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Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults, characterized by the accumulation of abnormal lymphocytes in the blood and bone marrow. Its incidence increases with age, typically affecting older adults, with a median age at diagnosis around 70 years. CLL prevalence varies geographically, with higher rates observed in Western countries compared to Asian populations. Despite advancements in treatment, CLL remains an incurable disease, often managed through monitoring and therapy to control symptoms and slow disease progression. The purpose of this case report is to highlight two unique incidents of previously undiagnosed CLL, incidentally found during Mohs micrographic surgery (MMS). One case features a cutaneous squamous cell carcinoma in situ and the other a basal cell carcinoma. We present these cases to highlight the importance of diagnostic vigilance during Mohs histopathological processing. Diagnosis of CLL is typically through routine complete blood panels. However, these cases present unique initial presentations that warrant careful detection in medical practice. Detecting CLL during the examination of pathology samples from MMS excision may not be common practice, but its presence emphasizes the significance of thorough patient evaluation during medical procedures. This unexpected finding underscores the importance of thorough pathology examination during surgical procedures, highlighting the potential for detecting concurrent or underlying systemic conditions. Early identification of CLL in this context allows for prompt intervention and comprehensive management, emphasizing the necessity of integrated care approaches in medical practice.

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Squamoid eccrine ductal carcinoma (SEDC) is a rare and under-recognized primary cutaneous tumor with a high risk for local recurrence and metastasis. The tumor has a biphasic histologic appearance consisting of a superficial portion indistinguishable from squamous cell carcinoma (SCC) and a deeper component demonstrating eccrine ductal differentiation. Because of superficial sampling, SEDC often is misdiagnosed as SCC during the initial biopsy. The diagnosis usually is made during complete excision when deeper tissue is sampled. Confirmation of the diagnosis can be achieved by immunohistochemical positivity for carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA), cytokeratin (CK) 5/6, and p63. In this article, we review the clinical and histologic details of 5 patients with SEDC who underwent successful treatment with Mohs micrographic surgery (MMS) at a single institution between November 2018 and May 2020. We also review the histologic patterns that helped distinguish SEDC from SCC upon complete excision. Our findings support the use of MMS as the treatment of choice for SEDC, given that all of the patients we reviewed required more than 1 Mohs stage for complete tumor clearance, and none demonstrated evidence of recurrence or metastasis after a mean follow-up period of 11 months.

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BACKGROUND: Quaternary ammonium compounds are a large class of chemicals used for their antimicrobial and antistatic properties. Two common quaternary ammonium compounds, alkyldimethylbenzyl ammonium chloride (ADBAC) and didecyldimethyl ammonium chloride (DDAC), are combined in common cleaners and disinfectants. Introduction of a cleaner containing ADBAC+DDAC in the vivarium caused neural tube defects (NTDs) in mice and rats. METHODS: To further evaluate this finding, male and female mice were dosed in the feed at 60 or 120 mg/kg/day, or by oral gavage at 7.5, 15, or 30 mg/kg ADBAC+DDAC. Mice also received ambient exposure to ADBAC+DDAC from the disinfectant used in the mouse room. Embryos were evaluated on gestational day 10 for NTDs, and fetuses were evaluated on gestational day 18 for gross and skeletal malformations. RESULTS: We found increased NTDs with exposure to ADBAC+DDAC in both rats and mice. The NTDs persisted for two generations after cessation of exposure. Notably, male exposure alone was sufficient to cause NTDs. Equally significant, ambient exposure from disinfectant use in the vivarium, influenced the levels of NTDs to a greater extent than oral dosing. No gross or significant axial skeletal malformations were observed in late gestation fetuses. Placental abnormalities and late gestation fetal deaths were increased at 120 mg/kg/day, which might explain the lack of malformations observed in late gestation fetuses. CONCLUSION: These results demonstrate that ADBAC+DDAC in combination are teratogenic to rodents. Given the increased use of these disinfectants, further evaluation of their safety in humans and their contribution to health and disease is essential. Birth Defects Research 109:1166-1178, 2017. © 2017 The Authors. Birth Defects Research Published by Wiley Periodicals, Inc.

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