Antibodies to Merkel cell polyomavirus and intratumoral CD8+ lymphocyte invasion predict outcomes in patients with MCC.

Merkel cell carcinoma (MCC) is a rare, highly lethal, cutaneous neuroendocrine carcinoma with a rapidly rising worldwide incidence. Risk factors include advanced age, history of ultraviolet exposure, and immunosuppression. Although the Merkel cell polyomavirus (MCPyV) is commonly found in normal skin of unaffected individuals, the virus is genomically integrated into early tumors, expresses a mutated T antigen that retains oncogenic activity, and is necessary to the survival and proliferation of MCC cell lines. The evidence points to a causal role for MCPyV in MCC development. Until now, immune responses to MCC and MCPyV have not been correlated with outcome. Two recent investigations examine factors related to prognosis.

Better response was associated with the presence of recurrent mutations or increased mutant-to-wild-type allelic ratios.

Although anti-BRAF treatments have received significant press of late, not all melanomas harbor BRAF mutations. Those that arise on mucosal, acral, and chronically sun-damaged (CSD) sites may harbor KIT alterations (mutations, amplifications, or both) instead. Given a different mechanism, these patients would likely benefit from some drug other than vemurafenib (see JW Dermatol Jun 6 2011).

Increased Anti-Annexin 1 Antibodies Are Likely in Discoid Lupus Erythematosus

But development of a commercially available diagnostic test is doubtful.

Chemokines: Attractive Targets in the Sunburn Reaction

The chemokine CXCL5 is a peripheral mediator of pain induced by UVB irradiation to the skin.

Dermatophytid eruptions secondary to tinea capitis may be more common than reported; they can be misdiagnosed as allergic drug eruptions.

The id reaction, a skin eruption involving a delayed hypersensitivity reaction, is triggered by a distant inflammatory dermatosis; it is also known as autoeczematization. Dermatophytid is an id reaction triggered by dermatophyte infection, most commonly seen in adult tinea pedis but also seen in tinea corporis and tinea cruris. Palm and sole eruptions are classic id reactions; disseminated edematous papules, vesicles, or pustules can occur in highly sensitized individuals. Dermatophytid can occur before or during oral antifungal treatment and is often misdiagnosed as an allergic drug eruption response to such agents. Reports of id reactions involving tinea capitis, one of the most common pediatric skin infections and particularly prevalent among children of African descent, are rare.

Rituximab and other biologic agents should be reserved for treating recalcitrant disease until more evidence shows otherwise.

Rituximab has been used in open-label case series and individual cases for patients with inflammatory myopathy who are refractory to standard therapies including systemic corticosteroids and immunosuppressive agents. The cases and series have primarily included adults. The effect on myopathy has been the primary outcome measure for most observations, and although some reports document improvement of skin disease, many reports suggest that skin disease is not dramatically affected. Little information is available on rituximab's effects in children or on its effectiveness for calcinosis, which more frequently complicates dermatomyositis (DM).

Car Seat Contact Dermatitis

This case series documents a novel form of "auto" immunity.

A small case series shows occurrence in children and supports its classification as a low-grade lymphoma.

Primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma (PCSM-TCL) was provisionally included in the World Health Organization–European Organization for Research and Treatment of Cancer (WHO-EORTC) lymphoma classification of 2005. The umbrella term described disease characterized by dermal infiltrates of small- to medium-sized T cells without clinical or pathological evidence of mycosis fungoides.

Although IVIg is labeled pregnancy Category C, it is likely an excellent choice of therapy.

Pemphigus often affects women of child-bearing age. Treatment usually involves the use of powerful immunosuppressive drugs and high doses of systemic corticosteroids, such as prednisone. When a patient with pemphigus becomes pregnant or develops pemphigus during pregnancy, treatment becomes even more complicated. Intravenous immunoglobulin (IVIg) is an apparently good treatment option.

Marginal Return: Safe and Sufficient Margins for Thick Melanoma

A 2-cm resection margin is sufficient for melanomas thicker than 2 mm.