Objective: The aim of this study is to investigate the risk factors associated with metastasis to various sites in melanoma, construct corresponding nomograms for predicting the risk of metastasis, and provide a reference for clinical practitioners in the diagnosis and treatment of this condition. Methods: Utilising SEER database data, we analysed 11,218 metastatic melanoma patients using logistic regression to identify metastasis determinants to bone, brain, liver, and lung, illustrated with a forest plot and developed an interactive nomogram for prediction. Additionally, we investigated prognostic factors for outcomes using the same statistical methods. Results: Our results indicate that histological behaviour, sex, race, marital status, tumour site, surgery at the primary site, postoperative lymph node dissection, and radiotherapy are independent predictors of brain metastasis; histological behaviour, sex, race, marital status, surgery at the primary site, radiotherapy, chemotherapy, Breslow thickness, and ulceration are independent predictors of bone metastasis; histological behaviour, race, marital status, tumour site, surgery at the primary site, postoperative lymph node dissection, chemotherapy, Breslow thickness, and ulceration are independent predictors of liver metastasis; and histological behaviour, age, sex, race, marital status, tumour site, surgery at the primary site, postoperative lymph node dissection, radiotherapy, chemotherapy, and ulceration are independent predictors of lung metastasis. We constructed interactive nomograms based on these factors to predict the probability of metastasis at different sites. Additionally, univariate and multivariate logistic regression analyses revealed that histological behaviour, age, sex, race, marital status, income, tumour size, tumour site, surgery at the primary site, radiotherapy, chemotherapy, Breslow thickness, and ulceration are factors influencing metastatic melanoma. Conclusions: This study has successfully established a nomogram for predicting metastatic melanoma. Among the factors influencing metastasis to various sites, histological behaviour, race, marital status, primary site surgery, and postoperative lymph node dissection were identified as common determinants. This suggests that these factors play a significant role in the metastasis of melanoma. Moreover, these factors also play a crucial role in affecting the prognosis. Therefore, in the clinical diagnosis and treatment process, it is imperative to consider these factors carefully and to analyse them according to the specific circumstances of different patients.
Calciphylaxis, also known as calcific uraemic arteriolopathy, is a rare cutaneous manifestation of systemic disease occurring in patients with chronic kidney disease. It typically presents as a painful necrotic and progressive skin ulcer of reticular pattern, mostly in the lower legs. It is a condition of substantial morbidity and mortality, with death most frequently due to sepsis. Although skin biopsy is a standard method to confirm the clinical diagnosis, non-invasive imaging often provides valuable clues. We report a case of extensive calciphylaxis in a lady with end-stage renal failure, where clinical radiography showed a typical net-like calcifications.
FFA has become an emerging cause of scarring alopecia and increasing cases have been described in the literature leading to its development in evidence-based management. With the growing evidence in the management of FFA, Finasteride is currently considered to be the most supported systemic treatment to stop the scarring process and to prevent irreversible hair loss. With the suitable patient population and careful patient education, Finasteride can be of great benefit in treating this disease which have an immense negative impact on the patient's quality of life.
Introduction: Acute and chronic graft-versus-host disease (GVHD) are multisystem disorders which are complications of haematopoietic stem cell transplant (HSCT). It is important to consider other differential diagnoses that may have similar clinical and histopathologic features as GVHD. Method: A retrospective analysis was conducted on adult patients from a single centre who developed GVHD after HSCT between January 2014 and June 2018. Results: Fourteen patients were included where 13 had acute GVHD and 1 had chronic GVHD. The median age was 35.0 years (IQR 26 to 44 years) while median onset of cutaneous symptoms for acute GVHD was 70 days (IQR 17.0 - 96.5 days). All cases had histopathological confirmation. For acute GVHD (n=13), classical presentation with generalised exanthem and perifollicular erythema is the commonest (84.6%, n=11), where 61.5% and 38.5% of patients had stage 2 and 3 extent of skin involvement, respectively (n=8, n=5). 76.9% (n=10) of patients with acute GVHD had other organs involvement, such as liver, eyes, and gut. Lerner's grade 2 was the most common histological grade for patients with acute GVHD (53.8%, n=7) followed by grade 1 (38.5%, n=5). One patient with chronic GVHD had lichen planus-like presentation. All patients had received various antibiotics within two months prior to onset. None of the skin biopsies showed significant eosinophilic infiltrates. Conclusion: Cutaneous manifestations of GVHD are among the earliest presenting complaints among patients who have undergone HSCT. Half of these patients only had skin GVHD without any other organs involvement. Hence, biopsy is important to confirm the diagnosis of GVHD along with clinical correlation.
Langerhans cell histiocytosis (LCH) is a haematolymphoid condition that is predominantly seen in the paediatric population. Occurrence in adult population is relatively rare. The disease has various clinical features and is easy to be misdiagnosed. Histopathology and immunohistochemical staining of skin biopsy are very important for the diagnosis of LCH. Treatment protocols remain controversial. Herein, we present a rare case of adult-onset Langerhans cell histiocytosis which was finally diagnosed after 2 years history of skin rash.
An eight-year-old girl presented with tender erythematous nodules over bilateral shins and right forearm for two weeks. She had a recent admission for fever and loose stool with a presumed diagnosis of gastroenteritis. Erythema nodosum associated with infective gastroenteritis was initially suspected. But further history revealed a two-month history of recurrent fever and loose stool with a history of short stature. Investigations showed iron-deficiency anaemia, positive fecal occult blood and negative stool microbiological workup lead to the suspicion of an alternative diagnosis. Skin biopsy showed panniculitis with septal and lobular involvement. Subsequent colonoscopy confirmed the diagnosis of underlying ulcerative colitis.
Pemphigus is a rare autoimmune blistering disorder. Rituximab is a useful therapy to avoid prolonged steroid use and its resultant side effects. We reviewed pemphigus patients that were treated with Rituximab at our centre. We found that Rituximab was effective and well tolerated with a nadir of Pemphigus Disease Activity Index and anti-desmoglein level at 6 months. Most patients only had clinical relapse of disease after 15 months.
Background: Foot eczema is a chronic debilitating condition that presents a psychosocial burden on patients and often follows a long course which is frequently refractory to conservative therapies. Aim: To conduct a prospective study to assess the efficacy of narrowband ultraviolet B (NBUVB) therapy for chronic foot eczema. Methods: Twenty patients with foot eczema participated in the study. NBUVB therapy was administered twice weekly for 12 weeks. Clinical findings, such as erythema, itching, induration, desquamation, and fissuring, were scored every four weeks for a period of 12 weeks. Results: The mean age of patients was 27.8 +/- 15.3 years. Their ages ranged from 4 to 55 years. Majority of patients were female [14 (70%)]. History of atopy was present among four (20%) patients. Thirteen (65%) had foot involvement while seven (35%) had both hand and foot involvement. Of the 20 patients who completed the study, eight (40%) had excellent response, eight (40%) had good response, three (15%) had partial response, and one (5%) had poor response to phototherapy. Average number of sessions required to produce >75% response was nine, with an average dose of 900 mJ/cm(2). There was a significant difference in all the clinical scores from baseline and at the end of 12 weeks (p<0.001). Conclusion: NBUVB therapy is a safe and effective treatment for patients with chronic foot eczema and can be considered as first-line treatment.
We evaluated the ResistancePlus® MG assay in providing macrolide resistance-guided treatment (RGT) for Mycoplasma genitalium infection at a UK sexual health centre. M. genitalium–positive samples from men with urethritis and women with pelvic inflammatory disease (PID) were tested for macrolide resistance–mediating mutations (MRMMs). MRMM-positive infections were given moxifloxacin 400 mg; otherwise 2 g azithromycin (1 g single dose and then 500 mg OD) was given. Among 57 M. genitalium–positive patients (32 men and 25 women), MRMMs were detected in 41/57 (72% [95% confidence interval (95% CI) 58–83%). Thirty-two of 43 patients given RGT attended for test of cure. Treatment failure rate was significantly lower at 1/32 (3%) than 10/37 (27%) before RGT ( n = 37 [men = 23 and women = 17]; p = 0.008). Treatment failure was lower in male urethritis (0/15 vs. 7/21 p = 0.027) but not in female PID. There was a trend of a shorter time to negative test of cure (TOC) in male urethritis (55.1 [95% 43.7–66.4] vs. 85.1 [95% CI CI 64.1–106.0] days, p = 0.077) but not in female PID. Macrolide resistance is higher than previous UK reports and higher than expected. RGT reduces overall treatment failure and is particularly beneficial in M. genitalium urethritis. Fluoroquinolone resistance will continue to rise with increasing fluoroquinolone use, and RGT is critical to direct appropriate azithromycin use and prevent overuse of moxifloxacin.
Background: Androgenetic alopecia (AGA) is a common form of hair loss, which can result in body image disorder and negative social feelings. Aim: The aim of this study was to evaluate the quality of life (QoL) and the risk of anxiety and depression in AGA patients. Method: Sociodemographic data of the patients and clinical severity of the disease were recorded. The QoL score of patient and controls was evaluated with DLQI and SF-36 instruments, their anxiety and depression risks were evaluated with HAD (HAD-A and HAD-D) instruments. Results: Sixty-eight patients with AGA were included in our study. Young male AGA patients' quality of life levels were found to be low according to role limitations due to emotional problems, emotional wellbeing and emotional scores of SF-36 scale and younger female AGA patients quality of life levels were also found to be low according to role limitations due to emotional problems, and emotional scores of SF-36 scale. The DLQI scores of patients of both sex were found to be significantly higher compared to control group. According to anxiety and depression risk assessment with HAD scale, it was found that 28.6% and 73.5% of patients were prone to suffer from anxiety and depression respectively. Conclusion: Apart from managing alopecia, practitioners should be aware of the possible psychosocial distress of AGA patients and manage accordingly.
Malignant acanthosis nigricans is a paraneoplastic cutaneous syndrome. Clinical findings such as tripe palms and mucocutaneous papillomatosis in atypical sites such as the oral mucosa are strong indicators of a visceral malignancy. We report on a rare case of oral acanthosis nigricans who presented with a 2.5-month history of diffuse hyperkeratotic verrucous papillomatous lesions in the entire oral mucosa which were symptomatic only when eating. Based on the clinical and histopathological findings, acanthosis nigricans with serous type endometrial carcinoma was diagnosed. However; the patient defaulted follow-up after the diagnosis and she died two months later.
Histoid leprosy is an uncommon variant of lepromatous leprosy. Its differential diagnoses include dermatofibroma, neurofibroma, molluscum contagiosum, xanthoma, keloids and can result in misdiagnosis in clinical practice. Herein, we report a female patient with histoid leprosy misdiagnosed as dermatofibroma, in order to illustrate the possibility of misdiagnosis, and give physicians an insight into histoid leprosy.
