Faculty Bibliography

INTRODUCTION/BACKGROUND:Nasal reconstruction has important functional and cosmetic considerations, as proper repair of nasal defects is necessary to maintain function of the nasal airway and to recreate the normal appearance of this central facial structure. Cheek advancement flaps provide matched, mobile and highly vascularized tissue for the reconstruction of nasal defects, allowing for the concealment of incisions within natural creases in a one-stage approach. However, cheek advancement flaps are often underutilized for nasal reconstruction because of their difficulty restoring nasal contour. METHODS:We describe reconstruction of 19 nasal dorsal and sidewall defects 0.8 to 3.0 centimeters (cm) in size. We incorporated a periosteal anchoring suture to maintain/restore nasal contour and additionally removed a half standing cone inferior to the defect to prevent encroachment of the nasal ala or alar crease. All patients were evaluated at least 3 months post-operatively. RESULTS:In all patients, we were able to restore concavity of the nasofacial sulcus, preserve the biconvex nasal tips, prevent alar flaring and retraction and conserve the alar groove. All patients had excellent functional and cosmetic outcomes. CONCLUSION/CONCLUSIONS:We believe this modified cheek advancement flap provides functionally and aesthetically superior results and can be considered as a first-line approach for repair of nasal dorsal and sidewall defects in sub selected patients.

Deliberate practice-based medical education has demonstrated superiority in trainee acquisition and maintenance of skills in several surgical subspecialties. In an effort to highlight the impact of a deliberate practice-based surgical curriculum on the technical proficiency of dermatology residents, a prospective cohort study including first- and second-year dermatology residents was performed. A total of 87.5% (7 of 8) first-year dermatology residents completed three hands-on simulations at 6-week intervals. Additionally, six of eight (75.0%) second-year dermatology residents at the same institution were evaluated at a single point-in-time session without accessing the surgical curriculum prior. A 5-point global rating scale (GRS) was used to assess resident performance on six core surgical techniques. Nonparametric ANOVA statistical methods using the Kruskal-Wallis test was performed. The residents' overall GRS increased from a median of 1-2.75 after completion of the curriculum (p < 0.01). There was a significant improvement in the median scores of each tested surgical technique. The first-year residents had a greater overall GRS after completion of the curriculum compared to the second-year residents (median of 2.13 versus 1.88, p < 0.001). Limitations include the small sample size and lack of a synchronized control group. Our study highlights the use of deliberate practice-based strategies as an effective modality in teaching surgical skills to dermatology residents.

B-cell chronic lymphocytic leukemia (CLL) is the most prevalent leukemia in the United States, and its diagnosis can have many dermatologic implications. For one, the cutaneous manifestations of CLL include several entities, most notably leukemia cutis, eosinophilic dermatosis of hematologic malignancy, and a heightened risk of skin infections. Additionally, CLL patients are at an increased risk of secondary malignancies, most commonly of the skin. Furthermore, a number of commonly utilized treatments for CLL have cutaneous implications which should be considered in the interdisciplinary management of CLL patients. In this review, we will provide an update on the diverse cutaneous manifestations of CLL and CLL-directed therapies in order to help guide dermatologic management of this increasingly prevalent patient population.

ABSTRACT/UNASSIGNED:Papillary dermal elastolysis has been described in the setting of experimental combination nivolumab and cabiralizumab immunotherapy. We report a third patient with distinctive, generalized atrophic macules that developed after a morbilliform eruption during a clinical trial for treatment of metastatic pancreatic adenocarcinoma. Histopathological findings demonstrated diminished elastic fibers in the papillary dermis, associated with a histiocyte-rich infiltrate and increased dermal mucin, features that should clue the dermatopathologist to this condition.

BACKGROUND:Dermatopathologists sometimes encounter patients with features of psoriasis vulgaris and additional changes of eczematous dermatoses. These cases are challenging to diagnose, and the clinical implications are unclear. In the age of targeted therapy, it is important to improve our understanding of these findings so that patients are managed appropriately. OBJECTIVE:To characterize the clinical characteristics, histopathological features, diagnostic workup, successful treatment, and outcomes of patients with overlapping histopathologic features of psoriasis vulgaris and eczema. METHODS:We conducted a retrospective chart review of 20 patients who had received the histopathologic diagnosis of psoriasis vulgaris with eczematous changes noted on skin biopsy. A database that included information about clinical characteristics, comorbidities, histopathological features, diagnostic workup, treatment modalities, and outcomes was created and analyzed. RESULTS:Twenty patients were included in this study, with an average age of 57.3 years. After clinicopathologic correlation, most patients were diagnosed with psoriasis (85%), and the remainder were determined to have an eczematous dermatitis. Thirty-five percent of patients were diagnosed with allergic contact dermatitis, either in combination with psoriasis (6 patients) or alone (1 patient). Topical glucocorticoids were the most common effective therapy used, and systemic therapies were required in nearly half of patients for successful treatment. CONCLUSION/CONCLUSIONS:This study offers insights into the clinically and histopathologically challenging diagnosis of psoriasis vulgaris with eczematous changes and offers the diagnostic term "eczematized psoriasis" to describe these patients. The presence of allergic contact dermatitis should be considered in these patients.