Molecular Testing Practices and Perceptions among Dermatopathologists

Abstract

Background

We evaluated how dermatopathologists are employing molecular testing in the setting of neoplastic skin diseases, and assess their opinions of the broader role and utility of molecular technologies in clinical practice.

Methods

A 15-question online survey was sent to Fellows of the American Society of Dermatopathology in April 2017.

Results

One hundred and thirty-six dermatopathologists completed the survey (response rate = 16%). A majority (94%) of respondents reported experience with one or more molecular testing strategies. Sixty-two percent of dermatopathologists order 12 or more molecular tests per year, while 5% of respondents order two or less assays per year. More frequent utilization of molecular testing is associated with relevant instruction during residency training (p=0.009), primary board certification in pathology (p=0.008), academic medical center affiliation (p=<0.0001), higher volume clinical practice (p=0.0002), presence of on-site clinical molecular pathology/cytogenetics laboratory (p=0.007), and greater physician confidence incorporating test results into histopathological assessments (p=<0.0001).

Conclusions

Wider adoption of molecular testing in dermatopathology may be limited by factors such as physician training, test costs/insurance coverage, logistical issues, and lack of evidence-based clinical practice guidelines. Dermatopathologists have concerns regarding clinical validity/utility and inappropriate/overuse of some molecular tests. The importance of longitudinal education in molecular technologies and their applications for trainee and practicing physicians is highlighted.

Antioxidant capacity of omega-3-fatty acids and vitamin E against imidacloprid-induced hepatotoxicity in Japanese quails

Abstract

Imidacloprid (IM) is a neonicotinoid insecticide, used in a wide range of agricultural activities worldwide. However, it results in ecosystem disturbances and signs of toxicity in human and animals. The current study was designed to elucidate the protective effects of omega-3-fatty acids (OFAs) and vitamin E (Vit E) against IM hepatotoxicity in Japanese quails. Seventy male quails (30 days old) were divided into seven groups (n = 10); G₁ −ve control; G₂ received IM (+ve control); G₃ received OFA; G₄ received Vit E; and G₅, G₆, and G₇ received OFA and/or Vit E with IM for 30 days, respectively. Blood and liver tissue samples were collected. Imidacloprid significantly (p < 0.05) increased serum levels of alanine transferase (ALT), aspartate transferase (AST), triglycerides (TGC), and low-density lipoprotein cholesterol (LDL-C), as well as liver tissue malondialdehyde (MDA) concentration. Moreover, IM caused a significant (p < 0.05) decrease in the levels of serum high-density lipoprotein cholesterol (HDL-C), as well as liver superoxide dismutase (SOD) enzyme activity and reduced-glutathione (GSH) concentration in comparison to the –ve control group. Histopathological changes in hepatocytes, including thick cell trabeculae with marked hydropic vacuolar degeneration of cytoplasm, were found in IM-treated group. Treatment with OFA and/or Vit E resulted in significant improvements in general body condition, serum HDL-C level, and liver tissue SOD enzyme activity and GSH concentration, as well as significant decreases in the levels of serum AST, ALT, TGC, LDL-C, and hepatic tissue MDA. In conclusion, OFA and Vit E have a protective effect against IM toxicity, especially in their combination.

Effect of calcination temperature on the properties of Ti/SnO 2 -Sb anode and its performance in Ni-EDTA electrochemical degradation

Abstract

Pd-doped Ti/SnO₂-Sb anode was prepared at different calcination temperatures by a wet-impregnation method and employed in simultaneous electrochemical catalytic degradation of Ni-EDTA and recovery of nickel. The results showed that Ti/SnO₂-Sb-Pd-500 could achieve the highest electrochemical activity (87.5% of Ni-EDTA removal efficiency), superior durability (50.7 h of accelerated lifetime), and higher Ni recovery (19.8%) on cathode. Cyclic voltammetry (CV) and linear sweep voltammetry (LSV) analysis suggested that Ni-EDTA degradation on anode was mainly indirect oxidation-controlled reaction, attributing to the high oxide state of MO_X + 1 and MO_X(·OH), rather than direct oxidation. Scanning electron microscope (SEM), X-ray diffraction (XRD), and X-ray photoelectron spectroscopy (XPS) analyses indicated that calcination temperature could modify the morphology of electrode surface and affect the incorporation and valence state transformation of metal species (Sb and Pd) in SnO₂ lattice. Ti/SnO₂-Sb-Pd-500 achieved the highest electrochemical capacity with the highest levels of adsorbed oxygen O_ads/E_T (27.11%) and lattice oxygen O_lat/E_T (29.69%). Moreover, the operation conditions for Ni-EDTA electrochemical degradation were optimized. These findings were valuable for developing a high-performance electrode for Ni-EDTA electrochemical degradation.

A review of the role of estrogen in dermal aging and facial attractiveness in women

Summary

Estrogens are known to have protective and favorable influences on skin health; conversely, androgens oppose the actions of estrogens. Estrogen's chemical messages are transmitted via the classical nuclear hormone estrogen receptors (ER) alpha and beta and the rapid-acting G-coupled membrane estrogen receptor. Androgens [both testosterone and 5α-dihydrotestosterone (5α-DHT)] bind the same androgen receptor. Estrogen levels peak in the mid- to late 20s in women and then decline by 50% by 50 years of age and dramatically decrease further after menopause. The loss of estrogens with aging contributes to diminished dermal health, whereas estrogen hormone therapy [eg, oral conjugated equine estrogens (CEE)] restores skin health. Several reports suggest positive correlations between the levels of circulating estrogens and: (1) perceived age, (2) attractiveness, (3) enhanced skin health, and (4) facial coloration in women. Based upon a psychological dermato-endocrine perspective, the positive correspondence of high estrogens levels with perceived age and facial attractiveness in women especially with aging demonstrates the importance of hormonal influences on observed dermal health and youthful appearance.

Congenital Langerhans cell histiocytosis presenting in a 27-week-gestation neonate

Abstract

Langerhans cell histiocytosis is exceedingly rare in premature infants, and the few cases reported suggest a poor prognosis with systemic involvement. We present a case of Langerhans cell histiocytosis limited to a single cutaneous lesion, presenting in a 27-week-gestation infant, which is the youngest gestational age of reported Langerhans cell histiocytosis cases. The lesion showed spontaneous resolution by 41 weeks corrected gestational age, and systemic involvement was absent, demonstrating a mild course of skin-only Langerhans cell histiocytosis in a premature infant.

Geographic tonguelike presentation in a child with pityriasis rosea: Case report and review of oral manifestations of pityriasis rosea

Abstract

Oral lesions are rarely reported in patients with pityriasis rosea. We report a case of a 3-year-old boy with clinical evidence of generalized pityriasis rosea who developed asymptomatic oral lesions similar in appearance to geographic tongue. The generalized eruption and tongue lesions resolved simultaneously within 4 weeks. We also review the literature on the oral manifestations of Pityriasis rosea.

Bascule syndrome associated with syncopal episodes

Abstract

Bascule syndrome is a recently described benign vasomotor dermatosis characterized by Bier anemic spots, cyanosis, and urticaria-like eruption. We report a case of a 13-year-old girl with cutaneous lesions consistent with Bascule syndrome who had had three exercise-related syncopal episodes. It would be recommended to exclude orthostatic intolerance or postural orthostatic tachycardia syndrome when evaluating patients with Bascule syndrome.

Subacute cutaneous lupus erythematosus presenting in twins

Abstract

Subacute cutaneous lupus erythematosus is a clinically distinct form of cutaneous lupus erythematosus, with age of onset typically in the second to fifth decades. Eleven cases have been reported in childhood, and we present the first known case of subacute cutaneous lupus erythematosus in identical twins. Although flares are typically photo-induced, we present an annular eruption typical of subacute cutaneous lupus erythematosus with concurrent pinworm infestation, with recurrence of disease with cutaneous larva migrans. The patient's identical twin had a similar eruption with pinworm infection. This case highlights the possibility of parasitic infestation as a trigger for subacute cutaneous lupus erythematosus in genetically susceptible individuals.

Parental use of sun protection for their children—does skin color matter?

Abstract

Background/Objectives

Excessive sun exposure during childhood is a risk factor for skin cancer. This study aimed to compare the frequency of ideal sun protection use between parents with lighter- and darker-skinned children and explore their attitudes and beliefs on sun safety and their choice of sun protection.

Methods

Parents of children aged 6 months to 6 years completed self-administered questionnaires about sun protection practices for their children. Parents assessed their child's Fitzpatrick phototype and were divided into lighter- (Fitzpatrick phototype I-III) and darker-skinned (Fitzpatrick phototype IV-VI) groups. Sun safety guidelines from the Canadian Dermatology Association were used to qualify ideal sun protection.

Results

A total of 183 parents were included. Overall, 31 parents (17%) used ideal sun protection for their children. As their children grew older, parents were less likely to use ideal sun protection (odds ratio = 0.69, 95% confidence interval = 0.53-0.90). Parents in the lighter-skinned group were more likely to use ideal sun protection for their children (odds ratio = 7.4, 95% confidence interval = 2.7-20.1), believe that sun exposure was harmful (odds ratio = 17.2, 95% confidence interval = 4.0-74.9), and perceive value in sun protection (odds ratio = 11.4, 95% confidence interval = 3.3-39.0); the darker-skinned group believed that darker skin tones provided more sun protection (odds ratio = 12.4, 95% confidence interval = 6.1-25.4).

Conclusion

Ideal parental sun protection efforts are overall low, particularly in parents of darker-skinned children. The identified attitudes toward and beliefs about sun safety may aid in delivery of future sun protection interventions, especially in multiracial populations.

Treatment outcomes of vitiligo in Asian children

Abstract

This retrospective study aimed to identify factors that predict treatment response in a cohort of Asian children with vitiligo. Shorter duration of vitiligo was associated with better repigmentation. Patients with focal vitiligo of short duration have a good chance of achieving repigmentation with topical agents alone.

Skin lesions serve as clues to relapse of pediatric blastic plasmacytoid dendritic cell neoplasm

Abstract

A 10-year-old girl with a history of blastic plasmacytoid dendritic cell neoplasm, a rare malignancy in children, presented with recurrent skin eruptions beginning while on maintenance chemotherapy, including mildly pruritic skin-colored plaques, tender indurated nodules, and violaceous bound-down plaques. This case highlights an unusual presentation of relapsed blastic plasmacytoid dendritic cell neoplasm on chemotherapy, with skin lesions providing important clues to the progression of systemic disease.

Time-resolved fluorescence spectroscopy for the diagnosis of oral lichen planus

Summary

Background

Lichen planus (LP) is a T-cell mediated autoimmune disorder of unknown aetiology that affects the skin, nails, oral and genital mucous membranes. Conventionally, oral LP (OLP) is diagnosed through clinical assessment and histopathological confirmation by oral biopsy.

Aim

To explore the use of time-resolved fluorescence spectroscopy (TRFS) to detect fluorescence lifetime changes between lesional OLP and perilesional normal mucosa.

Methods

In this pilot study, measurements of lesional and perilesional buccal and mouth floor mucosa were conducted in vivo with a TRFS system. Histopathological findings were consistent with OLP in 8 out of 10 patients biopsied. Two patients with histopathological diagnoses of frictional hyperkeratosis and oral candidiasis, respectively, were excluded from the study.

Results

Our preliminary data show that lifetime values in the 360–560 nm spectral range indicate a significant differentiation between normal and diseased tissue. In contrast to the standard oral biopsy procedure, this technique is noninvasive, painless, time-efficient and safe.

Conclusions

Future studies are needed to better elucidate the diagnostic capability of TRFS and to further explore the sources of fluorescence contrast. This pilot study suggests that, based on fluorescence lifetime parameters, TRFS is a very promising technology for the development of a novel OLP diagnostic technique.

Development and validation of a reproducible model for studying post-inflammatory hyperpigmentation

Abstract

Post-inflammatory hyperpigmentation (PIH) has been reported to be the second most important dermatological diagnosis in the African American population with up to 20% of diagnoses linked to PIH (Alexis et al., 2007). The prevalence of PIH is also high in Hispanic populations ranging from 6 to 7.5% (Sanchez, 2003). Although more frequent in dark-skinned individuals (Davis and Callender, 2010), PIH is not uncommon in fair skin types representing 5.7% of dermatological problems in a population of European ancestry with skin types I to III (Taylor et al., 2008).

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To fee or not to fee? The ethical issues of concierge medicine/dermatology

Concierge medicine is an emerging practice model that involves direct contracting with patients for medical services, often charging a flat monthly or yearly fee. There is considerable variation among concierge practices, but most include administrative service fees with an upfront annual payment to remain on a smaller patient panel.1

An open-label exploratory study evaluating the efficacy and safety of ingenol mebutate gel 0.05% for the treatment of verruca vulgaris

To the Editor: Current therapies for common warts (verruca vulgaris) often require months of treatment and focus on destruction, removal of callus, or stimulation of a local immune response.1-3 Topical use of ingenol mebutate gel, 0.05%, indicated for the treatment of actinic keratosis, induces necrosis and an inflammatory reaction.4 A recent case study series provided evidence for the efficacy of ingenol mebutate against anogenital warts.5

Frontal fibrosing alopecia and cutaneous comorbidities: A potential relationship with rosacea

To the Editor: Frontal fibrosing alopecia (FFA) is an increasingly prevalent lymphocytic, cicatricial alopecia with a yet unknown etiopathogenesis. Some cutaneous diseases have been associated with FFA, but the existing literature is limited to retrospective studies and case reports.1-3 The objective of our study was to analyze the frequency of associated cutaneous conditions in a large cohort of FFA patients.