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Despite well-defined clinical and histopathological features of melanoma, atypical presentations mimicking other skin disorders can result in a delayed diagnosis or misdiagnosis and subsequent inappropriate treatment. Rosai-Dorfman disease (RDD) is a rare histiocytic disorder with unique clinical and histopathological features. We report a case of melanoma treated with cryotherapy that mimicked RDD both clinically and histopathologically. We compare this RDD-like melanoma to classic RDD, outlining the importance of clinicopathological correlation prior to treatment, as well as the potential pitfalls in diagnosis after cryotherapy of pigmented lesions.

Social media is increasingly cited in plastic surgeon surveys as a reason for undergoing cosmetic procedures, especially non-invasive procedures like onabotulinumtoxinA (Botox) and dermal fillers. We explored trends between social media usage and public interest in cosmetic procedures, as well as how these effects differ by procedure and by specialty (dermatology or plastic surgery). Google Trends was queried for search terms and compared with aggregate user data from Instagram and Facebook. Search terms were the brand names of medications, as these are how the general public knows the medications. Benjamini-Hochberg adjustment for multiple comparisons was used; p<0.02 was considered significant, except for comparisons between specialties, where p<0.01 was significant. The terms dermatologist, Botox, Juvederm, Radiesse, CoolSculpting, Kybella, and facelift have increased in popularity over time, whereas the terms Restylane, liposuction, rhinoplasty, and breast augmentation were decreasing in popularity (p<0.02). No temporal change was observed for Sculptra, Radiesse, blepharoplasty, rhinoplasty and plastic surgeon. Dermatologist (r¼Instagram/r¼Facebook)(0.58/0.54), Botox (0.80/0.47), Juvederm (0.69/0.46) Radiesse (-0.89/-0.40), CoolSculpting (0.81/0.44), and Kybella (0.89/0.43) were associated with Instagram and Facebook user numbers (p<0.02). Blepharoplasty (0.69) and rhinoplasty (0.66) were only associated with Instagram users (p<0.02). Juvederm (r¼0.89) was only associated with dermatologist; Sculptra (r¼0.27), blepharoplasty (r¼0.48), and rhinoplasty (r¼0.66) were only associated with plastic surgeon (p<0.01). Significant correlations were seen for all other search terms between both specialties. Online interest in non-invasive cosmetic procedures is increasing, potentially driven in part by social media. Further, these data suggest that interest in dermatology, compared to other specialties, may especially be increasing due to this phenomenon. 334The sun and your health: Targeting teenagers and adolescents in British Columbia Skin cancer is one of the most preventable forms of cancer. Roughly, 85% of skin cancer cases could be avoided by reducing UV exposure, especially during adolescence. We conducted a pilot study to evaluate sun safety behaviors in this age group, as well as, the effects of an innovative intervention in changing sun protection attitudes and behaviours. Methods: Participants were recruited from 8 secondary schools in Vancouver, BC. Participants were segregated into the control arm (N¼38) or intervention arm (N¼138). All participants engaged in a 15-minute teaching session on the negative effects of sun exposure. The intervention group also had UV facial photographs taken to reveal UV related damage. To assess baseline attitudes/behaviours and the impact of the intervention, a survey was administered at 3 time points: prior to the study, immediately afterwards and at 6 months after the study. Results: Education alone and in combination with the intervention significantly improved knowledge ...

Introduction: Necrobiosis lipoidica (NL) is a chronic, granulomatous disease linked to diabetes mellitus (DM). Our aim was to characterize its histology and inflammatory cell features to better understand its etiology. Methods: A retrospective study was performed within Mayo Clinic from 1992 to 2017. Inclusion into the study required biopsy-proven NL where the histopathology and inflammatory infiltrate of 93 biopsies were reviewed by a dermatopathologist. Results: The granulomatous changes of NL were most commonly diffuse (84% No DM, 97% DM-2, 60% DM-1, p¼0.048). The pattern of inflammation was most often palisaded 54% and or tiered/layered 65% (59% No DM, 80% DM-2, 40% DM-1) involving the mid-dermis (98% No DM, 100% DM-2, 80% DM-1) (p¼0.016). Sarcoidal granulomas were more common in those without DM (24% No DM, 3% DM-2, 0% DM-1) (p¼0.025). The subcutis was involved in the non-DM and DM-2 30% of the time. Mucin was present more commonly in diabetics (17% non-DM, 53% DM-2, and 40% DM-1) (p¼0.01). Perivascular inflammation was present in 82% of cases and composed predominantly of lymphocytes (93% No DM, 100% DM-2, 80% DM-1) (DM-2 vs DM-1 p¼0.013) and plasma cells 73%. Lymphocytic infiltrates were ubiquitous and plasma cells (81% No DM, 83% DM-2, 40% DM-1) (DM-2 vs DM-1 p¼0.033) were significantly different in the infiltrate. Eosinophils were present (38% No DM, 10% DM-2, 20% DM-1) (p¼0.02) and were seen in differing amounts in the dermis (p¼0.049). Neutrophils were present (14% No DM, 50% DM-2, 60% DM-1) (p<0.001) and were seen in differing amounts in the dermis (12% No DM, 47% DM-2, 60% DM-1) (p <0.001). Giant cells were seen in 82% of cases. Foamy histiocytes were seen in 71% of cases and were often widespread (63% No DM, 30% DM-2, 33% DM-1) (p¼0.042). Conclusion: While sharing similar histopathology, the inflammatory profiles between the NL subgroups of Non-DM, DM-2 and DM-1 are distinct. NL may have different mechanisms between groups.