USA (Dr Seifarth). Dermatology and Plastic Surgery Institute (Dr Kundu) and Quantitative Health Sciences (Ms Worley), Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Who Inspired You,DF Accepting Nominations for,2013 Honorary Awards. Each year the Foundation honors those extraordinary. dermatologists who have left a lasting imprint on,the specialty The DF s honorary awards provide an. opportunity to recognize dermatology s formative,teachers and clinicians true role models who have. inspired and trained generations of dermatologists. Clark W Finnerud Award This award honors the, exceptional clinician who has also been a dedicated. and highly effective volunteer or part time teacher for. residents and medical students,Practitioner of the Year This dermatologist is. an exemplary clinician in private practice with, significant involvement in professional organizations. and participation in medical teaching and or research. Your nomination letter along with the nominee s,CV are due at the Dermatology Foundation by. August 1 2013 The 2013 Honorary Awards will be,presented at the DF Annual Meeting of Membership. in March 2014,Contact the DF staff with any questions. 847 328 2256 or dfgen dermatologyfoundation org,Malignant n 133 Skin 2008. Small Bowel 2011,Benign n 54, Case an excised lesion diagnosed by H E as a dysplastic nevus in 2008 was retrospectively. diagnosed as a primary melanoma 3 years later when CGH analysis matched the more. recent bowel melanoma, Pooled CGH plots 133 melanomas vs 54 nevi Each lane represents a chromosome 6 gain of 1q noting their significance then contrasting this to. The melanoma plot reveals characteristic widespread DNA gains and losses The benign. nevi show only 2 minimal gains which characterize the Spitz nevi subset the changes that characterize Spitz nevi. FISH and CGH The molecular dermatopathology lab at. aberrations many rather than few repeats gains and losses that UCSF founded by Dr Boris Bastian relies on FISH fluorescent in. have edges at important cancer genes In addition the genomic situ hybridization and CGH comparative genomic hybridization. damage in melanoma is not random LeBoit enumerated the for detecting changes in DNA copy number FISH appeared in the. most common melanoma associated aberrations loss of 9p the early 1980s and CGH roughly a decade later Although they both. short arm of chromosome 9 loss of the entire chromosome 9 use fluorescent labeled DNA probes that bind with relevant areas. loss of chromosome 10 loss of 6q the long arm of chromosome of DNA FISH uses focused probes that home in on a narrowly. 2 Spring 2013 Dermatology Foundation, defined area of the genome and bind to complementary se. quences CGH on the other hand can screen the entire genome. DERMATOLOGY FOCUS, in a single session and is also better than FISH at detecting DNA. losses LeBoit describes CGH as a competitive binding assay in. which the tumor DNA is microdissected out and fluorescently. labeled with an identifying color then hybridized with a refer. DF A PUBLICATION OF THE DERMATOLOGY FOUNDATION,Sponsored by. Medicis A Division of Valeant Pharmaceuticals, ence sample of normal DNA or more frequently now a DNA Editors in Chief. array that has been fluorescently labeled with a different identi David J Leffell MD Professor of Dermatology. fying color and with control DNA Yale School of Medicine New Haven CT. Misadventures A 22 year old woman with intussuscep Mary M Tomayko MD PhD Assistant Professor of Dermatology. tion of her small bowel was found to have a large tumor mass Al Yale School of Medicine New Haven CT. though it stained positively for the melanoma marker HMB 45 Heidi A Waldorf MD Director Laser and Cosmetic Dermatology. she denied any history of melanoma but mentioned a dysplastic The Mount Sinai Medical Center New York NY. nevus removed from her shoulder 3 years earlier A slide from. the excisional biopsy lacked any clear melanoma indicators Executive Director. Sandra Rahn Benz, making the diagnosis of dysplastic nevus very understandable. With immunohistochemical stains this melanocytic tissue Deputy Executive Director. showed a high proliferation rate and the absence of protein from Christine M Boris. the tumor suppressor p16 CGH analyses of both this tissue and Please address correspondence to. the bowel tumor produced strikingly similar chromosomal pro Editors in Chief. files proof that this bowel tumor metastasized from the misdi Dermatology Focus. agnosed skin lesion c o The Dermatology Foundation. 1560 Sherman Avenue Evanston Illinois 60201, A 65 year old woman who had had what was interpreted as a Tel 847 328 2256 Fax 847 328 0509. dysplastic nevus removed 11 years earlier now had a huge peri e mail dfgen dermatologyfoundation org. anal mass that was obviously a melanoma The highly unlikely pos. sibility that it was a metastasis to this site rather than a primary Published for the Dermatology Foundation by. tumor had to be explored because treatment would differ signifi Robert B Goetz Designer Production. cantly Reviewing tissue from the 11 year old biopsy morphology Sheila Sperber Haas PhD Managing Editor Writer. was similar except for the presence of melanoma associated giant This issue of Dermatology Focus is distributed without charge through. melanocytes that should have sounded the alarm Now CGH on tis an educational grant from Medicis A Division of Valeant Pharmaceuticals. sue from both lesions showed an almost identical pattern of gains The opinions expressed in this publication do not necessarily reflect those of. the Dermatology Foundation or Medicis A Division of Valeant Pharmaceuticals. and losses Thus the perianal melanoma was metastatic disease. Copyright 2013 by the Dermatology Foundation, and the original surgical plan to remove the patient s anus and. rectum would not provide benefit, Adventures After discussing the typical histology and Spitz nevus or not He illustrated this with H E stained tissue from. clear cut variants for Spitz nevi LeBoit noted those uncertain a 31 year old man that was typical except for a nest of cells with. cases especially in adults with very subtly aberrant features by dusty looking melanin a tip off to look further CGH analysis. H E staining CGH can determine whether the lesion is really a identified melanoma Continued on page 6. Deferred Giving,The Benefits of a Bequest to the DF. Contributing to There are a variety of ways to establish a be. the Dermatology quest and your attorney and or financial advisor. Foundation this year is the best way to ensure can recommend the best option for you Once. that the newest generation of physician scientists you have determined the best approach be sure. and investigators has the support they need to identify the Dermatology Foundation a 501 c 3. now to initiate work that will ultimately advance organization as the recipient of this gift in your. patient care A simple effective way to provide will or other instrument Please note that the DF. this much needed funding well into the future is able to accept only monetary donations. is a bequest to the Dermatology Foundation If you have questions about establishing. A bequest enables you to leave a legacy that a bequest for the Dermatology Foundation. will impact future generations of dermatologists feel free to address them to Sandra Benz. and patients By reducing your estate it also has DF Executive Director at 847 328 2256 or. the potential to reduce estate taxes srbenz dermatologyfoundation org. www dermatologyfoundation org Spring 2013 3, 2012 Looking Back Strong Specialty Support Continues. Newly elected President Dr Michael D Tharp had good news to share at the Dermatology. Foundation s annual membership meeting in Miami While concerns about a fiscal cliff. emerged in 2012 and colored the economic outlook I am happy to report that all of our. supporters were generous and enabled the Foundation to accomplish its mission this year. to identify and launch the early careers of the most promising future leaders in dermatology. Member Dermatologists,Board of Trustees Elects DF Officers. The Heart of the DF, The Board of Trustees is grateful to Dr Richard L Edelson. Dr Tharp was pleased to announce that for his long term volunteer service to the Dermatology. individual member contributions remained stable Foundation as an Executive Committee member and most. and substantial in 2012 totaling 2 9 million recently as President Following completion of his term. This ongoing support reflects the tremendous the Board of Directors elected the following officers to lead. the work of the DF,commitment individual physicians have to the. health and growth of the specialty and has President Michael D Tharp MD. ensured the Foundation s funding capacity Chairman Board. of Trustees Bruce U Wintroub MD,despite the notable difficulties currently faced. by many non profits Vice President Stuart R Lessin MD. Dr Tharp thanked all DF members for their Secretary. Treasurer Elizabeth I McBurney MD,participation and support in 2012 As a group. those giving at the leadership level had the, greatest impact on the Foundation s results giving Each Sustaining member has gone. Leaders Society members about 1 000 strong beyond their 25 000 AC pledge with an annual. comprise the largest sector of physicians contribution of 5 000 many have pledged to. supporting the specialty and provided nearly repeat this annual gift for nearly 20 more years. half of the DF s individual giving revenue about Industry Supporters. 1 4 million Industry giving remains an essential part. The Annenberg Circle reached a new high of of DF annual fundraising activities despite. 600 members and accounted for nearly 20 of the significant changes wrought by corporate. individual contributions in 2012 mergers and reduced budgets for charitable. Annenberg Circle Sustaining members grew donations Dr Tharp emphasized the Founda. at a rate beyond all others rising to a total of 124 tion s gratitude for all industry support which. and providing an additional 24 of individual totaled 2 7 million in 2012. Honorary Awardees, DF President Dr Michael D Tharp on right in each photo was delighted to present the Foundation s honorary awards. the annual recognition of exemplary dermatologists who have helped the specialty be the best it can be. 2012 Clark W Finnerud Award 2012 Practitioner of the Year Award 2012 Lifetime Career Educator. Robert A Silverman MD C William Hanke MD Vera H Price MD. 4 Spring 2013 Dermatology Foundation, 2013 Looking Forward 3 2 Million Invested in the Future. Every member and supporter of the DF in 2012 made it possible. for the Dermatology Foundation to award over 3 2 million in. research awards for 2013 Dr Bruce U Wintroub Chairman of. the DF Board of Trustees announced,Dr Wintroub expressed his. great pleasure in presenting 2013 Research Awards, the list of research awards Career Development Awards. that have been approved for 55 000 annual salary support. funding by the Dermatology 3 Health Care Policy, Foundation Board of Trustees 3 Dermatologic Surgery. Bruce U Wintroub MD 13 Physician Scientist,This investment will go to. 5 Science of Human Appearance, support 66 promising individuals and worthy projects he. 10 Medical Dermatology, noted We are extremely proud of our 2013 award recipients. 3 Dermatopathology, The great majority of DF funding now goes to the highly 3 Women s Health. competitive and effective Career Development Awards 12 Basic Science Research. CDAs Eighty percent 80 of past CDA recipients have. Fellowships, remained in academics and most have earned federal 30 000 45 000 salary support. research funding that translates to 10 of federal funding 4 Dermatologist Investigator. for every 1 invested by the DF 2 Pediatric Dermatology. Dr Tharp added that our ability to maintain a funding Grants. level of 3 2 million is quite an accomplishment in the current 20 000 project support. economic environment and we have all of our members 1 Patient Directed Investigation. and industry supporters to thank for making this possible 6 Basic Science Research. For a list of the 2013 award recipients and projects 1 Epidermolysis Bullosa Research. visit www dermatologyfoundation org, Especially generous is the DF s Cornerstone society contributors for their substantial support. Benefactor Galderma Laboratories Galderma the American Academy of Dermatology. contributed over 500 000 to the DF to support Women s Dermatologic Society Society for Inves. the Research Awards Program the Clinical tigative Dermatology The American Society of. Symposia and several other key membership Dermatopathology and DEBRA of America Inc. programs Dr Tharp thanked the Foundation s, Platinum Benefactors for their support at the The Time to Do More. 200 000 level AbbVie Amgen Pfizer Medicis The Foundation is the primary funding. Unilever and Valeant Dermatology He also source for new physician scientists and. recognized The Allergan Foundation Merz investigators in the specialty Without the. and SkinMedica as the DF s Gold Benefactors DF many of those who received awards today. who each contributed 100 000 or more would never have considered an investigative. career Dr Tharp emphasized Given the, Society Partners pending decreases in federal research funding. Important Supporters we have set the bar high this year and are. Dr Tharp noted how fortunate the DF is asking every DF member to contribute at the. to receive significant support for the Research highest level possible. Awards Program from our national regional and The only way to be certain the science. local society partners each year Each of these base of dermatology continues to expand. organizations believes in the DF s capability to is to ensure that those entering our field. identify promising individuals who have the have the early career funding they need. potential and motivation to keep dermatology After all if we do not fully support our field. advancing He recognized the following national who will. www dermatologyfoundation org Spring 2013 5, Conclusions Molecular analysis will alter our perspective est mortality in 10 12 days When skin involvement vesicular. on melanocytic lesions by promoting awareness that low risk eg is present it is a primary diagnostic source Treat with high dose. spitzoid tumors in young children and intermediate risk tumors parenteral acyclovir. exist between the extremes of benign and frankly malignant. Within a decade molecular studies not FISH or CGH but others. under development should become routine for all questionable Neonatal HSV. cases and may well replace H E staining entirely in 20 30 years. MINI SYMPOSIUM WOMEN S,CHILDREN S DERMATOLOGY,Five Diagnoses Not to Miss. Anthony J Mancini MD, Introduction Delayed incorrect diagnosis of these condi. tions which often involve the skin can have significant conse. quences The dermatologist can be instrumental in preventing this. For each Dr Mancini discussed typical and atypical presentations. and outcomes subtypes diagnostics cautions and treatment. Langerhans cell histiocytosis LCH ranges from benign. and self limited to disseminated organ involvement risking signifi. cant morbidity and possible mortality LCH can occur anywhere on. the skin with scalp palms soles and intertriginous zones most. common Be aware of refractory seborrheic dermatitis or inter Think of LCH refractory seborrheic dermatitis intertrigo. trigo look for lichenoid papules and for punctate erosions in fold purpura flexural erosions palm sole crusted papules. areas Neonates have a more vesicular often hemorrhagic presen hemorrhagic vesiculopustules neonate. tation LCH is diagnosed relatively easily from skin histopathology Consider immunodeficiency recalcitrant dermatitis. and immunostaining We often refer these patients to our oncol resistance to therapy GVHD growth failure. ogy colleagues for treatment recurrent unusual infections. Congenital immunodeficiency Mancini discussed and Recognize Kawasaki disease unexplained high fever. illustrated the various cutaneous manifestations In general severe rash conjunctivitis lip tongue changes perineal. atopic or seborrheic dermatitis erythroderma or intertrigo resist accentuation sick child. ant to proven treatment triggers concern as well as growth failure. alopecia and recurrent and or unusual infections especially with Diagnose DRESS syndrome facial periorbital edema. less common organisms Biopsy results of graft vs host disease hepatitis reactive lymphocytes eosinophilia 3 8 weeks. GVHD in an infant may indicate severe combined immunodefi after aromatic anticonvulsant sulfa drug started. ciency Treatments may include IVIG and stem cell transplantation Treatment drug withdrawal consider steroids IVIG. Kawasaki disease This acute vasculitis in young children Don t miss neonatal herpes newborn with vesicles. aka mucocutaneous lymph node syndrome involves medium may be hemorrhagic or pustular sometimes. sized arteries Coronary artery aneurysm is the most feared widespread erosions polycyclic patches Diagnosis. complication Have a high index of suspicion for this disease you cultures DFA PCR Treatment institute parenteral. do not want to miss it Diagnosis which is clinical is based on acyclovir if considering. unexplained high fever 5 days plus 4 5 additional criteria con. junctivitis lip tongue changes extremity changes edema then. desquamation polymorphous skin eruption with perineal accen Big Rashes in Little Patients. tuation and cervical adenopathy 1 5 cm High dose aspirin and Julie V Schaffer MD. single infusion high dose IVIG are the first line therapy Introduction Sudden onset of an extensive rash in a young. Drug hypersensitivity syndrome Aka DRESS drug child often frightens parents pediatricians and even dermatolo. reaction with eosinophilia and systemic symptoms this severe gists Recognition of clinical clues to the diagnosis enables der. cutaneous adverse reaction of altered drug metabolism is most matologists to provide reassurance in many of these situations. often associated with the aromatic anticonvulsants but can occur and facilitates initiation of appropriate evaluation and treatment Dr. with other agents Marked cytokine mediated inflammation Schaffer discussed four such rashes referred to her as emergencies. occasionally misdiagnosed as a bacterial or viral infection Urticaria multiforme A 10 month old boy had a low. presents 3 8 weeks after treatment begins Look for facial edema grade fever and widespread eruption of pink edematous annular. particularly periorbital skin rash often erythrodermic fever plaques some quite large Many lesions had a central dusky pur. lymphadenopathy and hepatitis Withdraw the drug Systemic plish color while central clearance in others was a clue to the tran. steroids may be required sient nature of this condition urticaria Frequently misdiagnosed. Neonatal herpes simplex infection HSV infection of as erythema multiforme or serum sickness like reactions giant. the newborn presenting 10 days to 3 weeks after birth is caused annular urticaria urticaria multiforme in infants and young. most often by HSV 2 and usually acquired intrapartum SEM children is often virally triggered and has a benign course Angio. disease skin eyes mouth appears in 10 12 days CNS disease edema hands feet face pruritus dermatographism and low. encephalitis in 16 19 days disseminated disease with the high grade fever are common If unsure of the diagnosis outlining. 6 Spring 2013 Dermatology Foundation, lesions in pen reveals their hourly or daily changes Antihistamines a work up that confirmed the diagnosis of neonatal lupus which. speed resolution and represent the therapeutic mainstay usually presents with skin changes at 1 month of age Anti Ro an. Reaction to molluscum A 5 year old boy had sudden onset tibodies were positive in both mother and patient skin biopsy was. of extremely pruritic edematous papulovesicles on his extensor typical for lupus Schaffer discussed the spectrum of cutaneous. arms and legs Although the eruption brought to mind Gianotti and extracutaneous manifestations. Crosti syndrome GCS or an id reaction Schaffer identified mol. luscum lesions in separate locations This GCS like inflammatory Vulvar Manifestations of Systemic Disease. reaction develops in 5 of molluscum patients signaling an effec. tive immune response that heralds resolution of the molluscum Bethanee J Schlosser MD PhD. Introduction In addition to primary inflammatory der. matoses vulvar skin and mucosa can be involved in systemic in. Molluscum The Bump That Rashes flammatory disorders Vulvar inflammation commonly results in. Retrospective study of 696 patients with molluscum scarring agglutination with loss of tissue mass and architectural. seen in NYU pediatric dermatology practice distortion Recognizing vulvar pathology requires familiarity with. Mean age 5 5 yr range 7 mo 17 yr normal vulvar anatomy Dr Schlosser discussed vulvar manifesta. tions of three systemic inflammatory conditions,Atopic dermatitis in 37 associated with. Metastatic Crohn s disease Mucocutaneous findings,higher of MC lesions. most often genital occur in 44 of Crohn s patients Metastatic. Molluscum dermatitis in 39 51 with Crohn s disease presents with knife like ulcerations of the skin folds. AD vs 32 without AD genital buttock axillary inframammary and painful vulvar. Inflamed MC lesions in 22 associated with edema erythema and purulent discharge These skin lesions pre. of MC lesions over next 3 months cede detectable bowel involvement in 20 of patients and the. Gianotti Crosti syndrome like reaction in 5 course of mucocutaneous and GI disease can differ significantly. heralded resolution of MC lesions Treatment of vulvar metastatic Crohn s disease involves systemic. EM Berger et al Arch Dermatol 2012 148 125764 immunosuppressive agents and anti TNF therapies. Acute vulvar ulcers of the nonsexual female Lip, Coxsackievirus A6 A 1 year old boy presented with fever schutz ulcers Acute vulvar ulcers affect nonsexual young. and a widespread vesicular eruption affecting his extremities in women teens early 20s and are classically associated with an. cluding palms soles and trunk with crusted papules around his acute febrile illness Triggering infections include group A strepto. mouth and within pre existing diaper dermatitis The distribution coccal pharyngitis acute EBV infection and acute Mycoplasma in. of the extensive vesicular exanthem eg the perioral region and fection Patients present acutely with painful aphthous ulcers of the. sites of dermatitis eczema coxsackium as well as classic locations labia majora labia minora and vaginal introitus Variable scarring. of hand foot and mouth disease HFMD pointed to a recently occurs but functional compromise is uncommon The diagnosis is. recognized variant due to coxsackievirus A6 which now has a clinical pathology is nonspecific Treatment entails analgesia and. significant presence in the U S Asia and Europe Despite the anti inflammatory topical oral agents Recurrence occurs in 50. more severe skin findings this form of HFMD typically resolves. without complications after a mean of 12 days,The Normal Vulva. Enteroviral Exanthem Coxsackievirus A6,CDC report 3 12 severe and extensive HFMD. Illustrated by, due to coxsackie A6 in the U S Prior outbreaks Dawn Danby and. Paul Waggoner,in Europe and Asia,80 patients from 7 pediatric dermatology centers. in the U S 7 11 6 12, Median age 1 5 yr range 4 mo 16 yr 50 with AD Vulvar Agglutination. 10 BSA in 60 intraoral lesions in 50 Loss of tissue mass. Extremities 100 buttocks 75 face 80 trunk 50, Fever in 75 no serious systemic neurologic manifestations Destruction of normal. Mean duration 12 days range 3 35,architecture, CDC MMWR Morb Mortal Wkly Rep 2012 61 213 4 K Flett et al Emerg Infect Dis Clitoral hood labia minora. 2012 18 1702 4 EW Mathes et al Pediatrics in press. posterior fourchette introitus, Neonatal lupus A 12 hour old girl born at 35 weeks to a Vagina. healthy mother was extremely small for gestational age with a pur Can occur without symptoms. puric eruption and concerning coagulation profile definitely Any vulvar disease can scar. scary looking Noting atrophy in affected skin was key in initiating. www dermatologyfoundation org Spring 2013 7,DF Honors the Specialty s Role Models. Each year the Dermatology Foundation pays tribute to dermatologists whose exemplary. capabilities and dedication have helped to make the specialty what it is today Presentation of the. 2012 awards was a highlight of the DF Annual Meeting on Saturday March 2 in Miami. The leaders honored by their peers for their outstanding contributions to dermatology are. Practitioner of the Year C William Hanke MD,Clark W Finnerud Award Robert A Silverman MD. Lifetime Career Educator Award Vera H Price MD, Dr Price was highlighted in the Winter 2012 13 issue. 2012 Practitioner of the Year Award Hawaii With each opportunity he took to improve his. C William Hanke MD knowledge and skills the more dermatology appealed. to him His new interest was further piqued by two,This annual award recognizes. dermatologists for exemplary inspirational dermatologists Drs Harry Arnold and. service as a private practitioner Allan Azumi who also helped launch his early career. combined with significant contri Dr Hanke completed his residency and fellowship train. butions to the specialty through ing at the Cleveland Clinic Foundation and then joined. leadership and teaching the full time dermatology faculty at Indiana University. Bill Hanke has dedi School of Medicine He rapidly rose to Professor. cated his professional of Dermatology Pathology and Otolaryngology Dr. career to his patients and Hanke left academia in 1998 to found the Laser. to bettering the world of Skin Surgery Center of Indiana which includes a der. C William Hanke MD dermatology a colleague matopathology lab and clinical trials center He also. notes He provides stellar founded a one year ACGME accredited Procedural. patient care in his state of the art private med Dermatology Training Program at St Vincent Hospital. ical surgical practice in Indianapolis has been in Indianapolis Training procedural dermatology. president of 11 major medical organizations fellows has been a highlight of my career he shares. holds several part time academic positions and Dr Hanke has always believed that service to the. teaches fellows in a private setting He conducts profession is important and has spent a significant. clinical research and has authored over 400 portion of his career doing just that He established a. medical publications including 91 book chap Dermatology Professorship at the University of Iowa and. ters and more than 20 books served on more than 20 organizational boards His presi. Dermatology is especially fortunate because dencies include the American Academy of Dermatology. Dr Hanke s interest in the specialty began purely by American Society for Dermatologic Surgery American. chance Although he had chosen cardiology by the College of Mohs Surgery and International Society for. time he graduated from the University of Iowa College Dermatologic Surgery His many awards include these. of Medicine his military service assigned him to der organization s highest honors including the AAD s Gold. matology responsibilities at Hickam Air Force Base in Medal Of Dr Hanke s accomplishments he finds his. of patients and should prompt evaluation for other causes of vulvar Conclusions Vulvar edema erosions and ulcers may be the. aphthae ie inflammatory bowel disease Beh et s presenting signs of systemic inflammatory disorders Assessment of. Graft vs host disease Vulvovaginal GVHD affects 1 3 of patients requires thorough history and review of systems detailed vul. women at 1 year post hematopoietic stem cell transplant and var examination and clinicopathologic correlation of skin pathology. almost 50 by 2 years but likely continues to be underdiag Multidisciplinary care is imperative for optimal treatment and preser. nosed and undertreated Patients most often present with ery vation of quality of life for patients with inflammatory vulvar disease. thema and erosions significant scarring clitoral agglutination. vaginal narrowing obliteration is not uncommon Most women. with vulvovaginal GVHD will have concomitant GVHD of the. conjunctiva oral cavity and skin but a minority will have GI or Vulvar edema erosions or ulcers may be the. liver GVHD Treatment of vulvovaginal GVHD involves modula initial manifestation of systemic disease. tion of systemic immunosuppressives use of potent topical cor Obtaining a thorough history and ROS is. ticosteroids and calcineurin inhibitors as well as adjunctive essential to making an accurate diagnosis. local estrogen therapy and vaginal dilators To ensure timely di Multidisciplinary care of patients with vulvar. agnosis and appropriate treatment Schlosser advises dermatol lesions is imperative. ogists to keep female transplant patients high on your radar. 8 Spring 2013 Dermatology Foundation, focused work on patient safety that began in the 1990s It was my very last elective of my fourth year and I. and reached a high point during his AAD presidency had already committed to pediatrics The dermatolo. most meaningful Safety is critically important When gists and residents I worked with were so energetic. I became president of the AAD I knew this was my oppor and knowledgeable and so happy with their work. tunity to heighten the specialty s focus on this area They ultimately influenced his career choice. A colleague praised all that Dr Hanke has When Dr Silverman began his pediatric resi. accomplished Bill Hanke provides the very dency at the University of Buffalo he formed a close. best of care to his patients I also greatly admire relationship with the dermatology department Main. the fact that he is able to maintain an active taining a strong interest in dermatology he went on. practice and yet serve dermatology as a dedi to complete a two year pediatric dermatology fellow. cated teacher and spokesperson for all of us ship at Harvard s Children s Hospital in Boston to. study congenital nevi just as pediatric dermatology. 2012 Clark W Finnerud Award was congealing into a sub specialty Dr Silverman. Robert A Silverman MD completed his dermatology residency at University. This annual award recognizes Hospitals of Cleveland then became the first Director. the exceptional dermatologist of Pediatric Dermatology at Rainbow Babies and. who is both an exemplary Children s Hospital and taught pediatric dermatology. clinician and a dedicated at Case Western Reserve University. volunteer or part time teacher,In 1989 Dr Silverman entered private practice. A fellow pediatric in Washington DC He also began to teach dermatol. dermatologist lauds Dr ogy to pediatric residents at Georgetown University. Silverman s extraordinary,and University of Virginia pediatric residents at. contributions to dermatol,INOVA Fairfax Hospital He also spent substantial. ogy as a part time teacher, time training residents in his office He has given. Robert A Silverman MD,and clinician a leader, in the field of pediatric countless grand rounds published 25 book chapters. dermatology who has worked tirelessly as an regularly organized and taught in seminars and CME. advocate for children with skin disease and an courses at AAD meetings Dr Silverman has held. educator and role model Dr Silverman s impact leadership positions in a variety of specialty organi. is amplified by the scope of his expertise which zations including the presidencies of the Washington. includes atopic dermatitis contact dermatitis nail DC Dermatological Society and the Society for. and hair diseases acne hemangiomas inherited Pediatric Dermatology and is currently a Director. skin diseases skin conditions of newborns and of the American Board of Dermatology. precursors to skin cancer A renaissance man of pediatric dermatology. Dr Silverman s life changing connection to der Dr Silverman admits that his clinical interests. matology began with his elective at the University have always been wide and varied He especially. of Virginia School of Medicine fascinating inspira loves to learn about the subtleties of pediatric. tional and an excellent fit for this highly visual skin disease from my youngest patients and. individual The problem for Dr Silverman was timing their parents. Perioral Rejuvenation in Women,Dana L Sachs MD,Facial Muscle Targets for. Introduction Dr Sachs discussed the nature and appropri. Botulinum Toxin Injection, ate treatment of age related changes in the perioral region of the. face aesthetically the second most important part of the face after. the eyes eyebrows She described the age related changes in skin. collagen subcutaneous fat muscles cartilage and bone that all. contribute and focused on ways to improve the perioral region. without enhancing the lips responding to the common patient. fear of overly enlarged lips After explaining the underlying Depressor Orbicularis. anguli oris oris, changes that produce perioral rhytides downturned oral commis DAO. sures drooping mouth corners a prominent mental crease cob. blestone chin and labiomental folds marionette or puppet lines Depressor. labii Mentalis, Sachs provided guidance tips and cautions for minimizing each inferioris. of them advising combining procedures for optimal results. www dermatologyfoundation org Spring 2013 9,Mark Your Calendar. 2014 DF Clinical Symposia Advances in Dermatology February 5 9 Naples FL. Here is why past attendees never miss this meeting Difficult Diseases in Medical Dermatology. This is the best and most well rounded CME Surgery and Aesthetics. program I attend Immunologic Skin Diseases,Pediatric Dermatology. This meeting teaches real dermatology,How to Avoid Harming Your Patient. Erudite and fresh perspectives Safety Issues in Dermatology. Discover the latest advances in dermatology that will Cutaneous Oncology Clinical Challenges. benefit your practice in these 7 Mini Symposia Infectious Diseases and the Skin. Registration begins in September 2013 Visit www dermatologyfoundation org. Tools and targets Botulinum toxin A Although its full face procedure or in appropriate patients limited to one. use for the perioral region is off label we use it all the time to region The fractionated ablative laser is beginning to supplant. treat wrinkles inject the orbicularis oris labiomental folds in the conventional CO2 laser. ject the depressor anguli oris and cobblestone chin plus the Illustrations Sachs presented 12 cases women ranging. mental crease inject the mentalis muscle Avoid for patients from their mid 40s to mid 70s illustrating patient concerns her. who cannot risk any muscle weakening in this area eg a profes assessment and treatment and before and after photographs. sional wind instrument player Onabotulinum toxin abobotu. linum toxin and incobotulinum toxin are all FDA approved Soft. tissue injectables This option for the lower face can be used MINI SYMPOSIUM CPC. to reconstitute the philtral columns turn up oral commisures. improve the lips and fill out perioral lines mental crease and Julie V Schaffer MD. labiomental crease Cross linked hyaluronic acid fillers are the Case 1 An 11 year old Chinese immigrant girl had an 1 5 year. workhorse for this part of the face Calcium hydroxylapatite can history of episodic outbreaks of vesiculated purpuric necrotic rel. also be used but not for the lips Prepare for possible occlusion atively pruritic skin lesions that healed with punched out scars Dur. or compression of vascular structures which can result in local ing attacks mostly in summertime and on exposed sites she was. tissue necrosis by having warm compresses nitroglycerin paste febrile sometimes with neutropenia Biopsy findings included a. and hyaluronidase on hand Resurfacing This option is espe dense perivascular and interstitial infiltrate with enlarged lympho. cially useful for improving and softening rhytides either as a cytes and prominent eosinophils Her blood contained extremely. high levels of EBV DNA Key was that many lesional lymphocytes. Perioral Region Botulinum Toxin A were positive for EBV RNA via in situ hybridization Her diagnosis. combined necrotic hypersensitivity to mosquito bites which favors. Perioral rhytides inject orbicularis oris Asian Hispanic children and atypical hydroa vacciniforme Dr. Labiomental folds inject depressor anguli oris DAO Schaffer discussed these conditions and the distressing prognosis of. Chin inject mentalis severe hydroa As we see patients from increasingly international. FDA approved agents onabotulinum toxin backgrounds this is important to have on one s radar. abobotulinum toxin incobotulinum toxin, The Lower Face Soft Tissue Injectables EBV and Necrotic. Lips Mosquito Bite Hypersensitivity,Philtral columns Predilection for Asian children. Perioral lines Japan Taiwan Korea, One previous report in a 7 yr old Hispanic boy in Texas. Oral commissures, Mental crease Bullous necrotic skin lesions systemic symptoms. eg fever lymphadenopathy,Labiomental creases Asymptomatic between episodes. Agents cross linked hyaluronic acid calcium Punched out ulcers scars. hydroxylapatite not for lips,Proliferation of EBV NK cells often progresses to. Resurfacing NK T cell lymphoma or hemophagocytic syndrome. SE Pacheco et al J Allergy Clin Immunol 2005 116 470 2. Perioral rhytides,Regionally in select patients,Lasers conventional CO2 is gold standard. fractionated ablative and nonablative,botulinum toxin A soft tissue injectables. Risks HSV scarring dyspigmentation,10 Spring 2013 Dermatology Foundation. Case 2 An 11 year old otherwise healthy girl had a 1 month Mark D P Davis MD. history of asymptomatic unilateral swelling of her vulva unre Case 1 This patient had an allogeneic hematopoietic cell. sponsive to antibiotics Schaffer observed erythema induration transplantation 2 months previously and had developed a wide. and a few linear erosions superficial ulcerations toward the per spread itching rash over the past 6 days Was this GVHD or a drug. ineal area Biopsy findings included a superficial and deep granu reaction Studies have demonstrated the impossibility of distin. lomatous dermatitis with giant cells and some peripheral guishing the two entities clinically or for drug reactions that show. lymphocytes The patient had mild iron deficiency anemia a high interface changes by biopsy Try to distinguish them via the pres. sedimentation rate and ASCA antibodies associated with ence absence of diarrhea plus liver function tests GI tract and liver. Crohn s disease A GI evaluation with endoscopy confirmed are the most commonly affected by GVHD If this fails treat as. Crohn s disease with involvement of the terminal ileum In con GVHD because delay or stopping the immunosuppressive drug. trast to adults with Crohn s disease extra intestinal mucous find could be fatal Biopsy does not have to be done before reaching. ings are the first sign of disease in 85 of pediatric cases Genital a treatment decision. involvement includes swollen labia scrotum or penis Case 2 Calciphylaxis involving vascular calcification and. skin necrosis is an under recognized and devastating syndrome. Genital Crohn s Disease in Children occurring in dialysis patients and recently reported to occur in. many other situations It presents a marked therapeutic dilemma. Persistent nontender induration erythema Dr Davis illustrated the difficulties and challenges via a patient on. of the vulva often unilateral scrotum penis dialysis for chronic renal failure who suddenly developed extraor. DDx dinarily painful ulcerations involving his legs thighs and abdomi. Cellulitis lymphedema nal pannus Recognition is emerging that calciphylaxis is not. Child abuse primarily a problem of calcium and phosphate deposition in vessel. Clues to CD Dx walls but a clot in the middle of these vessels akin to a myocardial. Perianal involvement infarct Clot busting drugs should be considered if the patient can. tolerate them Prognosis is dismal and pain is severe multidiscipli. Poor growth Fe deficiency anemia, nary care should include pain control and palliative care teams. Anti ASCA antibodies,Often associated with colorectal CD. DD Sackett et al J Pediatr Urol 2012 8 e55 8 AL Pinna et al Pediatr Dermatol 2006 23 49 52. Calciphylaxis, S Keiler et al Pediatr Dermatol 2009 26 604 9 RM Vaid et al Pediatr Dermatol 2010 27 279 81. MG Reinders et al JAAD 2011 65 49 50 A Porzionato et al Forensic Sci Int 2005 155 24 7 Under recognized syndrome. occurring in 4 of, Case 3 An adopted 2 year old Asian girl with mild develop hemodialysis patients. mental delay of unknown etiology had a 7 month history of per. Dismal prognosis, sistent acral papulovesicles and erosions She was commonly. indoors where temperature was maintained at 68 Although the 1 year survival 46. lesions were reminiscent of coxsackievirus infections the pro 2 year survival 20. longed course eliminated this possibility Biopsy showed a vacuo. No treatment has been shown to help consistently, lar interface dermatitis with necrotic keratinocytes and a. superficial and deep perivascular lymphocytic infiltrate She was Treatment strategies. ANA positive a brain MRI showed white matter changes Her Correct calcium phosphate levels. diagnosis combined Aicardi Gouti res syndrome an inherited Consider thrombolysis. inflammatory encephalopathy mimicking a congenital viral infec Pain control palliative care. tion and familial chilblain lupus This links garden variety lupus Multidisciplinary care. to AGS giving us insights into the pathogenic role of nucleic acid. metabolism, Case 3 This adult case of widespread atopic dermatitis AD. was presented to highlight widespread misconceptions in man. Aicardi Gouti res Syndrome agement The patient wanted to control her current flare and avoid. future ones She should use wet dressings to decrease crusting and. Inherited inflammatory encephalopathy mimicking, a congenital viral infection discomfort But for adult patients approaches intended to identify. food allergens elimination diet prick or RAST allergy testing are. Developmental delay often progressive not useful because as has been documented food allergy is not. with white matter changes microcephaly relevant to adult flares and test results are likely to be highly mis. Sterile pyrexia with CSF lymphocytosis leading For pediatric patients however 30 40 have immediate. and elevated interferon levels hypersensitivity reactions to food allergens and elimination is. Chilblain lupus acrally onset 1 2 yr appropriate Low and mid potency topical corticosteroids are. Mutations in genes encoding proteins that safe to use long term. regulate innate immune responses via processing,of nucleic acid debris Christopher J Arpey MD. TREX1 RNASEH2A C SAMHD1 ADAR1 Case 1 Dr Arpey noted that despite this case s poor ending. he had learned the most from it An 80 year old man with multiple. Usually autosomal recessive comorbidities long term multiple myeloma the most significant. JS Prendiville et al JAAD 2009 61 727 8 GM Abdel Salam et al Neuropediatrics that also included severe bilateral lower limb edema rapidly de. 2010 41 18 23 C Chahwan et al Clin Genet 2012 81 413 20. veloped a 1 cm crusted plaque in his left shin Arpey immediately. www dermatologyfoundation org Spring 2013 11, biopsied this well differentiated but fairly proliferative squamous working without them does the patient an injustice It is especially. cell carcinoma SCC planning a review in 2 weeks and excision important in correctly diagnosing inflammatory skin diseases. at 6 weeks By 2 weeks the lesion had grown fairly quickly but after Case 1 The patient had smooth surfaced erythematous le. discussion the original plan was maintained By surgery the lesion sions on the shoulder Several were annular The suspected di. was 4 5 cm with a much worse appearance In retrospect earlier agnosis was atypical erythema annulare centrifugum EAC. and more aggressive surgery would have been desirable Initial The biopsy appeared consistent with EAC until LeBoit used a. good healing was quickly replaced by an aggressive recurrence CD123 stain to visualize plasmacytoid dendritic cells immune. Arpey described the rapidly deteriorating situation including cells that produce IFN Most inflammatory diseases have very. metastatic disease by 12 weeks post op and emphasized the early small clusters of these cells but this patient had notably large. warning signs of aggressive SCC clusters key to diagnosing tumid lupus erythematosus LeBoit. believes that we should reappraise EAC and its diagnosis For. the patient with an annular eruption and gyrate erythema spon. Aggressive SCC giotic dermatitis reflects EAC If superficial and deep with lym. phocytes think of tumid lupus and erythema migrans With an. interface reaction think of subacute cutaneous lupus and an. nular lichen planus, Case 2 A 6 year old girl had multiple skin lesions arms but. tocks abdomen thighs that also occurred in other family mem. bers The clinician suspected xanthomas or histiocytosis LeBoit s. review of the biopsy pointed to papular mucinosis until he re. ceived clinical photographs showing the lesions slightly yellowish. Week 2 at time of Week 6 at time of color Staining for elastic tissue highlighted prodigiously thick col. preoperative assessment scheduled procedure, lagen bundles that appeared welded together identifying Buschke. Ollendorff syndrome The patient has been sent for skeletal films. Case 2 A 61 year old man presented with a back mass that to look for osteopoikilosis. appeared to be an epidermoid cyst but was in fact a poorly differ. entiated sebaceous cell carcinoma Difficulty in obtaining clear Buschke Ollendorff Syndrome. margins brought him to Arpey This was his first extra ocular case. although he learned that this incidence is rising especially below. the neck 20 of these tumors Recent data on the metastatic po. tential of poorly differentiated sebaceous cell carcinoma moti. vated Arpey to request a SLNB which was negative The patient. healed well with no recurrence at 6 months A recent review of pa. tients treated at the Mayo Clinic found a trend for improved prog. nosis with Mohs surgery vs WLE As extra ocular sebaceous cell. carcinomas differ in architecture from those on the eyelid very Clinical photo showing dermal papules and nodules with histopathology. well lobulated rather than pagetoid Arpey suspects that this may showing thick collagen bundles consistent with Buschke Ollendorff syndrome. actually be something different, Case 3 A 50 year old immunocompetent man had a 10 year Case 3 A 9 year old boy had annular lesions clinically. history of an enlarging mass in his left breast that had been treated thought to be granuloma annulare Histopathology disagreed and. with topical antifungals He finally sought treatment when the cen along with clinical images raised the possibility of mycosis fun. tral area eroded The nipple was obliterated Biopsy identified a very goides MF LeBoit does not normally do immunohistochemistry. aggressive basal cell carcinoma affecting the nipple and areola ex for MF but atypical aspects prompted him to stain for CD56 which. ceedingly rare in this area with no evidence of chest wall invasion was positive LeBoit noted a reflex among histopathologists to iden. and no metastases The patient underwent WLE a left axillary SLNB tify CD56 positivity with natural killer cell lymphoma an extremely. that found 2 11 nodes positive and then complete node dissection aggressive disease This case highlights that in a patient with char. He healed uneventfully and was still alive at 7 years acteristics clinically compatible with MF CD56 positivity does not. define the disease It is just an MF variant and is treated the same. as other cases of MF,Nipple Areola BCC,Very rare 25 30 cases in 2005 Taiwanese review. Mycosis Fungoides Variant, 10 20 metastatic rate to axilla but no deaths all men. YI Zhu et al Dermatol Surg 2001 27 971 4 CW Huang et al Kaohsiung. J Med Sci 2005 21 480 3 N Rosen et al Dermatol Surg 2005 31 480 3. There have only been a couple of reported cases of. SNLB used to detect metastatic BCC,M Harwood et al JAAD 2005 53 475 8. Philip E LeBoit MD, Clinical photo showing annular lesions in a 9 yr old boy. Dr LeBoit emphasized the irreplaceable value of clinical that were shown histopathologically to be a mycosis fungoides variant. images which he often receives by email This has opened up. another dimension in the practice of dermatopathology and Continued on page 15. 12 Spring 2013 Dermatology Foundation,Significant AK lesion reduction. uction at 1 2 and 4 weeks,ZHHN Z HHNV Z,ZHHNV HHNV 9HKLFOH. ZHHNV Z HHN,ZHHNV HHNV,ZHHNV 9HKLFOH,HGXFWLRQ LQ HVLRQ RXQW. DVW VTXDUHV PHDQ,3HUFHQW 5H,P 001 vs vehicle,Results from two Phase 3 vehicle contro. olled randomized double blind multicenter studies,vehicle controlled udies of patients N 384 with. actinic keratoses Secondary endpoint of percent reduction least squares mean in AK lesions at 1 2 and 4 weeks. compared active to vehicle,Significant,Si ifi t mean red d ti. reduction i the,in th numberb off AK K lesions,ith 1 weekk off trea. ttreatment,t t compared hi le1 2,d tto vehicle 12,X Flexibility to prescrib. be for as little as 1 week or as long, prescribe ng as 4 weeks depending on tolerability and treatment goals. Carac is indicated for the topical treatment of multiple. ple actinic or solar keratoses of the face and anterior scalp. Important Safety Information,Carac is contraindicate. ed in women who are nursing pregnant,contraindicated p or may become pregnant. nant as fluorouracil may cause,fetal harm,Carac should not be us. sed in patients with dihydropyrim,used midine dehydrogenase DPD enzyme. dihydropyrimidine nzyme deficiency, Rarely unexpected sysstemic toxicity e g stomatitis d. systemic diarrhea neutropenia and neu rotoxicity associated with. neurotoxicity,parenteral administratio,on of fluorouracil has been attrib. administration buted to deficiency of dihydrop,attributed pyrimidine dehydrogenase. dihydropyrimidine, DPD activity Symptomms included severe abdominal pain bloody diarrhea vomiting. Symptoms g fever and chills, Carac should be disconntinued if severe abdominal pa. discontinued ain bloody diarrhea vomiting fe,pain ever or chills develop when. using the product,Application of Carac to, o mucous membranes should be avoided due to the possibility. be y of local inflammation,and ulceration,In clinical trials the mos. st common drug related advers,most se events were application site reactions. adverse r 94 6 which, included erythema dr yness burning erosion pain an. dryness nd edema and eye irritation 5, Patients using Carac shhould avoid prolonged exposure. should e to sunlight or other forms of ult,traviolet irradiation during. ultraviolet, treatment as the intenssity of the reaction maybe incre. intensity eased,Please see brief sum,mmary of full Prescribing IInformation. summary nformation on adjacent page, References 1 Weiss J Menteer A Hevia O et al Effective treatmen. Menter treatment nt of actinic keratosis with 0 5 fluoroura acil cream for 1 2 or 4 weeks. fluorouracil,Cutis 2002 70 suppl 2 2229 2 JJorizzo. orizzo JJ SStewart, tewart D Bucko A et al Randomized trial evaluating a new 0 5 fluorouracil formulation. demonstrates, demonstrates efficacy after 1 2 or 4 week treatment in patients w with actinic. ith a eratosis Cutis 2002 70 335 339,ctinic kkeratosis 39. Except as where otherwise indicated, d all product names slogans and otherer marks are trademarks. of the Valeant family of companies 2013 All rights reserved CRC 13 005 6 30 2014. Carac Cream 0 5 Rx Only Pregnancy, fluorouracil cream Teratogenic Effects Pregnancy Category X. BRIEF SUMMARY See CONTRAINDICATIONS, IMPORTANT NOTE This information is a BRIEF SUMMARY of the complete prescribing Nursing Women. information provided with the product and therefore should not be used as the basis W LV QRW NQRZQ ZKHWKHU IOXRURXUDFLO LV H FUHWHG LQ KXPDQ PLON HFDXVH PDQ GUXJV DUH H FUHWHG LQ. for prescribing the product This summary has been prepared by deleting information KXPDQ PLON DQG EHFDXVH RI WKH SRWHQWLDO IRU VHULRXV DGYHUVH UHDFWLRQV LQ QXUVLQJ LQIDQWV IURP IOXRURXUDFLO. from the complete prescribing information such as certain text tables and references D GHFLVLRQ VKRXOG EH PDGH ZKHWKHU WR GLVFRQWLQXH QXUVLQJ RU WR GLVFRQWLQXH WKH GUXJ WDNLQJ LQWR DFFRXQW. 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EHHQ HVWDEOLVKHG LQ SDWLHQWV OHVV WKDQ HDUV ROG 9DOHDQW 3KDUPDFHXWLFDOV 1RUWK PHULFD. Geriatric Use ULGJHZDWHU 1, 1R VLJQLILFDQW GLIIHUHQFHV LQ VDIHW DQG HIILFDF PHDVXUHV ZHUH GHPRQVWUDWHG LQ SDWLHQWV DJH DQG ROGHU OO RWKHU WUDGHPDUNV DUH WKH WUDGHPDUNV RU WKH UHJLVWHUHG WUDGHPDUNV RI WKHLU UHVSHFWLYH RZQHUV. FRPSDUHG WR DOO RWKHU SDWLHQWV 9DOHDQW 3KDUPDFHXWLFDOV 1RUWK PHULFD. CRC 13 006 6 30 2014,MINI SYMPOSIUM Pay Online,EMERGING THERAPIES. From Empirical to Precision,Melanoma Medicine DF Contribution. Boris C Bastian MD Center, Introduction The 3 stages of medical care intuitive. solving medical problems via intuitive experimentation and Save time paper and postage while. pattern recognition empirical ie evidence based trial data supporting the specialty. provide response likelihoods but not individualized predic. tion and precision deep understanding of all aspects enables It is easy to become a member of the. precisely targeted treatments and predictable individual out Dermatology Foundation or renew your sup. comes Dr Bastian used the field of infectious disease to illus port through the DF s Contribution Center. trate progress from intuitive to precision beginning with. Leeuwenhoek s documentation of microbes to the first tar Simply visit www dermatologyfoundation org. geted therapy ie penicillin to precise diagnostics an array of and select Contribute Now It will take only. targeted agents and eradication of some diseases As treatment a minute to set up your DF account using. has improved the cost of diagnosis and treatment has steadily your current email address and zip code. declined Although most dermatologic care is in the intuitive Have your Visa or MasterCard ready to make. category the field as a whole particularly regarding cancer. is striving for this precision your payment Once complete the password. Looking at Cancer The evolution of a given cancer ex protected system allows you to view your. presses a variety of individual differences including the originating current membership information and make. cell the signaling networks it relies on the initial mutation the spe any future payments via credit card. cific secondary mutations and their order of occurrence Thus can. cers in the same tissue can vary considerably in prognosis making Need Assistance. diagnostic clarity the precondition for treatment precision Please contact the DF staff at 847 328 2256. Melanoma is currently a mixed bag of distinct types reflecting dif or dfcontribution dermatologyfoundation org. ferent cells of origin different initial mutations and different sec For security purposes the system will not store your credit card information. ondary mutations and we are not sufficiently able to distinguish. those that are really dangerous from those that are not Bastian dis. cussed the best characterized mutations and altered signaling The New Assay Bastian described the power of whole. pathways The mutational burden in melanoma genomes on sun genome sequencing the revolution taking place enabling mil. exposed sites is 1 2 orders of magnitude greater than in most other lions of molecules to be sequenced simultaneously and at a. solid tumors The task now is to separate the relevant from the minuscule fraction of earlier times and costs The Human. passenger mutations ie those that do not actively contribute Genome Project took 13 years and 3 billion today sequencing a. to tumor progression single human genome takes 1 week and 5 000 and provides. a far greater abundance of information in a single measurement. It is being applied to a broad range of problems in cancer and. Cancer Genome Analysis beyond, is expected to have a far reaching impact on our understanding of. cancer biology and will likely prompt new approaches to the detec. tion diagnosis treatment and possibly prevention of the disease Molecularly Targeted Therapies in the. Treatment of Nonmelanoma Skin Cancers,Oscar R Colegio MD PhD. Introduction Dr Colegio discussed the molecular under. standing and rationally targeted treatment for basal cell carcinoma. BCC dermatofibrosarcoma protuberans DFSP Kaposi s sar. coma KS and squamous cell carcinoma SCC, BCC Although still uncertain whether the epithelial cell of. origin is in the interfollicular epidermis hair unit or sebaceous. gland all 26 subtypes involve mutations in the hedgehog signal. ing pathway Most inactivate the patched gene s tumor suppressor. activity thus releasing the smoothened gene s proliferative stimu. lation via gli Sometimes smoothened itself becomes mutated. and no longer responds to patched s inhibition Although the gli. inhibiting molecule vismodegib approved in 2012 for treating. advanced and metastatic BCC recently showed efficacy in re. ducing tumor burden in basal cell nevus syndrome side effects. caused 50 of enrolled patients to stop treatment, DFSP This fairly rare typically low grade sarcoma is of. Reprinted with permission from M R Stratton Science 2011 331 1553 8. fibroblast or myofibroblast origin 10 of cases are fibrosarcoma.
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USA (Dr Seifarth). Dermatology and Plastic Surgery Institute (Dr Kundu) and Quantitative Health Sciences (Ms Worley), Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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0.05. The study revealed that, nurses related factors influencing utilization of the partograph included negative attitude and lack of training on partograph use. Majority of nurses working in labor ward felt that partograph use is time consuming and needed supervision on partograph use. In addition, majority of the nurses were not trained on ...
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This Advanced Construction Project Management course is designed to give experienced construction professionals the skills to manage larger and more strategic projects. You will prepare and present plans and reports to customers and executives and persuade them to approve your solutions to problems. These skills are a requirement for construction project managers who want to advance their ...
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humidity available. Data obtained from some experiments at a higher temperature are also shown in this figure and will be referred to later. When the data of Fig. 1 are plotted against the lowest humidity available instead of against the highest, there is a considerably greater scatter of points, indicating a less exact correlation.
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