Background Juvenile nasopharyngeal angiofibroma (JNA) is a rare but potentially lifethreatening fibrovascular tumor that is seen almost exclusively in adolescent males and usually presents with symptoms of nasal obstruction or severe epistaxis. The current gold standard of treatment consists of complete surgical resection; however, this is inherently challenging because of the tumor's invasive nature and a substantial risk of intraoperative hemorrhage. Flutamide, an anti-androgen antineoplastic agent, has been used preoperatively in attempts to reduce tumor volume allowing for surgical resection with more conservative procedural techniques and reduce intraoperative blood loss.Methods A literature review of PubMed and CINAHL was used to identify and analyze 29 male patients with JNA to determine the efficacy of the preoperative use of flutamide. ResultsOur analyses indicate that flutamide may be effective as a neoadjuvant agent by reducing tumor volume prior to resection in some patients but seemed to be more effective in the early stages of JNA without advanced tumor invasion. However, individual tumor response to flutamide was variable. Additionally, postpubertal patients seemed to demonstrate a greater reduction in tumor volume with flutamide compared to their prepubertal counterparts. Dosing regimen and side effects associated with flutamide therapy are also discussed. ConclusionFlutamide may be an effective neoadjuvant therapy in some cases of juvenile nasopharyngeal angiofibroma, but larger scale, case-control studies are likely needed to further expand on this conclusion. Postpubertal males with early-stage disease seemed to be the population that may benefit most from this treatment protocol.

Tumor necrosis factor‐alpha inhibitor therapy for inflammatory bowel disease may be associated with paradoxical cutaneous adverse events, most commonly psoriasiform eruptions. We present the case of a pediatric female patient with Crohn's disease who developed multiple concurrent cutaneous eruptions while on infliximab treatment, including morphea, psoriasiform dermatitis, and genital lichen sclerosus. Although refractory to skin‐directed treatments, all three conditions resolved upon discontinuation of infliximab, supporting their development as a paradoxical reaction to infliximab therapy.

Spitzoid melanocytic lesions describe a spectrum of pediatric melanocytic proliferations that range from benign Spitz nevi to malignant spitzoid melanomas. 1 Spitz nevi are benign pink to brown papules that develop within the first two decades of life. 2 Only ten cases of congenital Spitz nevi have ever been reported in the literature. 3 Atypical spitzoid neoplasm (ASN) is a poorly defined category within this spectrum that poses a unique diagnostic challenge due to overlapping histologic features with conventional Spitz nevus and spitzoid melanoma. 1,4 The clinical and histopathological features of ASN remain imprecise, leading to difficulty in diagnosis. 4 Additionally, the malignant potential of ASN is uncertain, leading to debate over the proper therapeutic approach. We report a unique case of congenital ASN mimicking an infantile hemangioma and highlight the clinical process undertaken for diagnosis and the multidisciplinary approach to management. We aim to highlight the unique features and atypical distribution of this segmental ASN, which has not been described in the literature.