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Introduction: Subungual acantholytic dyskeratotic acanthoma is a rare benign tumor of epidermal keratinocytes characterized by acantholysis and dyskeratosis. Only 7 other cases have been published in the literature. Case Presentation: A 29-year-old male presented with painful erythronychia and onycholysis of the left thumbnail. He worked as an electrician and was ambidextrous. Two months prior to the onset, he reported completing a mechanical task which led to repeated and sustained pressure to his left thumb. The clinical diagnosis was onychopapilloma, and a longitudinal excision was performed to remove the tumor. However, on histopathological examination, the primary features were hyperkeratosis, acantholysis, and dyskeratosis, consistent with a final diagnosis of subungual acantholytic dyskeratotic acanthoma. Conclusion: Nail trauma was reported by our case as a preceding feature, and this has not been described previously. Pain may accompany nail changes in the presentation of this tumor. Although subungual acantholytic dyskeratotic acanthoma is a benign tumor, it caused disruption in productivity, and our case highlights the need for timely access to specialist nail services.

Perioral ulcerative plaques have a broad list of differential diagnoses. We describe an unusual presentation of chronic progressive perioral ulceration due to herpes simplex type (HSV)-1 on a background of undiagnosed human immunodeficiency virus infection with acquired immunodeficiency syndrome. Whilst chronic mucocutaneous HSV is an AIDS-defining condition with both HSV-1 and HSV-2 implicated, typical reported cases describe vesicular eruptions rather than perioral ulcerative plaques. This case highlights that common infections may present atypically in immunocompromised individuals and may be a clue to underlying systemic illness.

BACKGROUND: Pure desmoplastic melanoma (pDM) is an uncommon subtype of malignant melanoma with comparative high rates of local recurrence and low rates of sentinel lymph node positivity. The melanoma-specific survival (MSS) of pDM compared to other melanoma subtypes is unclear, with conflicting reports and lack of multivariable analyses. OBJECTIVES: We aimed to describe clinicopathological characteristics of a cohort of patients with pDM and to compare the MSS of pDM with superficial spreading melanoma (SSM). METHODS: A prospective cohort study was performed of all primary invasive cutaneous pDM with known tumour location and thickness reviewed at a tertiary referral centre over 21 years. RESULTS: A total of 119 primary cutaneous invasive pDMs from 3570 total invasive cutaneous melanomas were included. Compared to 2272 SSMs, and due largely to their greater average thickness, patients with pDM had worse MSS (unadjusted hazard ratio, HR, 2.56, 95% confidence interval, CI, 1.56-4.22). After adjustment for clinicopathologic factors (including thickness, ulceration, mitotic rate, age and sex), there was evidence that patients with pDM had an improved MSS (adjusted HR, 0.49; 95% CI, 0.28-0.87). Median thickness of head and neck pDM was greater than non-head and neck pDM (P < 0.001). There was reduced univariable MSS in head and neck pDM compared to the rest of the body. CONCLUSIONS: Decreased univariable MSS of patients with pDM compared to SSM was explained by the increased frequency of adverse clinicopathologic features at diagnosis, in particular the greater Breslow thickness of pDM. After adjustment, patients with pDM had half the chance of melanoma-specific death compared to SSM. Head and neck pDM were thicker at diagnosis compared to the rest of the body, which may account for its poorer survival compared to the rest of the body.

The Centers for Disease Control and Prevention (CDC) estimate that influenza causes 36,000 deaths in the United States every year, and results in direct medical care costs of over $4.6 billion annually. Influenza and pneumonia are responsible for 8,800 deaths per year in California alone, making it the sixth leading cause of death among adults in the state, yet the illnesses are largely preventable by immunization.The California Adult Immunization Coalition (CAIC) is comprised of more than 20 organizations across California who are working together to increase immunization rates for influenza and pneumonia in adults. The CAIC analyzed influenza vaccination rates in California using data from the 2001 California Health Interview Survey (CHIS), and compared the results to the national Healthy People 2010 goals for adult immunization. The national goals specify that 90% of older adults (age 65 and over) should be immunized against influenza annually by the year 2010 (i.e., less than 10% should remain unimmunized).To deepen our understanding of this important public health issue, the CAIC has added several specific questions concerning adult immunizations to the 2003 CHIS survey. Results of this most recent survey will be available next year. Increasing California’s adult immunization rates to reach the national goal requires the persistent efforts of multiple sectors including vaccine suppliers, health departments, and individual health clinics and health providers’ offices.Key findings are:• 32.6% of older adults (age 65 and over) in California for whom annual flu shots are recommended did not get immunized in 2001. • Immunization rates among older adults varied by region; rates were found to be lowest in the Los Angeles region (63.9%) and highest in the Sacramento region (77.0%). However, no regions in California came close to meeting the national goal that 90% of older adults be immunized against influenza. • Although there was a strong age-related trend for the eld

The Centers for Disease Control and Prevention (CDC) estimate that influenza causes 36,000 deaths in the United States every year, and results in direct medical care costs of over $4.6 billion annually. Influenza and pneumonia are responsible for 8,800 deaths per year in California alone, making it the sixth leading cause of death among adults in the state, yet the illnesses are largely preventable by immunization.The California Adult Immunization Coalition (CAIC) is comprised of more than 20 organizations across California who are working together to increase immunization rates for influenza and pneumonia in adults. The CAIC analyzed influenza vaccination rates in California using data from the 2001 California Health Interview Survey (CHIS), and compared the results to the national Healthy People 2010 goals for adult immunization. The national goals specify that 90% of older adults (age 65 and over) should be immunized against influenza annually by the year 2010 (i.e., less than 10% should remain unimmunized).To deepen our understanding of this important public health issue, the CAIC has added several specific questions concerning adult immunizations to the 2003 CHIS survey. Results of this most recent survey will be available next year. Increasing California’s adult immunization rates to reach the national goal requires the persistent efforts of multiple sectors including vaccine suppliers, health departments, and individual health clinics and health providers’ offices.Key findings are:• 32.6% of older adults (age 65 and over) in California for whom annual flu shots are recommended did not get immunized in 2001. • Immunization rates among older adults varied by region; rates were found to be lowest in the Los Angeles region (63.9%) and highest in the Sacramento region (77.0%). However, no regions in California came close to meeting the national goal that 90% of older adults be immunized against influenza. • Although there was a strong age-related trend for the eld