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BACKGROUND The incarcerated population may have variable access to specialty care that may affect the detection and diagnosis of skin cancer. OBJECTIVE The purpose of the study was to characterize skin cancers in the incarcerated population and determine time to treatment initiation (TTI) after biopsy. METHODS A retrospective cohort study was performed using data from a single-center referral hospital of incarcerated patients with biopsy-proven basal cell carcinoma (BCC), squamous cell carcinoma (SCC), or melanoma between January 2009 and December 2019. The main outcome measured was TTI after biopsy. RESULTS One hundred thirteen patients, majority men (96.5%) and of Caucasian race (89.4%), were diagnosed and/or treated for 191 skin cancers. Of these 191 skin cancers, 118 were BCC (61.8%), 58 were SCC (30.4%), and 15 were melanomas (7.9%). The average TTI after biopsy for melanoma was 57 days (range: 21-136, median: 51, 95% confidence interval: 39.89-74.10) with an average Breslow depth of 1.57 mm. CONCLUSION The average TTI of melanoma in the incarcerated population in this study was greater than 30 days, which may have increased mortality risk.

Prior reports of TTS occurred after surgery for trigeminal neuralgia, and other structural, vascular, infectious, and traumatic trigeminal nerve insults. 1 Although there have been cases of trigeminal nerve damage and facial pain with anti-Hu/ANNA-1 paraneoplastic syndrome, 2,3 TTS secondary to paraneoplastic antibodies is a novel finding. TTS symptoms usually begin one year after trigeminal nerve damage but can appear only weeks later. 1 TTS is a clinical diagnosis and one of exclusion. 1 It is important to rule out skin infection and malignancy with skin biopsy, and TTS histopathology is nonspecific. 1 Medical and surgical histories provide clues into TTS etiology, and obtaining a brain MRI can be helpful in assessing trigeminal nerve damage. 1 Trigeminal trophic syndrome lacks universal treatment algorithms. However, a cornerstone of therapy is education to avoid scratching the ulcer. 1,4 We not only provided education but also put a physical barrier over the lesion to prevent picking. Emollients and topical corticosteroids do not have a role in TTS treatment. 1 We recommended dilute acetic acid soaks and mupirocin to treat the lesion's bacterial superinfection. Amitriptyline-ketamine cream helped with localized neuropathic pain. Neuralgia management includes gabapentin and carbamazepine, 1,4 similar to our case's duloxetine and pregabalin. Furthermore, the underlying anti-Hu/ANNA-1 autoimmune paraneoplastic syndrome required systemic corticosteroids. Surgical reconstruction, negative pressure wound therapy, and thermoplastic face masks have been effective for TTS. 1,4 However, we avoided aggressive surgical management as first-line treatment in the setting of metastatic small cell lung cancer with unknown prognosis. This case reinforces the classic trigeminal dermatome distribution, symptoms, and dermatopathology of TTS. We add additional insight into the treatment of TTS with physical barriers over the skin lesion and topicals for neuropathic pain and emphasize the importance of multidisciplinary care to help manage the underlying etiology of TTS.