longer follow up. Two patients developed metastases 2 years after diagnosis (bone, liver). 1 DCIS patient developed a second ipsilateral breast cancer away from the NAC, later found to have BRCA2+ mutation. Patient reported cosmesis at last visit was 72% excellent, 16.5% good, and 5.5% poor. Physicians score worse cosmesis compared to patients with 39% scored excellent and 61% good. Patient reported satisfaction with nipple sparing treatment was high, with 94% of patients choosing this treatment again. This novel approach of nipple preserving therapy using delayed adjuvant NAC RT after nipple sparing mastectomy, resulted in 100% nipple preservation without compromise of local control, in this specific patient population not eligible for nipple sparing mastectomy alone. This study supports further exploration of nipple preservation with a broader inclusion criterion.

40838 Outcomes of 3400 shave biopsies on the clearance of nonmelanoma skin cancer: benefits and limitations

40838 Outcomes of 3400 shave biopsies on the clearance of nonmelanoma skin cancer: benefits and limitations

Primary Cutaneous Epithelioid Mesenchymal Tumor With a Novel ATP2B4::GLI1 Gene Fusion.

GLI1 gene alterations (rearrangement or amplification) have been found in several bone and soft tissue tumors including pericytic tumors, gastric plexiform fibromyxoma, gastroblastoma, and a various group of epithelioid tumors with regional recurrence or distant metastasis. In this article, we describe a case of primary cutaneous epithelioid mesenchymal tumor harboring hitherto not reported ATP2B4::GLI1 gene fusion. A 42-year-old man presented with a growing firm lesion on the left postauricular scalp. Microscopically, the shave biopsy specimen revealed a dermal-based nodular proliferation of relatively monotonous epithelioid cells with round to ovoid nuclei and pale eosinophilic cytoplasm, accompanied by prominent stromal vasculature. Significant cytologic atypia, necrosis, and mitotic activity were absent. The tumor cells were partially positive for CD34 and S-100 protein, but were negative for other markers, including SOX-10, keratins, and myogenic markers. An ATP2B4::GLI1 gene fusion was identified by next-generation sequencing. Array CGH was also performed, but it did not show relevant chromosomal copy number changes. Awareness of this rare cutaneous tumor, and thus, reporting of additional cases is necessary for further delineating its full clinicopathologic spectrum.

GENEvaRX: A novel AI-driven method and web tool can identify critical genes and effective drugs for Lichen Planus

Lichen planus (LP) is an autoimmune disorder diagnosed based on physical symptoms and lab tests. Examples of symptoms include flat bumps, and itchy and purplish skin while lab tests include a shave biopsy of the lesion. When the pathology report shows consistency with LP and is negative for potential triggers for an allergy test and hepatitis C, a dermatologist typically prescribes corticosteroid in the form of pills or injection into the lesion to treat the symptoms. To understand the molecular mechanism of the disease and thereby overcome issues associated with disease treatment, there is a need to identify potential effective drugs, drug targets, and therapeutic targets associated the LP. Hence, we propose a novel computational framework based on new constrained optimization to support vector machines coupled with enrichment analysis. First, we downloaded three gene expression datasets (GSE63741, GSE193351, GSE52130) pertaining to healthy and LP patients from the gene expression omnibus (GEO) database. We then processed each dataset and entered it into our computational framework to select important genes. Finally, we performed enrichment analysis of selected genes, reporting the following results. Our methods outperformed baseline methods in terms of identifying disease and skin tissue. Moreover, we report 5 drugs (including, dexamethasone, retinoic acid, and quercetin), 45 unique genes (including PSMB8, KRT31, KRT16, KRT19, KRT17, COL3A1, LCE2D, LCE2A), and 23 unique TFs (including NFKB1, STAT1, STAT3), reportedly related to LP pathogenesis, treatments, and therapeutic targets. Our methods are publicly available in the GENEvaRX web server at https://aibio.shinyapps.io/GENEvaRX/.

DE05 Designing and implementing dermatology procedural video education for trainees

Abstract Surgical exposure can be varied during specialty training in dermatology. During the COVID-19 pandemic, this was compounded by the reduction in face-to-face teaching, adding a further barrier for trainees trying to access practical skills training. We sought to enable uniform, accessible and inclusive teaching of common biopsy techniques to improve the confidence and proficiency of dermatology trainees in performing these procedures, through a virtual self-directed format. We produced a series of concise educational videos detailing the biopsy consent process and instructional videos on techniques for punch biopsy, shave biopsy, incisional biopsy and simple excisions. Each video was ∼10 min in length with demonstration of the technique on porcine skin in real-time and step-by-step narration. The videos were developed according to up-to-date recommendations of best practice, including those from the British Society of Dermatological Surgery. We used multidisciplinary expert input from Mohs surgeons, specialist nurse practitioners, dermatopathologists, clinicians with expertise in medical education, learning innovation advisors and media experts. We highlighted important learning points for trainees during the videos such as common biopsy indications and complications, practical pitfalls and techniques to enhance biopsy efficiency, diagnostic yield and cosmetic outcome. Our educational videos were launched initially at a large teaching hospital in the UK and watched by 25 dermatology trainees, with plans for upcoming open-access via our education website. The effectiveness of our learning material was evaluated through a preintervention survey of trainees to gauge prior exposure to dermatology surgery, followed by a postintervention survey. We found evidence of a lack of exposure to procedural dermatology among trainees in the preintervention survey, with improvements in trainee confidence reported following the educational videos. Delivering procedural videos through an accessible online resource is beneficial for dermatology trainees and allied healthcare professionals performing biopsies and diversifies the modality of procedural dermatology education. An online video format provides self-directed education that has flexibility and enables repeated access to reinforce learning, which complements and enhances in-person practical teaching.

PA23 Primary cutaneous Ewing sarcoma in a 14-year-old boy

Abstract A 14-year-old boy presented with a 7-month history of a nodule on the right shoulder. It was initially pink and pea-sized but developed black areas as it grew. It was nontender but bled occasionally. He was otherwise well and took no regular medications. He was originally from the Philippines, having moved to the UK 2 years previously. His mother had a history of breast cancer. This was suspected to be a pyogenic granuloma and treated with a shave biopsy. Histology showed largely patternless sheets of small, blue, round cells, with diffuse and strong membranous reactivity for CD99 on immunohistochemistry. Further molecular analysis revealed EWSR1–FLI1 fusion, confirming Ewing sarcoma. Staging imaging showed no metastatic disease. Following further surgery, he was treated as per the Euro-Ewing protocol with vincristine (V), doxorubicin (D), cyclophosphamide (C), ifosfamide (I), etoposide (E; nine induction cycles: alternate VDC/IE followed by five consolidation cycles IE/VC). Ewing sarcoma most commonly arises from bone and is the second most common bone malignancy in children with an incidence of 2.93 per million. Primary cutaneous Ewing sarcoma is extremely rare, with most of the literature consisting of case reports. A 2015 retrospective review of 56 cases of cutaneous/subcutaneous Ewing sarcoma from the UK and France found that most cases were on the extremities (48%) or trunk (39%). Primary cutaneous Ewing sarcoma tends to occur in late-adolescent or young-adult females, whereas bone disease affects younger patients with a male predominance. Current treatment is similar to treatment for Ewing arising from bone. However, primary cutaneous Ewing sarcoma has a more favourable prognosis, with a 5-year overall survival rate of 93.8%. In summary, cutaneous Ewing sarcoma is a very rare malignancy, particularly in the paediatric population. It is important to consider this in the differential diagnosis of erythematous nodular lesions in children, in order to minimize delays in treatment.

Environmental and economic considerations for diagnostic biopsies in basal cell carcinomas. Comment on 'Biopsy type does not affect the number of stages during Mohs micrographic surgery: a retrospective study'.

Where there is clinical equipoise in the type of diagnostic biopsy undertaken, clinicians should account for the environmental and economic impact and opt for shave biopsies, rather than punch biopsies, more frequently.

The diagnosis and initial management of melanoma in Australia: findings from the prospective, population-based QSkin study.

To determine the proportions of newly diagnosed melanomas treated by different medical specialist types, to describe the types of excisions performed, and to investigate factors associated with treating practitioner specialty and excision type. Prospective cohort study; analysis of linked data: baseline surveys, hospital, pathology, Queensland Cancer Register, and Medical Benefits Schedule databases. Random sample of 43 764 Queensland residents aged 40-69 years recruited during 2011, with initial diagnoses of in situ or invasive melanoma diagnosed to 31 December 2019. Treating practitioner type and treatment modality for first incident melanoma; second and subsequent treatment events for the primary melanoma. During a median follow-up of 8.4 years (interquartile range, 8.3-8.8 years), 1683 eligible participants (720 women, 963 men) developed at least one primary melanoma (in situ melanoma, 1125; invasive melanoma, 558), 1296 of which (77.1%) were initially managed in primary care; 248 were diagnosed by dermatologists (14.8%), 83 by plastic surgeons (4.9%), 43 by general surgeons (2.6%), and ten by other specialists (0.6%). The most frequent initial procedures leading to histologically confirmed melanoma diagnosis were first excision (854, 50.7%), shave biopsy (549, 32.6%), and punch biopsy (178, 10.6%); 1339 melanomas (79.6%) required two procedures, 187 (11.1%) three. Larger proportions of melanomas diagnosed by dermatologists (87%) or plastic surgeons (71%) were in people living in urban areas than of those diagnosed in primary care (63%); larger proportions of melanomas diagnosed by dermatologists or plastic surgeons than of those diagnosed in primary care were in people with university degrees (45%, 42% v 23%) or upper quartile clinical risk scores (63%, 59% v 47%). Most incident melanomas in Queensland are diagnosed in primary care, and nearly half are initially managed by partial excision (shave or punch biopsy). Second or third, wider excisions are undertaken in about 90% of cases.

Treatment of Cutaneous Lesions in a Case of Blue Rubber Bleb Nevus Syndrome

Blue rubber bleb nevus syndrome (BRBNS), sometimes called Bean syndrome, is a rare sporadic congenital vascular disorder characterized by multiple venous malformations in various organ systems, most commonly the skin and gastrointestinal tract. The presence of characteristic skin lesions is often the first suggestion of this diagnosis, though chronic anemia and intestinal bleeding are also commonly present. We report a case of a patient with painful lesions on the plantar surfaces of the feet and a new cutaneous growth on the left labia majora. The plantar lesions were treated with Nd:YAG laser and the lesion on the labia majora was removed with a shave biopsy.

Biopsy type does not affect the number of stages during Mohs micrographic surgery: a retrospective study.

Mohs micrographic surgery (MMS) is the treatment of choice for high-risk basal cell carcinoma (BCC). However, there are no evidence-based recommendations regarding which biopsy type is more appropriate to obtain tumour samples prior to MMS. Shave or punch biopsies are performed depending on the clinical characteristics of the tumour, surgeon experience and local protocols. However, biopsy type might result in difficult histopathological interpretation and influence the practical implementation of MMS. We performed a retrospective study on 208 consecutive BCCs treated with MMS. Of the 208 BCC biopsies, 42 (20.2%) were obtained by the shave method and 166 (79.8%) via punch. Those obtained with the shave technique had a mean of 1.64 stages vs. 1.69 stages with the punch technique (P = 0.130). These findings suggest biopsy type does not affect Mohs surgery performance. The biopsy type of choice is the one deemed adequate for each specific case to obtain a diagnosis and tumour subtyping.

Clinical Impact and Accuracy of Shave Biopsy for Initial Diagnosis of Cutaneous Melanoma

IntroductionEffective treatment of malignant melanomas is dependent upon accurate histopathological staging of preoperative biopsy specimens. While narrow excision is the gold standard for melanoma diagnosis, superficial shave biopsies have become the preferred method by dermatologists but may transect the lesion and result in inaccurate Breslow thickness assessment. This is a retrospective cohort study evaluating an initial method of biopsy for diagnosis of cutaneous melanoma and indication for reoperation based on inaccurate initial T-staging. MethodsWe retrospectively analyzed consecutive patients referred to the Medical College of Wisconsin, a tertiary cancer center, with a diagnosis of primary cutaneous melanoma. Adult patients seen between 2015 and 2018 were included. Fisher's exact test was used to assess the association between method of initial biopsy and need for unplanned reoperation. ResultsThree hundred twenty three patients with cutaneous melanoma from the head and neck (H&N, n = 101, 31%), trunk (n = 90, 15%), upper extremity (n = 84, 26%), and lower extremity (n = 48, 28%) were analyzed. Median Breslow thickness was 0.54 mm (interquartile range = 0.65). Shave biopsy was the method of initial biopsy in 244 (76%), excision in 23 (7%), and punch biopsy in 56 (17%). Thirty nine (33%) shave biopsies had a positive deep margin, as did seven (23%) punch biopsies and 0 excisional biopsies. Residual melanoma at definitive excision was found in 131 (42.5%) of all surgical specimens: 95 (40.6%) shave biopsy patients, 32 (60.4%) punch biopsy patients, and four (19.0%) excision biopsy patients. Recommendations for excision margin or sentinel lymph node biopsy changed in 15 (6%) shave biopsy patients and five (9%) punch biopsy patients. ConclusionsShave biopsy is the most frequent method of diagnosis of cutaneous melanoma in the modern era. While shave and punch biopsies may underestimate true T-stage, there was no difference in need for reoperation due to T-upstaging based on initial biopsy type, supporting current diagnostic practices. Partial biopsies can thus be used to guide appropriate treatment and definitive wide local excision when adjusting for understaging.

Relationship between Clusters of Differentiation 4 Count and Type of Human Papilloma Virus with Giant Condyloma Acuminata

BACKGROUND: Condyloma acuminata (CA) is a sexually transmitted infection caused by the human papilloma virus (HPV). HPV infection is increasing in immunosuppressed patients which causes the development of CA lesions to be longer, recurrent, and larger. Clusters of differentiation 4 (CD4) count showed an association with the occurrence of giant condyloma acuminata (GCA). AIM: The aim of the study was to determine the relationship between CD4 count and type of HPV with GCA. SUBJECTS AND METHODS: This study was an analytic and observational study with a cross-sectional design with 20 human immunodeficiency virus-infected subjects (10 GCA and 10 non-GCA) selected using the consecutive sampling technique. CD4 examination using blood samples which were analyzed using fluorescence-activated cell sorting. CA lesions were taken using a shave biopsy technique and then the HPV type was examined using the polymerase chain reaction method. RESULTS: The majority of the study subjects were male with GCA 7 people (41.2%). The most age group was 26–35 years old with GCA 6 people (66.7%). The education of the subjects was mostly senior high school with GCA 9 people (56.2%). The employment of the subjects was mostly service and sales personnel with GCA 4 people (57.1%). Based on the location of the GCA lesions, there were 4 people (57.1%) in the genital area and 6 people (46.2%) in the anal area. A total of 9 people (90%) with GCA had severe immunosuppression. The results of the analysis showed that there was a significant relationship between CD4 count and GCA (p < 0.001). The most common HPV type in GCA was HPV-11, amounting to 6 people (46.2%). The results of the analysis showed that there was no significant relationship between the type of HPV and GCA (p = 0.275). CONCLUSION: There is a significant relationship between CD4 count with GCA and there is no relationship between type of HPV with GCA.

575 - New Initiative: Perform Skin Shave Biopsies By Advance Practice Providers in an Ambulatory Blood and Marrow Transplant Clinic

575 - New Initiative: Perform Skin Shave Biopsies By Advance Practice Providers in an Ambulatory Blood and Marrow Transplant Clinic

Diagnosis of Kaposi’s sarcoma

Kaposi’s sarcoma has a picture reminiscent of several skin conditions, so further testing is needed to show the diagnosis of Kaposi’s sarcoma. Lymphatic endothelium cells infected with KSHV or human herpesvirus 8 form the basis of Kaposi’s sarcoma (KS), a multicentric tumor (HHV-8). These macules and plaques might be purple, reddish-blue or dark brown-black in color. KS is distinguished by this look.” Inflamed, ulcerated nodular lesions are common. They are neither unpleasant or uncomfortable, and the overlying skin or underlying tissues seldom die as a result of them. The gold standard examination in establishing the diagnosis of KS is histopathology. Several techniques that can be used for histopathological tissue retrieval are punch biopsy, shave biopsy, excision biopsy and incision biopsy. Immunohistochemical examination can also be performed to rule out the differential diagnosis. Immunohistochemical examination that we can do is with LANA-1, CD 34, CD 31, D2-40. Diagnosis of Kaposi’s sarcoma is difficult to diagnose only from a clinical picture, so similar diagnoses, i.e. histopathological and immunohistochemical examinations, are required.

A Rare Case of Cutaneous Anaplastic Large Cell Lymphoma in an Adolescent Female

Primary cutaneous anaplastic large cell lymphoma (C-ALCL) is a CD30 positive lymphoproliferative disorder, which is the second most common group of cutaneous T-cell lymphomas. It is common in adults 50-70 years of age with a male to female ratio 2:1. Here, we report a 14-year-old Caucasian female who presented with a painless, growing, friable, hemorrhagic nodule on her right medial buccal cheek of 2 weeks’ duration. The lesion was traumatized during a basketball game and significant bleeding was noted. A shave biopsy was performed on the 1.7 cm x 1.3 cm lesion. Histopathology demonstrated epidermal necrosis, acanthosis, large atypical lymphocytes with a number mitoses, prominent eosinophils, and smaller lymphocytes. Immunohistochemical staining revealed CD30 positivity of much of the tumor infiltrate, but was not diffusely positive. Rare cells were granzyme positive. ALK-1, TdT, EBER, CD1a were negative. The diagnosis was confirmed by a second dermatopathologist. The patient was referred to oncology. Labs were within normal limits and PET/CT scan was negative for metastasis. The lesion started to spontaneously regress after the shave biopsy. Spontaneous regression of C-ALCL occurs in 20-42% of cases and usually has an indolent course, therefore, aggressive treatment is not appropriate. In most cases, solitary or localized lesions are treated with surgical excision or radiotherapy. Although, about half of cases reoccur, but are not life threatening. This unusual case of C-ALCL provides an additional example of a rare clinical presentation in an adolescent female and reiterates the important histopathological findings for diagnosis.

Representativeness of initial skin biopsies showing pure desmoplastic melanoma: implications for management

Desmoplastic melanoma (DM) is an uncommon subtype of melanoma with distinct clinicopathological features. It is classified into pure desmoplastic melanoma (PDM) when the proportion of desmoplastic melanoma is ≥90% of the dermally-invasive component, and mixed desmoplastic melanoma (MDM) when the proportion of desmoplastic melanoma is <90%. Studies have reported a lower sentinel lymph node biopsy (SLNB)-positivity rate in PDM compared to MDM and non-DM. As a result, some have recommended not performing SLNB in PDM patients. When PDM is identified in a partial biopsy of a melanoma, there is a risk that sampling bias may under-recognise MDM, but to the best of our knowledge this has not been previously assessed or quantified. The aim of this study was to assess the concordance of the proportion of desmoplastic melanoma in an initial partial biopsy of PDM with the proportion in the entire tumour following complete excision, in patients with cutaneous melanoma. A secondary aim was to determine how frequently this potentially resulted in a patient not receiving a SLNB. Seventy-eight cases of cutaneous melanoma were identified from the Melanoma Institute Australia (MIA) database and 23 cases from the Memorial Sloan Kettering Cancer Centre (MSKCC), where an initial biopsy contained PDM and a subsequent wide excision had residual invasive melanoma. Clinicopathological features were analysed in all patients, including whether a SLNB was performed, the results of SLNB, and any subsequent recurrence. Ninety percent (91/101) of cases were still classified as PDM in the complete wide excision specimen while 10% (10/101) of cases were reclassified as MDM, which was a significant change in classification of final desmoplastic melanoma subtype (p<0.001). The proportion of desmoplastic melanoma was also significantly different between the initial and excisional biopsies (p=0.004). Forty-eight (48/101) patients had a SLNB, of which two (4.5%) were positive for metastatic melanoma; both cases were PDM in the excision specimen. Of the 10 cases demonstrating MDM in the excision specimen, the initial biopsy was a punch biopsy in six cases, shave biopsy in two cases and subcutaneous tissue was sampled in two patients (one punch biopsy, one incisional biopsy). Four of these 10 patients underwent SLNB which was negative in all cases. Twenty-two patients developed recurrence in the follow-up period (median 30 months, range 1-192 months), three with MDM in their excision specimen. One patient did not have a SLNB and developed regional lymph node recurrence. In this study there was a 10% risk that the percentage of desmoplastic melanoma in an initial biopsy of PDM was not representative of the entire lesion, resulting in reclassification as MDM in the excision specimen. If a SLNB is not performed in such cases, a positive SLNB may be missed (one patient in our study) which could impact treatment options for the patient. We recommend caution in not offering a SLNB in the setting of an initial biopsy of PDM if the biopsy is small compared with the overall lesion. If a SLNB is not procured at the time of wide excision in such cases, the SLNs should still be mapped by lymphoscintigraphy to facilitate careful follow up and to enable earlier detection and treatment of nodal disease.

Pyogenic Granuloma-like Amelanotic Melanoma of the Fingernail

Amelanotic melanoma is an atypical melanoma that presents without pigmentation and can thus be misdiagnosed as benign neoplasm. Ungual trauma can induce amelanotic melanoma of the fingernail as well as pyogenic granuloma (PG). We present the case of a patient in his 60s with a PG-like lesion on his third nail plate that was preceded by ungual trauma one year ago. A shave biopsy revealed an ulcerated nodule composed of epitheloid cells with melanocytic atypia, extending 1.7 mm. Features were consistent with melanoma, confirmed with SOX10, S100, MART-1, and HMB45 immunostaining. This case demonstrates the integral role of histopathology and immunostaining in differentiating a benign PG from amelanotic melanoma, and thereby, preventing metastasis. We present this case to improve clinicians’ ability to recognize atypical melanomas and to emphasize the importance of biopsy in such cases to ensure timely treatment and patient outcomes.

Anorectal Syphilis Presenting at Crohn’s Disease: A Case Report

Abstract This article reports on a case of anorectal syphilis in a 54-year-old man with a history of Crohn’s disease. The patient began experiencing a new onset perianal rash approximately when his medication regimen for Crohn’s disease was switched from sulfasalazine to mesalamine. There was no reported history of new sexual partners or sexually transmitted infection exposures. Chief differential at this time included Cutaneous Crohn’s disease, Lichen Planus, Extramammary Paget’s Disease, and Porokeratosis Ptychotropica; however, shave biopsy results revealed unexpected syphilis. There is only one other reported case of syphilis presenting as Crohn’s disease, but the incidence of syphilis has been rapidly increasing within the last decade. A high index of clinical suspicion is needed to properly diagnose syphilis, even with a lack of sexual history, for new onset genital lesions.

Use of the DermaBlade for Debridement of Hypergranulatory Wound Tissue.

Use of the DermaBlade for Debridement of Hypergranulatory Wound Tissue.