Asymptomatic vesicular eruption on the chest in a breast cancer survivor. Diagnosis: Benign lymphangiomatous papules (BLAP) of the skin following radiotherapy

A 47-year-old woman with a history of inflammatory breast cancer presented with a 2- to 3-week history of asymptomatic lesions of the right chest and axilla. The cancer in her right breast had been treated 3.5 years earlier by bilateral mastectomy, right axillary lymph node dissection, tamoxifen therapy, and radiotherapy to the right chest. Physical examination revealed grouped vesicles, some on a background of mild erythema, and scattered, flesh-colored, flat-topped papules overlying the patient\u27s mastectomy scars and radiation field on the right chest and axilla (Figure 1). The left chest and axilla were unaffected. Results from a Tzanck preparation, direct fluorescent antibody testing for herpes simplex virus and varicella zoster virus, and viral cultures were negative. A punch biopsy specimen was obtained from the right axilla (Figure 2 and Figure 3)

Vitamin D deficiency is associated with a worse prognosis in metastatic melanoma

Vitamin D deficiency (≤20 ng/mL) is associated with an increased incidence and worse prognosis of various types of cancer including melanoma. A retrospective, single-center study of individuals diagnosed with melanoma from January 2007 through June 2013 who had a vitamin D (25(OH)D3) level measured within one year of diagnosis was performed to determine whether vitamin D deficiency and repletion are associated with melanoma outcome. A total of 409 individuals diagnosed with histopathology-confirmed melanoma who had an ever measured serum 25(OH)D3 level were identified. 252 individuals with a 25(OH)D3 level recorded within one year after diagnosis were included in the study and the individual and melanoma characteristics such as age, sex, Breslow thickness, ulceration, stage, mitotic rate, and LDH were obtained from the medical record. A worse melanoma prognosis was associated with vitamin D deficiency (P=0.012), higher stage (P20 ng/mL increase. Our results suggest that initial vitamin D deficiency and insufficient repletion is associated with a worse prognosis in patients with metastatic melanoma