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Biomedical subjects

D N Silvers

Publications and source records attributed to D N Silvers.

At least 19 recordsLinked to original sources
PubMed1995

Desmoplastic melanoma (or is it merely cicatrix?) arising at the site of biopsy within a conventional melanoma: pitfalls in the diagnosis desmoplastic melanoma.

We describe a case in which a "punch biopsy" specimen of a conventional melanoma on the cheek of a 25-year-old man led to a problem in differentiating a desmoplastic malignant melanoma from cicatrix. The circumstances of this case raise the issue of whether desmoplastic melanoma can arise at the site of trauma within a pre-existing melanoma.

Adult↗
PubMed1994

Histologic spectrum of neurothekeoma and the value of immunoperoxidase staining for S-100 protein in distinguishing it from melanoma.

Neurothekeoma, a benign cutaneous lesion of probable nerve sheath origin, is divided histologically into two subtypes--myxoid and cellular. However, we believe that neurothekeoma encompasses a wider spectrum of lesions, with the myxoid and cellular subtypes falling at either end of the morphologic spectrum. Because the cellular variant of neurothekeoma sometimes resembles melanoma, it presents a difficult diagnostic problem. We report the histologic and immunohistochemical findings in 14 cases of neurothekeoma and review the findings in 35 additional cases from the literature. A detailed analysis of the histologic spectrum is also included. When examined by immunostains, only the myxoid variants of neurothekeoma stain positively for S-100 protein. We conclude that when the histological differential diagnosis is between cellular neurothekeoma and melanoma, an S-100-positive lesion should be regarded as melanoma.

Adult↗
PubMed1994

Pustular eruption after drug exposure: is it pustular psoriasis or a pustular drug eruption?

Generalized pustular eruptions with fever present a diagnostic challenge. A history of preceding drug exposure, and rapid disappearance of the eruption after the drug is stopped, suggest a drug-induced aetiology rather than pustular psoriasis. We describe and evaluate the clinical and histological features of four patients who developed a generalized pustular eruption following drug administration. The history of preceding drug exposure and the presence of a variable number of eosinophils in the inflammatory infiltrate in the lesions of these cases suggested that the generalized pustular eruptions were drug-induced.

Adult↗
PubMed1994

Giant cell lichenoid dermatitis: a possible manifestation of sarcoidosis.

Giant cell lichenoid dermatitis is a recently described dermatosis thought to be an unusual lichenoid drug eruption. It is characterized by a generalized, pruritic, papulosquamous eruption sparing palms, soles, face and mucous membranes. Histopathologic findings include areas of epidermal hyperplasia and atrophy with focal vacuolar alteration of the basal layer, exocytosis and cytoid body formation. The dermis contains a band-like, mononuclear cell infiltrate at the dermoepidermal junction with admixed eosinophils, plasma cells and large multinucleate cells. The histologic differential diagnosis includes infectious processes, sarcoidosis, lichen nitidus, lupus erythematosus and lichen planus. We report 3 patients with giant cell lichenoid dermatitis, one of whom was subsequently diagnosed as having sarcoidosis. Because giant cell lichenoid dermatitis may resemble sarcoidosis both clinically and histologically, and because cutaneous sarcoid is often associated with systemic involvement, the diagnosis of sarcoid should be strongly considered in patients with giant cell lichenoid dermatitis.

Aged↗
PubMed1994

Shedding oral mucosa.

Four patients presented with asymptomatic gray-white oral mucosal tissues that sloughed and peeled away leaving a normal tissue base. This peeling phenomenon appeared unlike any known oral mucosal disease, although it somewhat resembled leukoedema and chemically irritated oral mucosa due to certain dentifrices and mouthwashes. Examination of biopsy tissue from three of the four cases along with stripped tissue from the fourth case revealed an intraepithelial cleft near the surface of each specimen. The linear cleft ran parallel to the epithelial surface. Foci of adjacent cells displayed intracellular edema, a feature commonly noted in leukoedema. There was evidence of neither acantholysis nor inflammation. The microscopic pattern was unlike the mucosal entities pemphigus vulgaris, mucosal pemphigoid, lichen planus, candidiasis, and mucosal biting. Although the authors questioned the patients in detail regarding all forms of mechanical and chemical trauma, including those from certain dentifrices and mouthwashes, they could not detect causative factors for these lesions.

Adult↗
PubMed1993

Pseudopelade of Brocq is lichen planopilaris: report of four cases that support this nosology.

Four patients are presented with pseudopelade of Brocq whose symptoms also illustrate the spectrum of symptoms of lichen planus. The literature is reviewed and the clinical and histologic features of pseudopelade of Brocq and lichen planopilaris are described. The literature on pseudopelade of Brocq is confusing and outdated. Since Degos's article in 1954, it has become commonly accepted that pseudopelade of Brocq is a nonspecific cicatricial end stage of scalp diseases resulting in alopecia. We maintain instead that pseudopelade of Brocq and lichen planopilaris are basically the same condition, namely a manifestation of lichen planus.

Adult↗
PubMed1992

The Tzanck smear: can dermatologists accurately interpret it?

BACKGROUND: The Tzanck preparation is a standard technique for the rapid diagnosis of herpes simplex and varicella-zoster virus infections. OBJECTIVE: This study was designed to determine the ability of practicing dermatologists to interpret Tzanck preparations accurately. METHODS: Dermatologists at different levels of training interpreted a series of Tzanck preparations under test conditions. RESULTS: Second- and third-year residents had a pooled average for correct responses of 91%; dermatologists in practice less than 10 years, 84%; dermatologists in practice more than 10 years, 67%. CONCLUSION: Dermatologists are able to use the Tzanck preparation effectively for diagnosing herpetic infections. Second- and third-year residents who are most likely to be diagnosing blistering eruptions in immunosuppressed or otherwise critically ill patients are especially accurate interpreters.

Clinical Competence↗
PubMed1992

Athlete's nodules: sports-related connective tissue nevi of the collagen type (collagenomas).

Sports-related connective tissue nevi of the collagen type (collagenomas) have been referred to as athlete's nodules. Surfers, boxers, marbles players, and football players are some of the athletes in whom these lesions have been observed. The nodules can be found on the dorsal aspect of the feet, knees, or knuckles and can readily be differentiated from other conditions by either clinical history or microscopic features or both. Treatment options include conservative measures or surgical intervention. Recurrent trauma and friction to the involved location are likely causative factors. Although the ultrastructural pathogenesis remains to be established, changes in the molecular metabolism of collagen resulting in enhanced synthesis and/or accumulation of collagen may have a contributory role.

Athletic Injuries↗
PubMed1991

'Melanoma? It can't be melanoma!' A subset of melanomas that defies clinical recognition.

We diagnosed histologically 178 cases of malignant melanoma in 1990. Thirteen cases were recorded in which the diagnosis of malignant melanoma was not considered by the clinician prior to biopsy or, in retrospect, following pathologic diagnosis. Eight of the 13 lesions were amelanotic. The majority were deeply invasive at the time of biopsy, implying poor prognosis. Despite improvements in early detection of malignant melanoma, a significant subcategory of melanomas escapes clinical diagnosis.

Basal Cell Carcinoma↗