Cutis
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We review the current therapy for cutaneous malignant melanoma. Early surgical resection offers the best likelihood of cure. The initial staging of melanoma patients determines subsequent therapeutic decisions and follow-up care. ⋯ We review the controversy over lymph node dissection, and recent recommendations for the use of lymphoscintigraphy. Interferon-alpha continues to be the only Food and Drug Administration-approved adjuvant therapy for high-risk patients. In addition, the follow-up care of melanoma patients will be discussed.
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A 63-year-old man with recurrent metastatic malignant melanoma presented with a painful right twelfth thoracic dermatomal eruption initially thought to be herpes zoster. However, 3 weeks later, the patient clearly had melanoma skin metastases confined exclusively to this dermatome. ⋯ We propose that in this patient, no herpes zoster infection occurred, but rather that skin metastases presented in a zosteriform pattern due to lymphatic spread from a previously excised paravertebral skin metastasis. This is the second reported case of malignant melanoma presenting as zosteriform metastases, and we suggest physicians consider this possibility in patients with melanoma presenting with dermatomal skin changes.
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Marjolin's ulcer-a term used to describe a malignancy arising in chronic ulcers of the skin, sinuses, scar tissue, and especially burns scars-occurs in two forms: an acute variant in which the malignant changes occur within a year of injury, and a chronic form in which the injury may precede the malignancy by decades. Illustrating the more common chronic form, we present the case of a 32-year old Haitian woman with an extensive squamous cell carcinoma arising from a burn scar on the dorsum of her right hand, with a review of the literature pertaining to burn scar carcinoma.
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Acute hemorrhagic edema of infancy (AHEI) is a benign form of leukocytoclastic vasculitis limited to the skin, which occurs in children younger than 2 years of age. The abrupt onset of fever, peripheral edema, and purpuric targetoid plaques in an infant may be confused with other dermatoses such as Henoch-Schönlein purpura, Sweet's syndrome, erythema multiforme, or septic vasculitis. Laboratory studies of patients with AHEI typically show normal results and the disorder follows a benign course with spontaneous resolution occurring in 1 to 3 weeks. We present a case of AHEI occurring in a 7-month-old boy and review the characteristic features of this acute dermatosis.
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Hair casts are often misdiagnosed because of their close resemblance to nits from an infestation with pediculosis capitis. In their clinical presentation both of these disorders may appear to have white keratinous material adherent to hair shafts and can look very similar. Microscopic examination provides the definitive and correct diagnosis. We report a case of hair casts, also referred to as pseudonits.