"Spitting Stitches": A Case of Transepidermal Elimination
0:00:04 Introduction: Dr. Jared Gardner presents a case involving a painful, itchy bump on a patient's abdomen, initially suspected to be skin cancer.
0:00:20 Patient History: The patient had solar lentigines and lichen simplex chronicus, indicating chronic skin irritation.
0:00:33 Initial Concerns: The lesion presented as a crater-like depression, raising concerns about squamous cell carcinoma or keratoacanthoma. Another possibility was a ruptured cyst or folliculitis.
0:00:58 Key Observation: Examination revealed keratin, degenerated material, and off-white particles within the lesion.
0:01:42 Polarized Light Examination: Under polarized light, the particles appeared bright and birefringent, indicating the presence of a foreign, polarizable material.
0:01:59 Discovery of Suture: It was discovered that the patient had a previous surgery, and a deep suture had migrated to the surface, causing the lesion. This is known as a "perforating suture" or "transepidermal elimination" of the suture.
0:02:28 Body's Response: The body attempts to eliminate foreign material by pushing it through the epidermis. This can also occur with granulomas or dead tissue, as seen in chondrodermatitis nodularis helicis (CNH).
0:03:01 "Spitting Stitches": The phenomenon is colloquially known as "spitting stitches," where the body tries to expel the suture material.
0:03:18 Clinical Significance: Identifying the foreign material helps explain reactive changes in the surrounding tissue and rules out malignancy.
0:03:39 Personal Anecdote: Dr. Gardner shares a case from his fellowship where a patient had a suture from a C-section 30 years prior that was being eliminated by her body.
0:04:32 Body's Persistence: The body persistently attempts to remove or wall off foreign material, even years after the initial placement.
0:04:58 Conclusion: While most sutures either dissolve or remain in place, some can trigger an immune response, leading to transepidermal elimination.