Immune checkpoint inhibitors such as pembrolizumab have revolutionized cancer treatment but can trigger severe cutaneous immune-related adverse events, including autoimmune bullous disorders. Most reported cases of pembrolizumab-associated bullous pemphigoid involve hemodynamically stable patients suitable for confirmatory skin biopsy with direct immunofluorescence. However, data are limited regarding critically ill, neutropenic patients where invasive diagnostic procedures and aggressive immunosuppression pose substantial risks. We report a 72-year-old woman with stage IIIB triple-negative breast cancer receiving neoadjuvant carboplatin, paclitaxel, and pembrolizumab who presented with febrile neutropenia and septic shock. She rapidly developed widespread bullae and erosions on both pressure-bearing and non-pressure-bearing sites. Given profound neutropenia and hemodynamic instability requiring vasopressor support, skin biopsy was deferred. Clinical diagnosis of pembrolizumab-induced autoimmune bullous eruption was based on temporal association with drug exposure, characteristic morphology, and distribution beyond typical pressure points. Pembrolizumab was discontinued, and empiric high-dose intravenous corticosteroids were initiated, but the cutaneous eruption progressively worsened. The patient developed refractory septic shock and died on hospital day 6. This case illustrates the profound diagnostic and therapeutic challenges of managing suspected immune checkpoint inhibitor-induced bullous disease in critically ill, neutropenic patients, where clinicians must balance the risks of invasive diagnostics and further immunosuppression against the morbidity of untreated immune-related adverse events. Heightened clinical suspicion and multidisciplinary collaboration are essential in such complex scenarios.

Human papillomavirus (HPV) is a well-established etiologic factor in oropharyngeal squamous cell carcinoma, but its role in oral tongue squamous cell carcinoma (OTSCC) and patterns of recurrence is less clearly defined. A 54-year-old former smoker with multiple comorbidities had HPV-positive pT2N0M0 squamous cell carcinoma of the left lateral tongue and floor of mouth resected in 2022 with partial glossectomy, floor-of-mouth resection, and elective neck dissection, without adjuvant therapy. He remained disease-free following revision tongue debulking for dysplasia in 2024. In February 2026, he presented with a one-month history of a painful right ventral tongue mass impairing oral intake. Examination revealed a 2.5-cm friable exophytic lesion on the right ventral tongue without palpable cervical lymphadenopathy. Punch biopsy demonstrated invasive moderately differentiated squamous cell carcinoma. PET/CT showed an intensely hypermetabolic right tongue lesion with suspicious ipsilateral cervical lymph nodes but no distant metastases; an incidental focus of sigmoid colon uptake was noted. A multidisciplinary tumor board considered the new lesion a metachronous contralateral OTSCC in the setting of prior extensive left tongue surgery and recommended induction chemoimmunotherapy with pembrolizumab, docetaxel, and cisplatin, followed by restaging and reassessment for further surgery or radiotherapy. The patient completed the first cycle with manageable toxicity and preserved oral intake; response assessment after two cycles is pending. This case illustrates metachronous contralateral OTSCC in an HPV-associated setting despite guideline-concordant initial management and highlights the emerging role of induction chemoimmunotherapy as a function-preserving strategy in locally advanced recurrent oral cavity cancer after prior major tongue resection.

Minoxidil is an FDA-approved topical medication of over-the-counter solutions used to treat androgenetic alopecia and other types of alopecia. It is a relatively safe topical medication used in dermatology clinics to promote hair growth. Minoxidil (2,4-diamino-6 piperidinopyrimidine-3-oxide), the active ingredient available as a solution or gel, is associated with numerous side effects, particularly when percutaneous absorption is increased. A 45-year-old man visited the emergency department with sudden vertigo, which was caused by excessive use of minoxidil solution and scalp irritation, and the symptoms resolved after he washed his hair and stopped using minoxidil. Systemic absorption is likely enhanced when the scalp skin barrier is disrupted, potentiating vasodilatory effects and subsequent vestibular symptoms. This case report highlights vertigo as an underrecognized systemic side effect of topical minoxidil, especially in the setting of impaired skin integrity and excessive use. Clinicians should be aware of this potential side effect and counsel patients on proper application practices..

Lymphangioma circumscriptum, also known as microcystic lymphatic malformation, is a rare benign lymphatic anomaly that typically presents in early childhood and most commonly involves the trunk, axillae, and genital regions. Facial involvement is uncommon and may pose diagnostic challenges due to its atypical location and resemblance to other vesiculobullous conditions. A 14-year-old female presented with an 8-year history of asymptomatic vesicular lesions localized to the right zygomatic region. Examination revealed grouped translucent vesicles with a frogspawn appearance. Histopathologic evaluation showed dilated dermal lymphatic channels with lymphoid aggregates, and immunohistochemistry was positive for D2-40, confirming the diagnosis. This case highlights a rare facial presentation of lymphangioma circumscriptum and underscores the importance of considering lymphatic malformations in the differential diagnosis of chronic vesicular facial lesions. Histopathologic and immunohistochemical evaluation remains essential to ensure accurate diagnosis and appropriate management.

Schwannoma is a benign, encapsulated peripheral nerve sheath tumor arising from Schwann cells. It commonly occurs in the head and neck region and extremities; however, involvement of the groin is exceedingly rare and often poses diagnostic challenges due to its nonspecific presentation. We report a case of a 50-year-old female presenting with a painless, gradually enlarging swelling over the medial aspect of the right groin for one year. Clinical examination revealed a 2 × 2 cm soft, mobile, non-tender, multilobulated nodule with normal overlying skin. Differential diagnoses included dermatofibroma, lipoma, dermoid cyst, nodular fasciitis, palisaded encapsulated neuroma, and squamous cell carcinoma. Excisional biopsy was performed. Histopathological examination demonstrated a well-encapsulated tumor with alternating hypercellular Antoni A and hypocellular Antoni B areas, along with Verocay bodies. Immunohistochemistry showed strong S-100 positivity, confirming the diagnosis of schwannoma. The postoperative course was uneventful with no recurrence. This case highlights the importance of considering schwannoma in the differential diagnosis of groin swellings and emphasizes the role of histopathology and immunohistochemistry in definitive diagnosis.