p63 expression has been identified in several cohorts as a predictor of poorer prognosis in Merkel cell carcinoma. We used multivariate analysis in a large independent cohort to determine the clinical utility of this parameter. Immunohistochemistry was used to determine p63 expression on MCC tumors from 128 patients. Of these, 33% had detectable p63 expression. p63 positivity was associated with an increased risk of death from MCC (hazard ratio 2.05, p = 0.02) in a multivariate Cox regression model considering stage at presentation, age at diagnosis, and gender. Although p63 expression correlated with diminished survival in this largest cohort reported thus far, the effect was weaker than that observed in prior studies. Indeed, within a given stage, p63 status did not predict survival in a clinically or statistically significant manner. It thus remains unclear whether this test should be integrated into routine MCC patient management.

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Physicians are urged to communicate more openly following medical errors, but little is known about pathologists' attitudes about reporting errors to their institution and disclosing them to patients. We undertook a survey to characterize pathologists' and laboratory medical directors' attitudes and experience regarding the communication of errors with hospitals, treating physicians, and affected patients. We invited 260 practicing pathologists and 81 academic hospital laboratory medical directors to participate in a self-administered survey. This survey included questions regarding estimated error rates and barriers to and experience with error disclosure. The majority of respondents (~95%) reported having been involved with an error, and respondents expressed near unanimous belief that errors should be disclosed to hospitals, colleagues, and patients; however, only about 48% thought that current error reporting systems were adequate. In addition, pathologists expressed discomfort with their communication skills in regard to error disclosure. Improving error reporting systems and developing robust disclosure training could help prevent future errors, improving patient safety and trust.

A healthy 22-year-old college student presented with 2 itchy, painful scalp nodules associated with intermittent lancinating pain. Lesions appeared after an alleged mosquito bite during his vacation in Belize. He initially presented to an emergency department and was diagnosed with cellulitis unresponsive to treatment with antibiotics and antifungal medication. FIGURE 1. Physical examination of the scalp reveals 2 warbles--boggy plaques with a central punctum and intermittently draining serosanguineous fluid. Zsolt B. Argenyi, MD, Section EditorFIGURE 2. Hematoxylin and eosin stain of the punch biopsy shows polarizable foreign material with fibrinous exudates, a foreign body reaction, and chronic inflammation.FIGURE 3.Hematoxylin and eosin stain of the excisional biopsy shows a cavity with inflammatory infiltrate and a bright refractile material-similar to what was seen in the punch biopsy specimen-a foreign object surrounded by eosinophils, and a focal granulomatous inflammation.