Toxic epidermal necrolysis in patient with breast cancer receiving letrozole.
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Antineoplastic Agents↗
Biomedical subjects
P Ang
Publications and source records attributed to P Ang.
Characteristics of Hori naevus: a prospective analysis.
BACKGROUND: Acquired, bilateral naevus of Ota-like macules or Hori naevus (HN) is a common dyschromia seen in Orientals. Other than the original report which documented the clinical spectrum in a group of 22 patients, there have not been many epidemiological reports of this condition. OBJECTIVES: To evaluate the epidemiology and clinical characteristics of HN in Asian patients. METHODS: A prospective analysis of 161 patients with HN seen from June 2003 to June 2004 was performed. RESULTS: All 161 patients in the study were women. Patients were Chinese (n = 155), Eurasian (n = 4), Malay (n = 1) and Indian (n = 1). The median age at onset was 30 years. The malar region was the most frequently affected area. Discrete brown macules were the most common early presentation. Confluent slate-grey macules occurred later. Aggravating factors included sun exposure and pregnancy. Sixty-seven patients reported a positive family history. CONCLUSIONS: We report our data on the largest series of HN in the literature so far. Predisposing factors in our study are Chinese race, female sex and positive family history. HN became progressively more confluent and grey over time, suggesting migration from the epidermis to the deeper dermis. More studies are needed to confirm the pathogenesis.
Adolescent↗
Detection of a novel Alu-mediated BRCA1 exon 13 duplication in Chinese breast cancer patients and implications for genetic testing.
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Adult↗
Darier's disease in Singapore.
BACKGROUND: Darier's disease is a rare, dominantly inherited genodermatosis. Although it has been well studied in caucasians, very little is known about the clinical spectrum of this disorder among Asians. OBJECTIVES: To determine the demographic and clinical profile of Asian patients with Darier's disease. METHODS: This is a retrospective study of all new cases of Darier's disease seen in our centre over a 20-year period (1982-2002). Results Twenty-four nonrelated cases of Darier's disease were studied. The incidence rate was 3.1 per million per decade. The gender distribution was 19 males and five females, and the ethnic origin was 21 Chinese, two Malays and one Nepalese. The peak age of onset was between 11 and 20 years. Sun exposure exacerbated the disease in 13 of the patients, and three had neuropsychiatric disorders. The disease affected predominantly seborrhoeic areas in 19 patients, flexural in three, acral in one and was segmental in one patient. Hand involvement was common and included palmar pits in nine patients, acrokeratosis verruciformis in four and nail changes in 12 patients. Haemorrhagic macules were not seen. Rare features included oral mucosal lesions (two patients) and guttate leucoderma (three patients). Pathogens involved in cutaneous infections included herpes simplex virus, Staphylococcus aureus, Streptococcus species and Morganella morgani. All patients treated with oral retinoids had improvement of clinical signs. In contrast, the response to topical retinoids was poor. CONCLUSIONS: Compared with western studies, our results show a similar incidence rate, age of onset, distribution of disease patterns and association with neuropsychiatric disorders. Features that differ include co-occurrence of guttate leucoderma, rarity of acrokeratosis, absence of haemorrhagic macules and poor response to topical retinoids.
Adolescent↗
Acceptance of prophylactic surgery and chemoprevention of cancer in Singapore - a survey.
INTRODUCTION: In addition to surveillance practices, chemoprevention and prophylactic surgery can reduce the risk of cancer in individuals at high risk. Sociocultural factors may have a role to play in such decision making. Little is known regarding the factors that play a role in decision making in Singapore. MATERIALS AND METHODS: One hundred and two individuals at normal risk completed a questionnaire on the concept of chemoprevention and prophylactic surgery. The results were analysed using the convenience sampling method. RESULTS: Participants were mostly Chinese (94.1%). More than 90% of the respondents answered the section on prophylactic surgery and chemoprevention. Thirty-eight individuals (41.3%) would not consider prophylactic surgery, while 42 (45.7%) would not consider prophylactic surgery now but might consider it in the future. Twenty-five individuals (26.9%) would not consider chemoprevention by taking a medication, 57% would not consider it now but might in the future. CONCLUSION: A cross-sectional public view suggests that medical prophylaxis is likely to be more acceptable to the general public compared to surgical prophylaxis.
Adolescent↗
Comparison of completely versus incompletely excised cutaneous squamous cell carcinomas.
INTRODUCTION: This is a retrospective case series of cutaneous squamous cell carcinomas (SCCs) which were incompletely excised in National Skin Centre, Singapore from 1991 to 1995. This study compared the characteristics of completely excised versus incompletely excised cutaneous SCCs. MATERIALS AND METHODS: All patients with histologically confirmed SCCs were traced from computerised medical database and information regarding patient profile, tumour characteristics, surgical treatment and outcome were collated. All patients were recalled for clinical examination and documentation of cure. Completely excised and incompletely excised SCCs were compared with regards to the patient and tumour characteristics. RESULTS: There were 57 patients with 63 SCCs who were treated with surgical excision over the 5-year period. Fifty were recalled for physical examination. There were 30 males and 27 females and their mean age was 83.3 years. All except 1 were Chinese of Fitzpatrick skin type 4. One-third of patients had daily or weekly sun exposure in the past and 21.1% had occupational sun exposure; 3.5% had prior arsenic exposure and 3.5% were previously treated with radiotherapy for other malignancies. The mean duration of SCCs was 18.7 months; 7.9% of patients had multiple SCCs and 15.9% had underlying actinic keratoses. The mean diameter of the tumours was 1.97 cm and nearly half were located on the head and neck. All the SCCs were primary and localised to the skin; 84.1% of them were completely excised with a 4 to 6 mm margin. Incompletely excised SCCs were associated with the male sex, larger tumours and tumours on the genitals and lower limbs. CONCLUSION: In our experience, the tumour clearance rate is 84.1% following conventional excision. Incomplete excision is associated with male sex, larger tumours and those on the genitals and lower limbs.
Aged↗
Extensive calcinosis cutis in relapsed acute lymphoblastic leukaemia.
INTRODUCTION: Hypercalcaemia with calcinosis cutis occurring at relapse of acute lymphoblastic leukaemia (ALL) is rare and unusual. CLINICAL PICTURE: A 19-year-old lady with B precursor ALL presented with extensive waxy, verrucous, tender plaques over the flexures of her arms and legs a week after relapse of leukaemia. She was found to have hypercalcaemia, hyperphosphataemia, hyperuricaemia and acute renal impairment. Skin biopsy was consistent with calcinosis cutis. There was no evidence of metastatic calcification in other organs. TREATMENT: Hypercalcaemia was treated with aggressive hydration and intravenous pamidronate. High doses of analgesics were required for partial pain relief. OUTCOME: Cutaneous lesions proved resistant to early calcium lowering and were a source of constant pain. She succumbed to leukaemia four months later. CONCLUSION: Treatment of calcinosis cutis was unsatisfactory and would have been dependent on the successful treatment of the underlying leukaemia.
Adult↗
Clinical profile and treatment outcome of livedoid vasculitis: a case series.
INTRODUCTION: Livedoid vasculitis is a painful ulcerative condition affecting the legs that is often difficult to treat. In this case series, the clinical profile of 6 patients with livedoid vasculitis and their treatment response to aspirin and pentoxifylline are reported. MATERIALS AND METHODS: This is an open trial. Investigations to exclude secondary causes of livedoid vasculitis were done. Skin biopsies were performed for histology and direct immunofluorescence. Four patients were treated with pentoxifylline and 2 with aspirin. Response to treatment was assessed at the third and sixth weeks. Thereafter, treatment was individualised according to each patient's clinical response. RESULTS: Only 1 out of 6 patients had a good response. This patient was treated with pentoxifylline. Most patients required treatment with drugs such as prednisolone, colchicine and azathioprine to control disease activity after the trial period. CONCLUSION: Pentoxifylline or aspirin did not result in significant improvement for most of our patients when used alone. Combination with immunosuppressive treatment yielded better results.
Adult↗
Nonablative laser resurfacing: a systematic review of the literature.
'Nonablative laser resurfacing' is a new treatment for photoaged skin, the aim of which is to wound the upper dermis in order to induce dermal fibrosis and improve the clinical appearance. Unlike conventional laser resurfacing or dermabrasion, the epidermis is protected and retained to avoid the problems associated with open wounds and reepithelialization. A number of lasers and light sources have been developed or adapted for this purpose.
Dermabrasion↗
Efficacy and tolerability of irinotecan in patients with advanced colorectal cancer in Singapore.
INTRODUCTION: Colorectal cancer is the commonest malignancy encountered in Singapore. The long-term outcome of patients with advanced diseases is poor. For many decades, 5-fluorouracil was the only effective cytotoxic drug against colorectal cancers. Randomised trials have documented the efficacy of irinotecan in patients with metastatic colorectal cancer. We investigated the efficacy and safety profile of irinotecan (CPT-11), as a second-line treatment for an Asian population who had failed 5-fluorouracil-based chemotherapy. MATERIALS AND METHODS: A total of 33 patients were enrolled in the study between October 1996 and May 1999. This was an open label phase II study. All patients who had received at least one dose of CPT-11 were evaluated for toxicity. Thirty patients were evaluated for response. RESULTS: Six patients (20%) had partial responses and 1 (3%) experienced minor response. Fourteen patients (47%) progressed. Nine patients (30%) had stable disease. The range of time to progression was 5.8 months to 21 months. The median survival was 9.5 months. There was no treatment-related death. Seven patients (23%) who received treatment had diarrhoea. Only 2 of the 7 patients had grade 3-4 diarrhoea. Eleven patients (37%) suffered from haematological toxicity, of whom 2 patients had grade 3-4 neutropenia. CONCLUSION: We demonstrated efficacy and tolerability of CPT-11 in Singaporean patients with advanced colorectal cancer.
Adult↗
Genetic susceptibility for breast cancer--risk assessment and counseling.
The incorporation of genetic information into clinical oncology practice is a process in evolution, necessitating consideration of cancer risk assessment, ethical and social implications of testing and efficacy of treatment, and prevention interventions. Although most cancers do have a hereditary component, recognizing individuals who are at unusually high risk is important for planning their surveillance practices and considering options for risk management over a lifetime, and because of implications for their family members. Genetic information has enormous potential to inform and transform cancer risk identification, risk reduction, and treatment practices. In this review, we summarize basic information about breast cancer genetics, examine accumulating data about the prevalence and penetrance of deleterious mutations and management options for BRCA1 and BRCA2 mutation carriers, and discuss some of the counseling issues that may occur as physicians and patients explore this exploding area of oncology. The rapid incorporation of careful genetic testing into oncology practice is an important step toward more precise risk management. Currently, the time necessary for careful discussion of the complex issues raised by genetic testing for inherited breast/ovarian cancer susceptibility may necessitate referral to geneticists or genetic counselors for truly informed consent to be obtained. However, identification of women for whom testing is appropriate and management of cancer risk with women after testing, are critical new functions for oncologists. They are only the beginning of exciting new opportunities in cancer risk and prevention.
BRCA2 Protein↗
Primary intrathoracic malignant effusion: a descriptive study.
BACKGROUND: Patients who present with malignant pleural/malignant effusion without a definite primary site are not well described in the medical literature. In the course of our clinical practice, we have observed certain traits that are peculiar to patients with such a presentation. We have applied the term primary intrathoracic malignant effusion (PIME) to describe this condition. STUDY OBJECTIVES: Patients must fulfill the following criteria before a diagnosis of PIME can be made: clinical presentation dominated by pleural/pericardial effusion; histologic proof of malignancy obtained from the pleura and/or pericardium; no definite primary site in the lungs or elsewhere from CT scan of the chest, chest radiograph, or physical and endoscopic examination; no history of malignancy; and no history of asbestos exposure. Exposure to environmental tobacco smoke (ETS) among the nonsmokers was examined in a case-control setting. METHODS: We conducted a retrospective search of our database of patients who were referred to the Department of Medical Oncology with a diagnosis of pleural/pericardial effusion from January 1993 to January 2000. RESULTS: Seventy-one of 200 patients from our database met the criteria. A significant majority of the patients were women (65%) and nonsmokers (72%). All patients had adenocarcinoma shown on biopsy. The majority of patients (63%) had disease localized to the intrathoracic serosal surfaces; the rest had distant metastases involving the lung (50%), bone (27%), liver (19%), brain (8%), and skin (4%). Six patients had two or more sites of distant metastases. There was a significant association with ETS exposure when compared to a control group comprised of patients with colonic cancer, matched for sex and age. The median survival was 10 months for patients with disease localized to the pleura/pericardium and 7 months for those with distant metastases. Thirty-eight patients (54%) received chemotherapy. All had platinum-based chemotherapy, except for three patients. The median survival for patients treated or not treated with chemotherapy was 12 months and 5 months, respectively. This difference in survival was statistically significant (p = 0.003). CONCLUSIONS: PIME should be viewed as a distinct entity. Its etiology remains largely unknown, although exposure to environmental tobacco smoke may play a part. Platinum-based chemotherapy may have a positive biological effect on this disease. More studies are required to elucidate the epidemiology, possible etiologic factors, and treatment options for this group of patients.
Adult↗
Pruritic linear eruption on a child.
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Child↗
Retrospective study of Mycobacterium marinum skin infections.
BACKGROUND: Although infection by Mycobacterium marinum is well reported in the literature, there have been few epidemiologic studies. The purpose of this study was to review the epidemiology of patients with cutaneous M. marinum infection over a 3-year period at the National Skin Centre in Singapore. METHODS: Patients with a diagnosis of cutaneous M. marinum infection, confirmed histologically, were collated from computerized data from 1995 to 1997. Thirty-eight patients were diagnosed as having cutaneous M. marinum infection based on history, and clinical and histologic features. RESULTS: Out of the 38 cases of M. marinum infection, there were 30 men and eight women. The age range was 14-85 years (mean: 44.7 years). The duration of disease ranged from 1 to 132 months (mean: 19 months). Thirteen patients (34.2%) had fish rearing as a hobby and four patients (10.5%) had occupational exposure to fish. Twelve patients (31.5%) gave a history of trauma to the disease site. All patients had biopsies of the lesions. All showed infective granulomas/granulomatous inflammation on histology. Acid-fast bacilli were identified in five out of 38 patients (13.2%) and mycobacteria were isolated in one out of 35 patients (2.9%). Nineteen patients received treatment with cotrimoxazole-trimethoprim alone, three with minocycline alone, five with minocycline and cotrimoxazole-trimethoprim, seven with various combinations of drugs, one with excision, and three defaulted treatment. The duration of treatment ranged from 4 to 38 weeks (mean: 14.9 weeks). Twenty-six patients (68.4%) showed clinical improvement, two (5.3%) had no response, and 10 (26.3%) were lost to follow-up. None of the patients worsened with treatment. The follow-up period ranged from 1 to 20 months (mean: 6.8 months). CONCLUSIONS: The diagnosis of cutaneous M. marinum infection is mainly clinical, with supporting evidence from histologic features and the response to therapy. Risk factors include a history of trauma and water/fish-related hobbies or occupations. There is a poor yield of positive isolates in our experience; however, empirical treatment usually produces a good clinical response. In future, the polymerase chain reaction (PCR) technique may become more widely available as a rapid, sensitive, and specific means of diagnosis.
Adolescent↗
Use of a peripherally implanted subcutaneous permanent central venous access device for chemotherapy--the Singapore General Hospital experience.
BACKGROUND: Venous access for chemotherapy patients at the Singapore General Hospital has conventionally been via an externalised (Hickman) catheter. A peripherally implanted permanent subcutaneous central venous access device (P.A.S.Port) was introduced in 1996. AIMS: We review its use, complications and cost competitiveness with other chemotherapy delivery systems. METHODS: A retrospective study of clinical records was conducted with follow up interviews of patients and nursing staff. RESULTS: Twelve patients had the P.A.S.Port inserted for administration of chemotherapy as an outpatient procedure. Immediate complications were pain (8%) and bruising (8%). One port-related infection (8%) one week following insertion was reported and one patient complained of interference with elbow movement as a late complication. Cost analysis was favourable for P.A.S.Port over an externalised Hickman catheter or chest-placed port at one year. Patient and nursing staff acceptance was high. CONCLUSION: P.A.S.Port insertion is a safe outpatient procedure and is an alternative for permanent venous access.
Catheterization, Central Venous↗
Pseudomembranous colitis in a patient treated with paclitaxel for carcinoma of the breast: a case report.
INTRODUCTION: The concomitant antimicrobial properties of antineoplastic agents may play a role in causing pseudomembranous colitis, which has been documented for cisplatin, cyclophosphamide and 5-fluorouracil. CLINICAL PICTURE: We describe the first case reported in the English literature of severe pseudomembranous colitis occurring in a patient given paclitaxel as adjuvant chemotherapy for breast cancer. There was no prior antibiotic therapy. Stool culture confirmed Clostridium difficile. TREATMENT: Oral vancomycin, metronidazole and cholestyramine led to prompt improvement of intestinal symptoms, which resolved in two weeks. OUTCOME: Repeat colonoscopy performed 3 months later showed total resolution of the colitis. CONCLUSIONS: Awareness of pseudomembranous colitis after paclitaxel chemotherapy can avert life-threatening complications.
Antineoplastic Agents, Phytogenic↗
Classical and amyopathic dermatomyositis seen at the National Skin Centre of Singapore: a 3-year retrospective review of their clinical characteristics and association with malignancy.
INTRODUCTION: Dermatomyositis is a condition well-known to medical physicians, especially rheumatologists and dermatologists. Classically, patients present with typical cutaneous features and proximal muscle weakness. Amyopathic dermatomyositis has been reported in recent literature where patients present with skin changes without muscle involvement. MATERIALS AND METHODS: We reviewed 28 patients diagnosed with dermatomyositis at the National Skin Centre over a 3-year period from 1996 to 1998 to assess the prevalence of this amyopathic variant in our local population and its association with malignancy. RESULTS: Out of the 28 patients, 13 (46.4%) had no clinical or laboratory evidence of myositis at presentation. Nine patients (32.1%) had clinical muscle weakness and 6 patients (21.4%) had laboratory evidence of myositis. Malignancies were detected in 12 patients (42.8%), half of which were nasopharyngeal carcinomas. There was no significant difference in the prevalence of malignancy between those with detectable muscle weakness (33.3%) and those without (47.4%). However, there was a significant higher prevalence of malignancy in those with clinical and laboratory evidence of myositis (66.6%) than those without (15.4%). CONCLUSION: We conclude that amyopathic dermatomyositis is a common presentation in our population and may have a lower risk of malignancy than the classical variant. Screening for malignancy, especially nasopharyngeal carcinoma, is recommended for all dermatomyositis patients.
Adolescent↗
Cutaneous Rosai-Dorfman disease presenting as pustular and acneiform lesions.
We report 2 cases of cutaneous Rosai-Dorfman disease (CRD) presenting with pustular and acneiform lesions. To our knowledge, these are the first reports of CRD presenting in this pattern. One patient had spontaneous resolution of the lesions, whereas the other was treated with cryotherapy with clinical improvement. We present a review of the literature regarding CRD and highlight the benign nature of this condition.
Acneiform Eruptions↗