Dr. Silapunt is a specialist in varicose vein treatment, surgical dermatology, laser procedures, facial rejuvenation, injectables and cosmetic dermatology. She completed her residency training at The University of Texas Medical School at Houston, Houston, Texas, and then pursued a fellowship in phlebology (vein treatment), laser, and dermatologic procedures in Charlotte, North Carolina. Dr. Silapunt is board certified in Dermatology (ABD), and she is certified by the American Board of Venous and Lymphatic Medicine (ABVLM). She is a certified Phlebology Sonographer (RPhS, ultrasound testing for leg veins) and an invited speaker on varicose veins at national meetings. Dr. Silapunt is editor of the textbook “Treatment of Leg Veins, 2nd edition” as well as an author of the chapter called “Sclerotherapy and Laser Vein Treatment” in the textbook “The Art of Aesthetic Surgery: Principles and Techniques”. She is also an author of the chapter called “Repair of the Split Earlobe, Ear Piercing, and Earlobe Reduction” in the 1st, 2nd and 3rd editions of the textbook “Surgery of the Skin”.
Neuroendocrine tumors arise from neuroendocrine cells, and are relatively uncommon. These tumors are grouped into a relatively broad class of malignancies due to their inherent ability to synthesize and secrete peptide hormones. Cutaneous metastases secondary to neuroendocrine tumors are rare. Herein we report a case of a 75-year-old woman who presents with a rare cutaneous metastatic disease. She presented to our clinic with a 1-year history of an enlarging asymptomatic lesion on her left anterior shoulder. Four years previously she had been diagnosed with metastatic low-grade neuroendocrine carcinoma of unknown primary, with metastases to liver, lung and bone. The patient had no personal history of skin cancer. Physical examination revealed an 8-mm, well-demarcated, dome shaped, erythematous nodule with a smooth surface and speckled black pigmentation at its center. (Fig. 1) Histology demonstrated multiple nodular dermal aggregates of cells with atypical small round nuclei and scant cytoplasm. (Fig. 2) Immunohistochemical studies showed that the tumor cells stained strongly positive for chromogranin A and synaptophysin, but stained negative for cytokeratin 20. The patient started palliative chemo-radiation therapy and passed away soon after.
Michael Migden is a distinguished US-based Dermatologist and an Associate Professor, Departments of Dermatology, Division of Internal Medicine, and Head and Neck Surgery, Division of Surgery, at the University of Texas MD Anderson Cancer Center, Houston, TX, USA. At MD Anderson, he is a Program Director of the ACGME Fellowship: Micrographic Surgery and Dermatologic Oncology. He also serves as a Faculty Member in the Department of Ophthalmic Plastic and Reconstructive Surgery. He has served as a Principal Investigator for studies on the smoothened inhibitors sonidegib, vismodegib, and taladegib, and on immune therapy trials in non-melanoma skin cancer. He has published numerous primary and expert review articles on basal cell carcinoma.
Statement of the Problem: While most BCCs, accounting for ≈75% of skin cancers in the UK, are treated effectively with surgery and/or radiotherapy, limited data exist for the prevalence/burden of BCCs that become locally advanced (laBCC), thus potentially not amenable to surgery or radiotherapy (NATSOR). The burden of laBCC(NATSOR) was evaluated based on UK population, patterns of recurrence and per-patient cost. Methodology & Theoretical Orientations: Linked records from primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care UK databases were used to extract demographic, medical history, prescription and cost data for BCC patients. In the absence of unique laBCC diagnosis codes, an exclusion-based patient identification algorithm was developed by UK experts. Patients first treated for laBCC between 1/2007-12/2012 with ≥2 years follow-up were indexed. Non-laBCC controls were propensity matched for birth year, BCC diagnosis, sex, and comorbidities. Pairs where controls had BCC-related events ≤2 years before case indexing were excluded. Findings: Of the 64,126 patients with BCC whose linked records were assessed, 159 patients (0.25%) were identified as having laBCC(NATSOR). In 29 control-matched cases, recurrence rates at 1, 2, 3 and 4 years post-indexing were 21%, 41%, 62%, and 76%, respectively. Patients with laBCC(NATSOR) used significantly more healthcare resources (range, £301-5,743) than controls (range, £18-4,491), with a difference in overall annualized burden per patient of £1,242 (P=0.0002). Conclusions & Significance: In this UK-based analysis, only 0.25% of patients with BCC with linked records were identified as having laBCC(NATSOR). Recurrence rates in this population were high and likely contributed to the increased per-patient cost compared with patients without laBCC(NATSOR). Given the stringent exclusion algorithm and limitations of the analysis (lack of laBCC diagnosis codes and missing data [resource use, cancer drug therapy/radiotherapy]), the burden of laBCC(NATSOR) in the UK estimated in this analysis is conservative. Control-Match Cases of BCC Recurrence in the UK (n=29) Year 1 21% Year 2 41% Year 3 62% Year 4 76% UK Costs Patients with IaBCC(NATSOR) range, £301-5,743 Non-IaBCC Controls range, £18-4,491 Figure 1: IaBCC=locally advanced basal cell carcinoma; NATSOR=not amenable to surgery or radiotherapy.