clinicalRetinoid medications for acne are significantly associated with development of pyogenic granulomas; removal of medication often resolves the lesion↗
▶Ep 49 · 4:47
clinicalPyogenic granuloma surgical resection has approximately 3% recurrence rate with gross negative margins↗
▶Ep 49 · 4:54
quoteYou do not need to take, um, a wider margin, so about a 3% recurrence rate with that.↗
▶Ep 49 · 5:04
clinicalShave excision with curettage of pyogenic granuloma has 9.5% recurrence rate↗
▶Ep 49 · 5:20
quoteSilver nitrate actually has the lowest success rate, 15% recurrence rate with it.↗
▶Ep 49 · 5:20
clinicalSilver nitrate treatment for pyogenic granuloma has 15% recurrence rate, the highest among treatment options↗
▶Ep 49 · 5:33
quoteYou're not gonna get a path specimen, and it may require multiple treatments.↗
▶Ep 49 · 8:28
epidemiologicalIn a large study, 80% of characteristic Spitz nevi involuted spontaneously↗
▶Ep 49 · 8:44
clinicalHalf of pediatric dermatologists would observe classic Spitz nevi without excision, waiting for spontaneous resolution↗
▶Ep 49 · 9:43
clinicalIn a series of 30 patients with incompletely removed Spitz nevi, 24 were observed and none recurred; 6 were re-excised and only 1 had residual disease↗
▶Ep 49 · 10:23
clinicalIn a retrospective study with 1-3mm margins for Spitz nevi, 20% had positive margins on re-excision↗
▶Ep 49 · 10:45
guidelineBarnhill recommends 3-5mm margins for classic Spitz nevi, 1cm for atypical, and melanoma-protocol margins for severely atypical based on depth↗
▶Ep 49 · 11:56
epidemiologicalAbout one-third of Spitz nevi cases had nodal micrometastases on sentinel lymph node biopsy in combined adult and pediatric series↗
▶Ep 49 · 12:18
clinicalIn 8 series, 39% of Spitz nevi with sentinel lymph node biopsy were positive, but all patients remained disease-free at 3-year follow-up without further intervention↗
▶Ep 49 · 14:12
quote24 patients. Uh, well, small studies. We got not a lot of these in kids, all right, but we see them. We see it. We've, I, I suspect all of us have seen at least a few.↗
▶Ep 49 · 18:28
epidemiologicalPediatric melanoma ABCDE criteria capture only 40% of cases in children under 10 and 60% in children over 11↗
▶Ep 49 · 19:35
guidelineMelanoma margin recommendations: 5mm for in situ, 1cm for ≤1mm thick, 1-2cm for 1-2mm thick, 2cm for >2mm thick↗
▶Ep 49 · 19:50
clinicalCochrane review suggests 2cm margins are adequate for thick melanomas; no benefit demonstrated for 4cm margins↗
▶Ep 49 · 20:12
epidemiologicalGiant congenital nevi (>20cm) have 8% melanoma risk, higher if hairy; 60% of melanomas occur in first decade, reported as young as 3 years↗
▶Ep 49 · 20:35
epidemiologicalPediatric melanoma has higher metastatic rate to lymph nodes (about 25%) than adults, especially in children younger than 10 and with thicker lesions↗
▶Ep 49 · 21:02
clinicalIf sentinel node is negative in melanoma, probability of subsequent recurrence is only about 5%↗
▶Ep 49 · 21:08
clinicalIf sentinel node is negative in melanoma, probability of non-sentinel node being positive is low but not zero↗
▶Ep 49 · 27:50
quoteI would not operate on this. I, I would do a CBC and a chest X-ray, and the main reason for doing those is because they're virtually always normal and it helps to reassure the family.↗
▶Ep 49 · 28:02
quoteI think a 6 year old with a single node in the neck that's not growing, I think the chance of lymphoma is almost zero.↗
▶Ep 49 · 30:57
clinicalAcute unilateral cervical lymphadenopathy is mostly bacterial (strep and staph); acute bilateral is usually viral↗
▶Ep 49 · 31:30
clinicalChronic/subacute unilateral lymphadenopathy suggests atypical mycobacteria, Bartonella, tuberculosis, or toxoplasmosis↗
▶Ep 49 · 31:45
clinicalChronic/subacute bilateral lymphadenopathy suggests EBV, CMV, or HIV↗
▶Ep 49 · 32:43
clinicalLymphadenopathy may persist 6-8 weeks after antibiotic treatment↗
▶Ep 49 · 34:22
clinicalBiopsy indications for cervical lymphadenopathy include: >3cm, hard/fixed, supraclavicular or epitrochlear location, multiple nodal groups, systemic symptoms, hepatosplenomegaly, significantly abnormal labs, or abnormal imaging↗
▶Ep 49 · 34:58
clinicalFNA for lymph nodes has 90% sensitivity and specificity but 10% false rate, with higher false-negative rate in Hodgkin lymphoma↗
▶Ep 49 · 35:39
epidemiologicalMalignancy rate in cervical lymph node biopsies varies 10-25% overall but ranges 12-80% depending on referral patterns and specialty↗
▶Ep 49 · 38:00
clinicalAtypical mycobacterial lymphadenitis is a local problem in immunocompetent children, usually age 1-5 years, enters through oropharynx, and is not considered contagious↗
▶Ep 49 · 38:31
clinicalIn a randomized multicenter trial for atypical mycobacterial lymphadenitis, surgery had 96% cure rate versus 66% cure rate with antibiotics alone↗
▶Ep 49 · 38:56
clinicalIn a series of 55 patients with confirmed atypical mycobacteria, 45 started on antibiotics and 30 (67%) resolved without surgery↗
▶Ep 49 · 50:31
clinicalNeonatal breast mastitis occurs mostly in term or near-term infants due to estrogen exposure; very uncommon in preemies because estrogen levels don't rise↗
▶Ep 49 · 50:44
epidemiologicalPeak age for neonatal mastitis is 2-4 weeks; majority are staph but gram negatives reported↗
▶Ep 49 · 51:26
clinicalParenteral antibiotics for 7-14 days may be needed for neonatal mastitis because infants have delayed absorption and delayed antibiotic efficacy↗
▶Ep 49 · 52:39
clinicalIn two small series of neonatal mastitis with I&D, breast deformity occurred in 2 of 5 patients (40%) in one study and 2 of 7 patients (29%) in another↗
▶Ep 49 · 1:03:11
clinicalFibroadenomas are the most common breast lesion in the under-20 age group, representing an exaggerated response to estrogen↗
▶Ep 49 · 1:03:20
epidemiologicalAbout 10-15% of fibroadenomas are multiple and 10% are bilateral↗
▶Ep 49 · 1:03:27
clinicalFibroadenomas typically increase in size over 6-12 months, then stabilize and can regress completely↗
▶Ep 49 · 1:04:17
clinicalExcisional biopsy for fibroadenoma is recommended if continuing to grow, changing, over 5cm, symptomatic, complex on ultrasound, unreliable follow-up, or severe family anxiety↗
▶Ep 49 · 1:05:00
clinicalJuvenile fibroadenomas are larger lesions with rapid growth, greater than 5cm, but only 10% reach that size↗
▶Ep 49 · 1:05:14
clinicalJuvenile fibroadenomas larger than 5cm are difficult to distinguish from cystosarcoma phyllodes, even on percutaneous biopsy↗
▶Ep 49 · 1:05:57
clinicalSimple fibroadenomas (isolated, well-demarcated, solid) have no increased cancer risk if no family history and no adjacent breast tissue abnormality↗
▶Ep 49 · 1:06:14
clinicalComplex fibroadenomas (with cysts, calcifications, or abnormal surrounding tissue) carry a slight increased risk of future breast cancer up to 20 years after diagnosis↗
▶Ep 49 · 1:06:42
epidemiologicalMalignant breast disease in pediatric patients is rare and more commonly metastatic from other sites than primary breast tumors↗
▶Ep 49 · 1:06:53
epidemiologicalLymphoma patients treated with chest radiation at young ages have up to 25% higher incidence of malignant breast disease↗
▶Ep 49 · 1:07:05
guidelineAmerican Society of Clinical Oncology discourages BRCA genetic testing before age 20 due to lack of timely medical benefit and psychosocial risks↗
Danielle's statements about Soft Tissue Sarcoma (lymph nodes)98 statements
clinicalRetinoid medications for acne are significantly associated with development of pyogenic granulomas; removal of medication often resolves the lesion↗
▶Ep 2 · 4:14
clinicalRetinoid medications for acne are significantly associated with development of pyogenic granulomas; removal of medication often resolves the lesion↗
▶Ep 2 · 4:47
clinicalPyogenic granuloma surgical resection has approximately 3% recurrence rate with gross negative margins↗
▶Ep 2 · 4:47
clinicalPyogenic granuloma surgical resection has approximately 3% recurrence rate with gross negative margins↗
▶Ep 2 · 4:54
quoteYou do not need to take, um, a wider margin, so about a 3% recurrence rate with that.↗
▶Ep 2 · 4:54
quoteYou do not need to take, um, a wider margin, so about a 3% recurrence rate with that.↗
▶Ep 2 · 5:04
clinicalShave excision with curettage of pyogenic granuloma has 9.5% recurrence rate↗
▶Ep 2 · 5:04
clinicalShave excision with curettage of pyogenic granuloma has 9.5% recurrence rate↗
▶Ep 2 · 5:20
quoteSilver nitrate actually has the lowest success rate, 15% recurrence rate with it.↗
▶Ep 2 · 5:20
clinicalSilver nitrate treatment for pyogenic granuloma has 15% recurrence rate, the highest among treatment options↗
▶Ep 2 · 5:20
quoteSilver nitrate actually has the lowest success rate, 15% recurrence rate with it.↗
▶Ep 2 · 5:20
clinicalSilver nitrate treatment for pyogenic granuloma has 15% recurrence rate, the highest among treatment options↗
▶Ep 2 · 5:33
quoteYou're not gonna get a path specimen, and it may require multiple treatments.↗
▶Ep 2 · 5:33
quoteYou're not gonna get a path specimen, and it may require multiple treatments.↗
▶Ep 2 · 8:28
epidemiologicalIn a large study, 80% of characteristic Spitz nevi involuted spontaneously↗
▶Ep 2 · 8:28
epidemiologicalIn a large study, 80% of characteristic Spitz nevi involuted spontaneously↗
▶Ep 2 · 8:44
clinicalHalf of pediatric dermatologists would observe classic Spitz nevi without excision, waiting for spontaneous resolution↗
▶Ep 2 · 8:44
clinicalHalf of pediatric dermatologists would observe classic Spitz nevi without excision, waiting for spontaneous resolution↗
▶Ep 2 · 9:43
clinicalIn a series of 30 patients with incompletely removed Spitz nevi, 24 were observed and none recurred; 6 were re-excised and only 1 had residual disease↗
▶Ep 2 · 9:43
clinicalIn a series of 30 patients with incompletely removed Spitz nevi, 24 were observed and none recurred; 6 were re-excised and only 1 had residual disease↗
▶Ep 2 · 10:23
clinicalIn a retrospective study with 1-3mm margins for Spitz nevi, 20% had positive margins on re-excision↗
▶Ep 2 · 10:23
clinicalIn a retrospective study with 1-3mm margins for Spitz nevi, 20% had positive margins on re-excision↗
▶Ep 2 · 10:45
guidelineBarnhill recommends 3-5mm margins for classic Spitz nevi, 1cm for atypical, and melanoma-protocol margins for severely atypical based on depth↗
▶Ep 2 · 10:45
guidelineBarnhill recommends 3-5mm margins for classic Spitz nevi, 1cm for atypical, and melanoma-protocol margins for severely atypical based on depth↗
▶Ep 2 · 11:56
epidemiologicalAbout one-third of Spitz nevi cases had nodal micrometastases on sentinel lymph node biopsy in combined adult and pediatric series↗
▶Ep 2 · 11:56
epidemiologicalAbout one-third of Spitz nevi cases had nodal micrometastases on sentinel lymph node biopsy in combined adult and pediatric series↗
▶Ep 2 · 12:18
clinicalIn 8 series, 39% of Spitz nevi with sentinel lymph node biopsy were positive, but all patients remained disease-free at 3-year follow-up without further intervention↗
▶Ep 2 · 12:18
clinicalIn 8 series, 39% of Spitz nevi with sentinel lymph node biopsy were positive, but all patients remained disease-free at 3-year follow-up without further intervention↗
▶Ep 2 · 14:12
quote24 patients. Uh, well, small studies. We got not a lot of these in kids, all right, but we see them. We see it. We've, I, I suspect all of us have seen at least a few.↗
▶Ep 2 · 14:12
quote24 patients. Uh, well, small studies. We got not a lot of these in kids, all right, but we see them. We see it. We've, I, I suspect all of us have seen at least a few.↗
▶Ep 2 · 18:28
epidemiologicalPediatric melanoma ABCDE criteria capture only 40% of cases in children under 10 and 60% in children over 11↗
▶Ep 2 · 18:28
epidemiologicalPediatric melanoma ABCDE criteria capture only 40% of cases in children under 10 and 60% in children over 11↗
▶Ep 2 · 19:35
guidelineMelanoma margin recommendations: 5mm for in situ, 1cm for ≤1mm thick, 1-2cm for 1-2mm thick, 2cm for >2mm thick↗
▶Ep 2 · 19:35
guidelineMelanoma margin recommendations: 5mm for in situ, 1cm for ≤1mm thick, 1-2cm for 1-2mm thick, 2cm for >2mm thick↗
▶Ep 2 · 19:50
clinicalCochrane review suggests 2cm margins are adequate for thick melanomas; no benefit demonstrated for 4cm margins↗
▶Ep 2 · 19:50
clinicalCochrane review suggests 2cm margins are adequate for thick melanomas; no benefit demonstrated for 4cm margins↗
▶Ep 2 · 20:12
epidemiologicalGiant congenital nevi (>20cm) have 8% melanoma risk, higher if hairy; 60% of melanomas occur in first decade, reported as young as 3 years↗
▶Ep 2 · 20:12
epidemiologicalGiant congenital nevi (>20cm) have 8% melanoma risk, higher if hairy; 60% of melanomas occur in first decade, reported as young as 3 years↗
▶Ep 2 · 20:35
epidemiologicalPediatric melanoma has higher metastatic rate to lymph nodes (about 25%) than adults, especially in children younger than 10 and with thicker lesions↗
▶Ep 2 · 20:35
epidemiologicalPediatric melanoma has higher metastatic rate to lymph nodes (about 25%) than adults, especially in children younger than 10 and with thicker lesions↗
▶Ep 2 · 21:02
clinicalIf sentinel node is negative in melanoma, probability of subsequent recurrence is only about 5%↗
▶Ep 2 · 21:02
clinicalIf sentinel node is negative in melanoma, probability of subsequent recurrence is only about 5%↗
▶Ep 2 · 21:08
clinicalIf sentinel node is negative in melanoma, probability of non-sentinel node being positive is low but not zero↗
▶Ep 2 · 21:08
clinicalIf sentinel node is negative in melanoma, probability of non-sentinel node being positive is low but not zero↗
▶Ep 2 · 27:50
quoteI would not operate on this. I, I would do a CBC and a chest X-ray, and the main reason for doing those is because they're virtually always normal and it helps to reassure the family.↗
▶Ep 2 · 27:50
quoteI would not operate on this. I, I would do a CBC and a chest X-ray, and the main reason for doing those is because they're virtually always normal and it helps to reassure the family.↗
▶Ep 2 · 28:02
quoteI think a 6 year old with a single node in the neck that's not growing, I think the chance of lymphoma is almost zero.↗
▶Ep 2 · 28:02
quoteI think a 6 year old with a single node in the neck that's not growing, I think the chance of lymphoma is almost zero.↗
▶Ep 2 · 30:57
clinicalAcute unilateral cervical lymphadenopathy is mostly bacterial (strep and staph); acute bilateral is usually viral↗
▶Ep 2 · 30:57
clinicalAcute unilateral cervical lymphadenopathy is mostly bacterial (strep and staph); acute bilateral is usually viral↗
▶Ep 2 · 31:30
clinicalChronic/subacute unilateral lymphadenopathy suggests atypical mycobacteria, Bartonella, tuberculosis, or toxoplasmosis↗
▶Ep 2 · 31:30
clinicalChronic/subacute unilateral lymphadenopathy suggests atypical mycobacteria, Bartonella, tuberculosis, or toxoplasmosis↗
▶Ep 2 · 31:45
clinicalChronic/subacute bilateral lymphadenopathy suggests EBV, CMV, or HIV↗
▶Ep 2 · 31:45
clinicalChronic/subacute bilateral lymphadenopathy suggests EBV, CMV, or HIV↗
▶Ep 2 · 32:43
clinicalLymphadenopathy may persist 6-8 weeks after antibiotic treatment↗
▶Ep 2 · 32:43
clinicalLymphadenopathy may persist 6-8 weeks after antibiotic treatment↗
▶Ep 2 · 34:22
clinicalBiopsy indications for cervical lymphadenopathy include: >3cm, hard/fixed, supraclavicular or epitrochlear location, multiple nodal groups, systemic symptoms, hepatosplenomegaly, significantly abnormal labs, or abnormal imaging↗
▶Ep 2 · 34:22
clinicalBiopsy indications for cervical lymphadenopathy include: >3cm, hard/fixed, supraclavicular or epitrochlear location, multiple nodal groups, systemic symptoms, hepatosplenomegaly, significantly abnormal labs, or abnormal imaging↗
▶Ep 2 · 34:58
clinicalFNA for lymph nodes has 90% sensitivity and specificity but 10% false rate, with higher false-negative rate in Hodgkin lymphoma↗
▶Ep 2 · 34:58
clinicalFNA for lymph nodes has 90% sensitivity and specificity but 10% false rate, with higher false-negative rate in Hodgkin lymphoma↗
▶Ep 2 · 35:39
epidemiologicalMalignancy rate in cervical lymph node biopsies varies 10-25% overall but ranges 12-80% depending on referral patterns and specialty↗
▶Ep 2 · 35:39
epidemiologicalMalignancy rate in cervical lymph node biopsies varies 10-25% overall but ranges 12-80% depending on referral patterns and specialty↗
▶Ep 2 · 38:00
clinicalAtypical mycobacterial lymphadenitis is a local problem in immunocompetent children, usually age 1-5 years, enters through oropharynx, and is not considered contagious↗
▶Ep 2 · 38:00
clinicalAtypical mycobacterial lymphadenitis is a local problem in immunocompetent children, usually age 1-5 years, enters through oropharynx, and is not considered contagious↗
▶Ep 2 · 38:31
clinicalIn a randomized multicenter trial for atypical mycobacterial lymphadenitis, surgery had 96% cure rate versus 66% cure rate with antibiotics alone↗
▶Ep 2 · 38:31
clinicalIn a randomized multicenter trial for atypical mycobacterial lymphadenitis, surgery had 96% cure rate versus 66% cure rate with antibiotics alone↗
▶Ep 2 · 38:56
clinicalIn a series of 55 patients with confirmed atypical mycobacteria, 45 started on antibiotics and 30 (67%) resolved without surgery↗
▶Ep 2 · 38:56
clinicalIn a series of 55 patients with confirmed atypical mycobacteria, 45 started on antibiotics and 30 (67%) resolved without surgery↗
▶Ep 2 · 50:31
clinicalNeonatal breast mastitis occurs mostly in term or near-term infants due to estrogen exposure; very uncommon in preemies because estrogen levels don't rise↗
▶Ep 2 · 50:31
clinicalNeonatal breast mastitis occurs mostly in term or near-term infants due to estrogen exposure; very uncommon in preemies because estrogen levels don't rise↗
▶Ep 2 · 50:44
epidemiologicalPeak age for neonatal mastitis is 2-4 weeks; majority are staph but gram negatives reported↗
▶Ep 2 · 50:44
epidemiologicalPeak age for neonatal mastitis is 2-4 weeks; majority are staph but gram negatives reported↗
▶Ep 2 · 51:26
clinicalParenteral antibiotics for 7-14 days may be needed for neonatal mastitis because infants have delayed absorption and delayed antibiotic efficacy↗
▶Ep 2 · 51:26
clinicalParenteral antibiotics for 7-14 days may be needed for neonatal mastitis because infants have delayed absorption and delayed antibiotic efficacy↗
▶Ep 2 · 52:39
clinicalIn two small series of neonatal mastitis with I&D, breast deformity occurred in 2 of 5 patients (40%) in one study and 2 of 7 patients (29%) in another↗
▶Ep 2 · 52:39
clinicalIn two small series of neonatal mastitis with I&D, breast deformity occurred in 2 of 5 patients (40%) in one study and 2 of 7 patients (29%) in another↗
▶Ep 2 · 1:03:11
clinicalFibroadenomas are the most common breast lesion in the under-20 age group, representing an exaggerated response to estrogen↗
▶Ep 2 · 1:03:11
clinicalFibroadenomas are the most common breast lesion in the under-20 age group, representing an exaggerated response to estrogen↗
▶Ep 2 · 1:03:20
epidemiologicalAbout 10-15% of fibroadenomas are multiple and 10% are bilateral↗
▶Ep 2 · 1:03:20
epidemiologicalAbout 10-15% of fibroadenomas are multiple and 10% are bilateral↗
▶Ep 2 · 1:03:27
clinicalFibroadenomas typically increase in size over 6-12 months, then stabilize and can regress completely↗
▶Ep 2 · 1:03:27
clinicalFibroadenomas typically increase in size over 6-12 months, then stabilize and can regress completely↗
▶Ep 2 · 1:04:17
clinicalExcisional biopsy for fibroadenoma is recommended if continuing to grow, changing, over 5cm, symptomatic, complex on ultrasound, unreliable follow-up, or severe family anxiety↗
▶Ep 2 · 1:04:17
clinicalExcisional biopsy for fibroadenoma is recommended if continuing to grow, changing, over 5cm, symptomatic, complex on ultrasound, unreliable follow-up, or severe family anxiety↗
▶Ep 2 · 1:05:00
clinicalJuvenile fibroadenomas are larger lesions with rapid growth, greater than 5cm, but only 10% reach that size↗
▶Ep 2 · 1:05:00
clinicalJuvenile fibroadenomas are larger lesions with rapid growth, greater than 5cm, but only 10% reach that size↗
▶Ep 2 · 1:05:14
clinicalJuvenile fibroadenomas larger than 5cm are difficult to distinguish from cystosarcoma phyllodes, even on percutaneous biopsy↗
▶Ep 2 · 1:05:14
clinicalJuvenile fibroadenomas larger than 5cm are difficult to distinguish from cystosarcoma phyllodes, even on percutaneous biopsy↗
▶Ep 2 · 1:05:57
clinicalSimple fibroadenomas (isolated, well-demarcated, solid) have no increased cancer risk if no family history and no adjacent breast tissue abnormality↗
▶Ep 2 · 1:05:57
clinicalSimple fibroadenomas (isolated, well-demarcated, solid) have no increased cancer risk if no family history and no adjacent breast tissue abnormality↗
▶Ep 2 · 1:06:14
clinicalComplex fibroadenomas (with cysts, calcifications, or abnormal surrounding tissue) carry a slight increased risk of future breast cancer up to 20 years after diagnosis↗
▶Ep 2 · 1:06:14
clinicalComplex fibroadenomas (with cysts, calcifications, or abnormal surrounding tissue) carry a slight increased risk of future breast cancer up to 20 years after diagnosis↗
▶Ep 2 · 1:06:42
epidemiologicalMalignant breast disease in pediatric patients is rare and more commonly metastatic from other sites than primary breast tumors↗
▶Ep 2 · 1:06:42
epidemiologicalMalignant breast disease in pediatric patients is rare and more commonly metastatic from other sites than primary breast tumors↗
▶Ep 2 · 1:06:53
epidemiologicalLymphoma patients treated with chest radiation at young ages have up to 25% higher incidence of malignant breast disease↗
▶Ep 2 · 1:06:53
epidemiologicalLymphoma patients treated with chest radiation at young ages have up to 25% higher incidence of malignant breast disease↗
▶Ep 2 · 1:07:05
guidelineAmerican Society of Clinical Oncology discourages BRCA genetic testing before age 20 due to lack of timely medical benefit and psychosocial risks↗
▶Ep 2 · 1:07:05
guidelineAmerican Society of Clinical Oncology discourages BRCA genetic testing before age 20 due to lack of timely medical benefit and psychosocial risks↗
