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Background: Metastatic basal cell carcinoma (mBCC) is rare and there are limited data regarding patient and tumor risk factors, optimal treatments, and disease prognosis., Objective: To assess patient and tumor characteristics, therapeutics, and outcomes of mBCC stratified by location of metastasis., Methods: Retrospective cohort study of 53 patients with mBCC treated at 4 large academic centers in Boston, Massachusetts; Philadelphia, Pennsylvania; and Cleveland, Ohio between January 1, 2005 and December 31, 2021., Results: A total of 53 patients with mBCC were identified across 4 centers, 22 (42%) of whom had mBCC with spread limited to lymph nodes and 31 (58%) patients with distant organ spread (with or without lymph node involvement). Overall, half (n = 11) of patients with nodal metastasis achieved complete remission of disease, compared with just 1 (3%) patient with distant metastasis. The 5-year survival for nodal and distant metastatic patients was 89.3% and 61.0%, respectively., Limitations: Small sample size due to disease rarity., Conclusions and Relevance: Patients with nodal disease are more likely to have disease remission whereas patients with distant metastasis are more likely to have persistent disease and die from their disease. However, 5-year survival rates exceed 50%, even for stage IV disease., Competing Interests: Conflicts of interest Dr Ruiz has received research support from Regeneron and Pellepharm, and has consulted for Regeneron, Checkpoint Therapeutics, and Feldan Therapeutics. Dr Silk has received research support from Biohaven Pharmaceuticals, Replimune, Morphogenesis, Shattuck Laboratories, Regeneron, and Merck, is a member of the Regeneron Ad Board as of July 2023, and is on the Board of Directors of the Society for Immunotherapy of Cancer. Dr Schoenfeld has received research support from Merck, BMS, Regeneron, Debiopharm, and EMD Serono, has consulting, scientific advisory board, and travel fee relationships with Castle Biosciences, Genentech, Immunitas, Debiopharm, BMS, Tilos, ACI Clinical, Astellas, Stimit, Merck KGA, SIRPant, and EMD Serono, has received expert witness fees from Pearson Doyle Mohre & Pastis, is a member of the Data Safety Monitoring or Advisory Board at ACI Clinical, EMD Serono, and Merck KGA, has stock options in Immunitas, and has equity in Doximity. Dr Koyfman has received research support from Merck, BMS, Castle Biosciences, and Regeneron, has consulted for Merck, Regeneron, and Galera, writes for Up To Date, and is a member of the advisory board for Alpha Part. The other authors have no conflicts of interest to declare., (Copyright © 2023 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Conflicts of interest None disclosed.

Competing Interests: Dr Ruiz received research support paid to the institution from Regeneron and PellePharm, and served as a consultant for Regeneron, Checkpoint Therapeutics, and Feldan Therapeutics. Dr Silk received research support paid to the institution from Biohaven Pharmaceuticals, Replimune, Morphogenesis, Shattuck Laboratories, Regeneron, and Merck, participated in the Regeneron Ad Board in July 2023, and served on the Board of Directors of the Society for Immunotherapy of Cancer. Dr Schoenfeld received research support paid to the institution from Merck, BMS, Regeneron, Debiopharm, and EMD Serono, served as a consultant or on the scientific advisory board or received travel fees from Castle Biosciences, Genentech, Immunitas, Debiopharm, BMS, Tilos, ACI Clinical, Astellas, Stimit, Merck KGA, SIRPant, and EMD Serono, received expert witness fees from Pearson Doyle Mohre & Pastis, participated in the data safety monitoring or advisory board of ACI Clinical, EMD Serano, and Merck KGA, had stock options in Immunitas, and had equity in Doximity. Dr Koyfman received research support from Merck, BMS, Castle Biosciences, and Regeneron, served as a consultant for Merck, Regeneron, and Galera, wrote for UpToDate, and participated in the advisory board for Alpha Part. Authors Groover and Ganger and Drs Gupta, Murad, Forrester, Anstadt, Su, Heusinkveld, Lukens, and Vidimos have no conflicts of interest to declare.

Background: Evidence is controversial and limited concerning whether surgical delays are associated with tumor growth for cutaneous squamous cell carcinomas (SCCs) and basal cell carcinomas., Objective: Identify tumor subpopulations that may demonstrate an association between tumor growth and surgical delay., Methods: We retrospectively analyzed 299 SCCs and 802 basal cell carcinomas treated with Mohs surgery at a single institution. Time interval from biopsy to surgery represented surgical delay. Change in major diameter (ΔMD) from size at biopsy to postoperative defect represented tumor growth. Independent predictors of ΔMD were identified by multivariate analysis. Linear regression was then utilized to assess for whether the ΔMD from these independent predictors trended with surgical delay., Results: Surgical delays ranged from 0 to 331 days. Among SCCs, histologic subtype and prior treatment were identified as independent predictors of ΔMD. Significant associations between ΔMD and surgical delay were found for poorly- and moderately-differentiated SCCs, demonstrating growth rates of 0.28 cm and 0.24 cm per month of delay, respectively. The ΔMD for SCCs with prior treatment and basal cell carcinoma subgroups did not vary with surgical delay., Limitations: Retrospective design, single center., Conclusion: Surgical delays of less than a year were associated with tumor growth for higher-grade SCCs, with effect sizes bearing potential for clinical significance., Competing Interests: Conflicts of interest None disclosed., (Copyright © 2021 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Competing Interests: The authors declare no conflicts of interest.

Competing Interests: The authors declare no conflicts of interest.

The Sepsis-3 taskforce defined sepsis as suspicion of infection and an acute rise in the Sequential Organ Failure Assessment score by 2 points over the preinfection baseline. Sepsis-3 studies, though, have not distinguished between acute and chronic organ failure, and may not accurately reflect the epidemiology, natural history, or impact of sepsis. Our objective was to determine the extent to which the predictive validity of Sepsis-3 is attributable to chronic rather than acute organ failure., Design: Retrospective cohort study., Setting: General medicine inpatient service at a tertiary teaching hospital., Patients: A total of 3,755 adult medical acute-care encounters (1,864 confirmed acute infections) over 1 year., Interventions: None., Measurements and Main Results: We measured the total Sequential Organ Failure Assessment score at the onset of infection and separated its components (baseline and acute rise) using case-by-case chart reviews. We compared the predictive validities of acuity-focused (acute rise in Sequential Organ Failure Assessment ≥ 2) and conventional (total Sequential Organ Failure Assessment ≥ 2) implementations of Sepsis-3 criteria. Measures of predictive validity were change in the rate of outcomes and change in the area under receiver operating characteristic curves after adding sepsis criteria to multivariate logistic regression models of baseline risk (age, sex, race, and Charlson comorbidity index). Outcomes were inhospital mortality (primary) and ICU transfer or inhospital mortality (secondary). Acuity-focused implementations of Sepsis-3 were associated with neither a change in mortality (2.2% vs 1.2%; p = 0.18) nor a rise in area under receiver operating characteristic curves compared with baseline models (0.67 vs 0.66; p = 0.75). In contrast, conventional implementations were associated with a six-fold change in mortality (2.4% vs 0.4%; p = 0.01) and a rise in area under receiver operating characteristic curves compared with baseline models (0.70 vs 0.66; p = 0.04). Results were similar for the secondary outcome., Conclusions: The evaluation of the validity of organ dysfunction-based clinical sepsis criteria is prone to bias, because acute organ dysfunction consequent to infection is difficult to separate from preexisting organ failure in large retrospective cohorts., Competing Interests: Dr. Moorman has ownership interests in AMP3D (Charlottesville, VA), a company that provides advanced predictive analytic solutions. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)

Competing Interests: The authors declare no conflicts of interest.

Familial cerebral cavernous malformations due to the common Hispanic mutation (FCCM1-CHM) is an endemic condition among the Hispanic population of the Southwestern United States associated with significant morbidity and mortality. Cutaneous vascular malformations (CVMs) can be found in individuals with FCCM1-CHM, but their morphology, prevalence, and association with cerebral cavernous malformations (CCMs) has not been well characterized. A cross-sectional study of 140 individuals with confirmed FCCM1-CHM was performed with statistical analyses of CVM, CCM, and patient characteristics. We then compared these findings to other cohorts with Familial cerebral cavernous malformations (FCCM) due to other mutations. We observed a higher overall prevalence and a different predominant morphological subtype of CVM compared to previous FCCM cohorts. While the number of CVMs was not a reliable indicator of the number of CCMs present, each person with one or more CVMs had evidence of central nervous system (CNS) disease. Awareness of the morphology of these cutaneous lesions can aid in the diagnosis of individuals with FCCM-CHM in Hispanic patients or those with family history of CCM., (© 2020 Wiley Periodicals, Inc.)

Erythema multiforme (EM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) comprise a family of mucocutaneous diseases associated with significant morbidity and mortality. Previous studies have confirmed the presence of autoantibodies to desmoplakin (Dp) I and II in patients with EM, SJS, and TEN. Truncated Dp production leads to characteristic changes visible on light microscopy: perinuclear clumping of keratin filaments and dyskeratotic keratinocyte. Based on these observations, the question arises as to whether a loss of Dp immunoreactivity in skin biopsies could serve as a diagnostic marker of EM, SJS, and TEN. This study analyzed Dp immunostaining patterns in 20 patients with EM or SJS/TEN. To assess the specificity of this approach, Dp immunostaining was also performed on specimens from patients with 5 potential histologic mimics of EM, SJS, and TEN. All of the samples from patients with EM, SJS, and TEN demonstrated absent or markedly diminished staining for Dp. A χ test demonstrated a statistically significant difference between the staining patterns in EM, SJS, and TEN and each of the other diagnostic groups that were investigated. This is the first report demonstrating statistically significant specificity of Dp staining patterns in EM/SJS/TEN as compared with other interface dermatitides.

Pyoderma gangrenosum (PG) is a rare inflammatory dermatosis that is most often associated with inflammatory bowel disease, but which can occur as a pathergic reaction around surgical incisions. The authors report the case of a patient who developed postoperative PG over the course of several months after undergoing extensive spinal instrumentation between the T4 and iliac levels. This is only the second such case occurring after spine surgery to be reported. The authors additionally review the literature to characterize treatment approaches and outcomes for this condition. The case highlights a potentially severe adverse effect of surgery that can be difficult to recognize and causes delays in effective treatment. It also demonstrates the importance of multidisciplinary collaboration in the effective care of patients.