The Experts below are selected from a list of 306 Experts worldwide ranked by ideXlab platform
James S Wrobel - One of the best experts on this subject based on the ideXlab platform.
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a case of mistaken identity classic kaposi sarcoma misdiagnosed as a diabetic foot ulcer in an atypical patient
Clinical Diabetes and Endocrinology, 2019Co-Authors: Garneisha M Torrence, James S WrobelAbstract:The presentation of Kaposi sarcoma is divided into four known clinical subtypes. In this case report we describe classic Kaposi sarcoma in an African-American heterosexual, diabetic, seronegative human immunodeficiency virus male. Classic Kaposi sarcoma is rare in this patient demographic and can be easily misdiagnosed. The patient presented with a lesion between the fourth and fifth digits of his right foot which was initially diagnosed as a diabetic foot ulcer. Despite local wound care, the lesion did not resolve. A Shave Biopsy was performed and histopathology findings were consistent with classic Kaposi sarcoma. The patient tolerated local radiotherapy well and had complete resolution of his pedal lesion. There have been emerging associations between diabetes and Kaposi sarcoma. As such, clinicians should have a low threshold when considering the Biopsy of suspicious pedal lesions in patients with diabetes. The utilization of appropriate Biopsy technique may lead to the diagnosis of classic KS tumors in populations outside of the current four widely accepted clinical subtypes.
Garneisha M Torrence - One of the best experts on this subject based on the ideXlab platform.
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a case of mistaken identity classic kaposi sarcoma misdiagnosed as a diabetic foot ulcer in an atypical patient
Clinical Diabetes and Endocrinology, 2019Co-Authors: Garneisha M Torrence, James S WrobelAbstract:The presentation of Kaposi sarcoma is divided into four known clinical subtypes. In this case report we describe classic Kaposi sarcoma in an African-American heterosexual, diabetic, seronegative human immunodeficiency virus male. Classic Kaposi sarcoma is rare in this patient demographic and can be easily misdiagnosed. The patient presented with a lesion between the fourth and fifth digits of his right foot which was initially diagnosed as a diabetic foot ulcer. Despite local wound care, the lesion did not resolve. A Shave Biopsy was performed and histopathology findings were consistent with classic Kaposi sarcoma. The patient tolerated local radiotherapy well and had complete resolution of his pedal lesion. There have been emerging associations between diabetes and Kaposi sarcoma. As such, clinicians should have a low threshold when considering the Biopsy of suspicious pedal lesions in patients with diabetes. The utilization of appropriate Biopsy technique may lead to the diagnosis of classic KS tumors in populations outside of the current four widely accepted clinical subtypes.
Milind Rajadhyaksha - One of the best experts on this subject based on the ideXlab platform.
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translational advances in reflectance confocal microscopy of skin cancer machine learning based image classification and tumor mapping in Shave Biopsy wounds
Optical Molecular Probes Imaging and Drug Delivery, 2011Co-Authors: Milind RajadhyakshaAbstract:Translational advances in reflectance confocal microscopy of skin cancers include automated methods to localize the dermo-epidermal junction, and imaging of residual tumor with a contrast agent in Shave Biopsy wounds toward intra-operative mapping. Article not available.
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in vivo reflectance confocal microscopy of Shave Biopsy wounds feasibility of intraoperative mapping of cancer margins
British Journal of Dermatology, 2010Co-Authors: Alon Scope, Daniel S Gareau, M Kenkre, J A Lieb, Umar Mahmood, Kishwer S. Nehal, Milind RajadhyakshaAbstract:Background Reflectance confocal microscopy (RCM) images skin at cellular resolution and has shown utility for the diagnosis of nonmelanoma skin cancer in-vivo. Topical application of Aluminum Chloride (AlCl3) enhances contrast in RCM images by brightening nuclei.
Keyvan Nouri - One of the best experts on this subject based on the ideXlab platform.
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the pulsed dye laser for the treatment of basal cell carcinoma
Lasers in Medical Science, 2011Co-Authors: Christopher J Ballard, Maria Patricia Rivas, Michael P Mcleod, Sonal Choudhary, George W Elgart, Keyvan NouriAbstract:Basal cell carcinomas (BCC) have a specialized microvasculature system that can be targeted by the 585-nm pulsed dye laser (PDL) utilizing the theory of selective photothermolysis. Seven volunteers with nine well-defined, Biopsy-proven BCCs, were treated with the PDL (585-nm wavelength, a single 450-μs pulse, 7-mm spot size, and 9.0 J/cm2 energy). The lesions, along with a 4-mm border of normal skin were treated. Pain assessment was carried out immediately after the laser treatment. A deep Shave Biopsy with histological examination occurred 4 weeks after the laser treatment. Pain was assessed on a scale of 0 (no pain) to 10 (worst pain possible). The average patient score was 2.1 (range 1–4). On histology, 5/9 (55.6%) sites demonstrated no evidence of BCC; however, 4/9 (44.4%) sites showed residual BCC. Although the PDL was able to clear over half of the BCCs in this study, there was an unacceptably high persistence rate of 44.4%. The PDL did not achieve the clearance rate that can be attained with current standard BCC treatment modalities. At this time, we do not recommend that a single treatment with the 585-nm PDL can be used as a primary therapy for BCC.
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eccrine porocarcinoma arising in a seborrheic keratosis evaluated with dermoscopy and treated with mohs technique
International Journal of Dermatology, 2003Co-Authors: Robert H. Johr, Sogol Saghari, Keyvan NouriAbstract:A 78-year-old white woman returned for a routine 6-month skin cancer examination. She had a history of actinic keratosis and multiple basal cell carcinomas. She had no personal or family history of dysplastic nevi or melanoma. The patient was asymptomatic and unaware of any new or changing skin lesions. The patient had multiple lentigines, hemangiomas, and actinic and seborrheic keratoses on all sun-exposed areas. There were no less than 10 seborrheic keratoses on the right mid-back, and one was found to have a 1-cm, reddish nodule asymmetrically located within it (Figs 1 and 2). A clear papule on the left preauricular area was found on Biopsy to be a basal cell carcinoma. The nodule on the back was still present 1 month later and it was felt that further evaluation was indicated. As melanoma has been reported to develop in seborrheic keratoses, we decided to examine the lesion using digital dermoscopy. Figure 1. The right mid-back with multiple seborrheic keratoses one of which contains a reddish nodule within it Download figure to PowerPoint Figure 2. Close-up gross image of the eccrine porocarcinoma within a seborrheic keratosis Download figure to PowerPoint With digital dermoscopy, a well-demarcated reddish nodule was asymmetrically located within a brown lesion. It blanched significantly with pressure. Within the nodule, there were dotted and irregular linear vessels (atypical vascular pattern; also known as polymorphous vascular pattern) and regular-appearing brown dots. Surrounding the reddish nodule, there were pale and pigmented, comedo-like openings, fissures, and ridges (brain-like appearance). Some of the follicular openings appeared to be within the wall of the nodule (Figs 3 and 4). Comedo-like openings, fissures, and ridges are primary dermoscopic criteria for the diagnosis of a seborrheic keratosis; however, the vascular pattern seen has not been reported in seborrheic keratosis. Due to the patient's age and the rarity of significant pathology arising in a seborrheic keratosis, a Shave Biopsy was performed. Figure 3. A digital dermoscopic image demonstrating follicular openings, ridges, and furrows, primary criteria diagnostic of a seborrheic keratosis. Within the wall of the reddish nodule, there are dotted and linear irregular small blood vessels (atypical vascular pattern) Download figure to PowerPoint Figure 4. Firm pressure blanches the nodule making it easier to see the atypical vascular pattern Download figure to PowerPoint To our surprise, the specimen was interpreted by an experienced dermatopathologist as a well-differentiated eccrine porocarcinoma. Due to the high local recurrence rate and metastatic potential of this carcinoma, the patient was referred for Mohs’ surgery. Both the basal cell carcinoma and the eccrine porocarcinoma were excised in one stage. A metastatic work-up was negative and the patient appears to be doing well.
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eccrine porocarcinoma arising in a seborrheic keratosis evaluated with dermoscopy and treated with mohs technique
International Journal of Dermatology, 2003Co-Authors: Robert H. Johr, Sogol Saghari, Keyvan NouriAbstract:A 78-year-old white woman returned for a routine 6-month skin cancer examination. She had a history of actinic keratosis and multiple basal cell carcinomas. She had no personal or family history of dysplastic nevi or melanoma. The patient was asymptomatic and unaware of any new or changing skin lesions. The patient had multiple lentigines, hemangiomas, and actinic and seborrheic keratoses on all sun-exposed areas. There were no less than 10 seborrheic keratoses on the right mid-back, and one was found to have a 1-cm, reddish nodule asymmetrically located within it (Figs 1 and 2). A clear papule on the left preauricular area was found on Biopsy to be a basal cell carcinoma. The nodule on the back was still present 1 month later and it was felt that further evaluation was indicated. As melanoma has been reported to develop in seborrheic keratoses, we decided to examine the lesion using digital dermoscopy. With digital dermoscopy, a well-demarcated reddish nodule was asymmetrically located within a brown lesion. It blanched significantly with pressure. Within the nodule, there were dotted and irregular linear vessels (atypical vascular pattern; also known as polymorphous vascular pattern) and regular-appearing brown dots. Surrounding the reddish nodule, there were pale and pigmented, comedo-like openings, fissures, and ridges (brain-like appearance). Some of the follicular openings appeared to be within the wall of the nodule (Figs 3 and 4). Comedo-like openings, fissures, and ridges are primary dermoscopic criteria for the diagnosis of a seborrheic keratosis; however, the vascular pattern seen has not been reported in seborrheic keratosis. Due to the patient's age and the rarity of significant pathology arising in a seborrheic keratosis, a Shave Biopsy was performed. To our surprise, the specimen was interpreted by an experienced dermatopathologist as a well-differentiated eccrine porocarcinoma. Due to the high local recurrence rate and metastatic potential of this carcinoma, the patient was referred for Mohs' surgery. Both the basal cell carcinoma and the eccrine porocarcinoma were excised in one stage. A metastatic work-up was negative and the patient appears to be doing well.
Rainer Hofmannwellenhof - One of the best experts on this subject based on the ideXlab platform.
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follow up of actinic keratoses after Shave Biopsy by in vivo reflectance confocal microscopy a pilot study
Journal of The European Academy of Dermatology and Venereology, 2010Co-Authors: Erika Richtig, Verena Ahlgrimmsiess, Silvia Koller, Armin Gerger, Michael Horn, J Smolle, Rainer HofmannwellenhofAbstract:Background Monitoring of treatment efficacy after Shave Biopsy of actinic keratoses (AK) is often difficult, as clinical and dermoscopic features may not be reliable. Objectives We investigated the applicability of in-vivo reflectance confocal microscopy (RCM) for the follow-up of AK after Shave Biopsy. Methods A total of 10 lesions were investigated by RCM before Shave Biopsy, after 3 and 12 months by two observers in agreement blinded to location, patients and time interval. Results At baseline all lesions showed typical clinical, dermoscopic and RCM criteria of AK. Three months after Shave Biopsy, all lesions presented clinically as normal skin (NS), but two lesions showed features suspicious for AK by RCM. After 12 months, one lesion of these two lesions changed into NS in RCM, whereas the other lesion progressed into clinical visible AK. At baseline, the two observers diagnosed 10 of 10 lesions correctly in RCM, after 3 months eight of 10 lesions and after 12 months all lesions were diagnosed correctly. Conclusions Our results suggest that RCM might be a useful tool in the follow-up of AK after Shave Biopsy and might be used in inconclusive clinical and dermoscopic presentations of lesions after surgery or other treatment modalities.