Journal of the American Academy of Dermatology
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J. Am. Acad. Dermatol. · Nov 2000
ReviewMerkel cell carcinoma: report of 10 cases and review of the literature.
Merkel cell carcinoma (MCC) is a rare primary neuroendocrine skin tumor that usually arises in the head and neck or the extremities of elderly patients. Because of the limitation of retrospective data, optimal treatment is not well defined. ⋯ MCC has a high incidence of locoregional recurrence with distant metastases that is more common with higher stage lesions. Early local management of smaller lesions results in good long-term survival. It is not known whether prophylactic lymph node dissection and/or radiation and adjuvant radiation increases survival. Long survival can be achieved after treating locoregional recurrence. The role of chemotherapy is still controversial and should be considered in patients with advanced disease and those not thought to be candidates for surgery.
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J. Am. Acad. Dermatol. · Nov 2000
Case ReportsNeutrophilic dermatosis of the dorsal hands: pustular vasculitis revisited.
An entity termed "pustular vasculitis of the hands" was recently described. Patients with this condition presented with low-grade fevers and erythematous plaques, pustules, and bullae limited to the dorsal hands and fingers, which were characterized histologically by a dense neutrophilic infiltrate and leukocytoclastic vasculitis. We describe patients with a similar clinical presentation, but who lacked vasculitis on biopsy findings. ⋯ Our 3 patients had clinical lesions similar to those termed pustular vasculitis of the hands, but which lacked leukocytoclastic vasculitis on biopsy findings. Because of histologic findings and a therapeutic response more characteristic of Sweet's syndrome, we propose the term neutrophilic dermatosis of the dorsal hands. In addition, low-dose dapsone is proposed as a possible first-line therapy in this condition, especially in those with recurrent disease.
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J. Am. Acad. Dermatol. · Nov 2000
A comparison of hourly block appointments with sequential patient scheduling in a dermatology practice.
There is significant demand for dermatologic care, and manpower is limited. Increasing patient encounters stress office processes. Analyses of the effects of schedule manipulation in a high-volume dermatology office have not been described. ⋯ Within the parameters of this study, block scheduling did not significantly affect patient waiting times. Block scheduling created more patient-free time for the physician and clinical staff than did sequential scheduling. Block scheduling increased the quality of the practice environment from the perspective of the physician and the staff.