Ayse Kavak

Extensive cutaneous metastasis of transitional cell carcinoma of the bladder

Abstract Cutaneous metastasis of bladder carcinoma is extremely rare. Iatrogenic implantations have been the main cause in the majority of cases of transitional cell carcinoma with cutaneous metastasis. Otherwise, primary cutaneous metastasis is accepted as the late manifestation of systemic spread. The present paper describes a case of relatively early and extensive skin metastasis of transitional cell carcinoma in a 78‐year‐old man. The patient had a histopathological diagnosis of poorly differentiated (grade III) muscle invasive transitional cell carcinoma with a staging of T2NOMO 6 months prior to presenting. He presented to our outpatient clinic with a 3‐month history of skin lesions as multiple, rubbery subcutaneous nodules. Radiological reinvestigation revealed no other metastatic site (including bone and lung), except for a metastatic nodule in the liver. The present paper reports an interesting and rare case of extensive skin metastasis of transitional cell carcinoma as the primary complaint.

Persistent serpentine supravenous hyperpigmented eruption associated with docetaxel

Various mucocutaneous reactions have been reported with the use of systemic docetaxel. We describe a 47‐year‐old man who developed a persistent serpentine supravenous hyperpigmented eruption (PSSHE), beginning at the site of docetaxel injection and spreading along the superficial venous network in the anterior aspect of the right forearm and distal arm. The eruption occurred after the first infusion of docetaxel following insufficient venous washing. A second infusion was administered through a vein in the other forearm, but this time, abundant venous washing was performed and a similar eruption did not occur. To our knowledge, this is the second report of docetaxel‐induced supravenous discoloration and we discussed the terminology and mechanism of this unique reaction.

Dyskeratosis congenita associated with three malignancies

Dyskeratosis congenita is a rare inheritable disorder characterized by abnormalities of the skin, nails and oral mucosa. Aplastic anaemia resulting from bone marrow hypoplasia is a frequent cause of death. Squamous cell carcinoma developing from leukoplakia and visceral malignancies are other complications of the disease. We report here a case of dyskeratosis congenita in a man who developed three neoplasias of different systems over a period of many years. Squamous cell carcinoma and gastric adenocarcinoma manifested 17 years after the man was diagnosed with Hodgkins disease.

Unilateral Nevoid Telangiectasia and Hyperthyroidism: A New Association or Coincidence?

Telangiectasia and spider angioma were distributed in a unilateral, dermatomal pattern in a female patient. Physical examination and laboratory studies revealed hyperthyroidism. The possible effects of thyroid hormones on formation of vascular nevi were considered to be noteworthy.

Measurement of epidermal thickness in a patient with psoriasis by computer-supported image analysis.

The aim of the present study was to measure full epidermal thickness, stratum corneum thickness, rete length, dermal papilla widening and suprapapillary epidermal thickness in psoriasis patients using a light microscope and computer-supported image analysis. The data obtained were analyzed in terms of patient age, type of psoriasis, total body surface area involvement, scalp and nail involvement, duration of psoriasis, and family history of the disease. The study was conducted on 64 patients and 57 controls whose skin biopsies were examined by light microscopy. The acquired microscopic images were transferred to a computer and measurements were made using image analysis. The skin biopsies, taken from different body areas, were examined for different parameters such as epidermal, corneal and suprapapillary epidermal thickness. The most prominent increase in thickness was detected in the palmar region. Corneal thickness was more pronounced in patients with scalp involvement than in patients without scalp involvement (t=-2.651, P=0.008). The most prominent increase in rete length was observed in the knees (median: 491 microm, t=10.117, P=0.000). The difference in rete length between patients with a positive and a negative family history was significant (t=-3.334, P=0.03), being 27% greater in psoriasis patients without a family history. The differences in dermal papilla distances among patients were very small. We conclude that microscope-supported thickness measurements provide objective results.

Lokale DMSO-Behandlung der makulösen und papulösen Amyloidose

ZusammenfassungMakulöse Amyloidose (MA) und Lichen amyloidosus (LA) sind die zwei am häufigsten vorkommenden Varianten der primär kutanen Amyloidosen, bei denen ein heftiger Juckreiz im Vordergrund der klinischen Symptomatik steht. Leider zeigen aber die verschiedenen Therapiemaßnahmen wie Antihistaminika, Kortikosteroide, UVB, Etretinat, Dermabrasion usw. wenig oder keinen Erfolg. In den letzten Jahren wurde in der Literatur über die erfolgreiche Therapie mit lokalem Dimethylsulphoxid (DMSO) berichtet. In unserer Studie haben wir Patienten mit MA, LA und biphasischer Amyloidose mit 50%iger DMSO-Lösung lokal behandelt. Während einer Behandlungsdauer von 6–20 Wochen wurde bei 9 von insgesamt 10 Patienten klinische Besserung erzielt. Das schnelle Ansprechen des Juckreizes auf die Therapie innerhalb der ersten Woche ist auf den die Mastzelldegranulation bzw. -depletion fördernden Effekt von DMSO zurückzuführen. Mittels DMSO-Therapie wurde auch eine vollständige Rückbildung der lichenoiden papulösen Effloreszenzen innerhalb von durchschnittlich 11 Wochen erzielt, welche am ehesten durch das Abklingen des Juckreizes und des damit verbundenen Kratzeffektes erklärt werden kann. Trotz der guten klinischen Ergebnisse war histopathologisch kein Verschwinden der Amyloidmassen festzustellen. In den weiteren Verlaufskontrollen nach Ende der Therapie wurden Rezidive der klinischen Symptomatik beobachtet, wobei weitere prospektive Studien zur Bestimmung der optimalen Behandlungsdauer notwendig erscheinen.SummaryMacular amyloidosis (MA) and lichen amyloidosus (LA) are the two major variants of the primary cutaneous amyloidoses which present with severe and therapy resistent itching. Various therapeutic modalities such as antihistamines, intralesional injection or topical application of corticosteroids, etretinate, UVB irradiation and dermoabrasion have been employed with variable success. Recently, in a few case reports authors have observed encouraging beneficial clinical effects by using topical dimethyl sulphoxide (DMSO). In our study 10 patients with either MA or LA or biphasic amyloidosis were treated with a 50% solution of DMSO in water. 9 of them showed marked clinical improvement at the end of 6–20 weeks of treatment. Degranulation and depletion of the mast cells by DMSO is the most probable explanation for the rapid improvement of itching beginning within the first week of therapy. Remarkable flattening of the lichenoid papules which was obtained within 11 weeks of treatment is interpreted as a result of the improvement of itching and the related scratch effect. Histological examination after treatment revealed no disappearance of amyloid deposits in the papillary dermis. In the follow-up period relapses of itching and papules were observed. Therefore further studies are needed to find out the optimal procedure of therapy.

Port‐wine stain, laser therapy and pregnancy: risk factors for multiple pyogenic granulomas?

Editor Pyogenic granuloma (PG) and port-wine stain (PWS) are an acquired vascular tumour and a congenital malformation, respectively. A 35-year-old woman presented at 8 months’ gestation with a 1-month history of enlarging masses on the congenital lesion of the face. A congenital purple macular lesion limited to the right side of the face was found to be consistent with PWS. In addition, four red papules 2– 6 mm in diameter were localized to PWS areas excluding normal skin (fig. 1). Spontaneous or post-traumatic bleeding history was denied. There was no oral or nasal lesion. Neurological and ophthalmological examinations were all normal. The patient had undergone five sessions of laser therapy 6 years earlier. She denied similar lesions during her first pregnancy 9 years ago. Lesions were excised with shave excision. The histopathological findings were consistent with PG. Lesional oestrogen and progesterone receptor assay was found to be negative. No recurrence was observed during the 2-year followup period. PGs are frequent vascular tumours in pregnancy. Reported PG cases were mostly in the second or third trimester. One may speculate that the gradual increase in both oestrogen and progesterone, reaching eventually to a cumulative level, may induce PG formation. PGs associated with PWSs have been reported particularly after laser treatment or cryotherapy, sometimes without preceding trauma. However, one should not ignore the possibility of unrecognized traumas. PG in pregnancy may appear on the PWS spontaneously or after laser therapy. PG is a rare (0.23%) and early (few weeks to few months) complication of laser therapy. Our patient had been treated with laser for PWS 6 years ago and PGs occurred at the seventh month of pregnancy. Although PG could be induced by pregnancy itself, it is important to bear in mind that there was no PG history during the first pregnancy. As laser treatment was performed after first pregnancy, it is questionable whether the trauma effect of laser therapy could persist and thus facilitate the formation of multiple PGs. There have been different and conflicting results for oestrogen and progesterone receptor assessment in vascular lesions. Although we could not detect any receptor positivity, it is possible that there are limitations to current available methods. As a conclusion, it is possible that PG is already a frequent tumour in pregnancy and its association with PWS could be a coincidental finding. However, PG prefers a mucosal location other than skin and the location limited to a PWS area suggests that this is a distinct location. It can be speculated that a congenital malformation (PWS) could provoke another vascular entity (PG) due to ‘pregnancy (hormonal) trauma’ – and possibly due to a long-term contributing effect of laser therapy.

Non‐Hodgkin's lymphoma and auricular hypoplasia: associated with juvenile colloid milium or ligneous conjunctivitis?

The exact nature of amyloid‐like hyaline material deposits in the skin is not well understood in some disorders. Three of those – ligneous conjunctivitis, ligneous periodontitis and colloid milium – have been rarely reported in a same patient. We report a case of mucosal and skin deposits of an amyloid‐like homogeneous material associated with non‐Hodgkins lymphoma and congenital auricular hypoplasia. We discussed and reviewed the literature on these unique associations to determine whether these are the same pathological process. We also noted whether this case represents a new syndrome or a coincidental association.

Bilateral multiple piloleiomyomas on the breast

Piloleiomyomas are benign smooth muscle tumors arising from the erector pilorum muscles in the skin. They vary in size and number, and are often spontaneously painful or sensitive to touch and cold. In this paper, we present two young female patients who have multiple breast piloleiomyoma and discuss the related findings.

Preliminary study among truck drivers in Turkey: Effects of ultraviolet light on some skin entities

In this study, we aimed to compare driver (left) and opposite (right) sides for some skin entities in drivers. We also evaluated the effect of occupational duration, age and skin type among this population. One hundred and forty‐eight truck drivers were included in this study. Sun exposed areas were classified. Dermatological entities such as actinic keratosis, solar lentigo, seborrheic keratosis, melanocytic nevus, spider angioma, ephelid, basal cell carcinoma (BCC), squamous cell carcinoma, and melanoma were compared to driver and right sides. In addition, drivers were divided into two subgroups according to: (i) age (subgroups A1, 20–40 years, and A2, >40 years); (ii) occupational duration (subgroups O1, 1–10 years, and 02, >10 years); and (iii) skin type (subgroups S1, skin types I and II, and S2, skin types III and IV. Each of the two subgroups were compared with respect to the total prevalence (left and right sides) of lesions excluding the location. Seborrheic keratosis and lentigo solaris were found to be increased on the driver side of the face (P = 0.00) and ear (P = 0.013), respectively. Statistically significant increases of lesions on the driver side were determined according to the subgroups: melanocytic nevi were found to be increased on the driver side in A1 (P = 0.00), A2 (P = 0.00), O2 (P = 0.00), S1 (P = 0.00) and S2 (P = 0.006) groups; actinic keratoses were found to be significantly increased on the driver side in A2 and O2 groups (P = 0.03 for both).