Letter Regarding Editorial by Samuel Zagarella

Abstract

formation of the cyst. It has been suggested that HPV 6/11 may induce the formation of a cyst through a latent infection or by infection of hair follicles. Reports of HPV 6/11 in pubic hairs plucked from patients with condyloma acuminatum have demonstrated positivity, even after the patients were successfully treated for HPV. 6 Therefore, there is a possibility that HPV may persist in skin after lesions have essentially cleared.Other theories have drawn similarities to other virus infections found in cysts. Ramos-Garibay et al, described an epidermoid cyst infected with molluscum contagiosum and postulated that the virus infects the follicular infundibulum during the formation of the cyst and that growth factors associated with it may contribute to follicular hyperplasia. 6,10 Similarly, HPV 6 of 11 may also drive growth factors and play a similar role in the development of a verrucous cyst. 6 Our case adds to the exceedingly rare literature reporting HPV type 6/11associated verrucous cysts; in our search of the existing literature, we found only one other similar previously reported case. 6 We propose the terminology cystic condyloma to describe this phenomenon.

Evaluation of the Indications for Sentinel Node Biopsy in Early-Stage Melanoma with the Advent of Adjuvant Systemic Therapy: An International, Multicenter Study

“…1,9,11 Some academic centers published algorithms to provide a further, nuanced selection criterion, [12][13][14][15][16] and others debated whether SNB should be offered at all. 17,18 Ultimately, the role of SNB for accurately staging patients with cutaneous melanoma remains, but the primary rationale for offering the procedure has altered to identifying those most likely to benefit from adjuvant systemic therapy. The focus of the current study is to reappraise those who are least likely to benefit from being staged by the procedure, particularly if the outcome does not alter subsequent management of the patient.…”

In Response

“…The reply by Faries et al highlights a biased opinion that strongly favors sentinel lymph node biopsy (SLNB). 1 Given the high cost of SLNB to patients and the health care system ($14,000 to $18,000 per procedure in the United states in 2018), the medical community is justified in challenging and questioning the value of this operation.…”

“…The reply by Faries et al highlights a biased opinion that strongly favors sentinel lymph node biopsy (SLNB). 1…”