D.M. Macdonald

Basal cell carcinoma complicating naevus sebaceus

A large mass of atypical basal cells, fused in one area with the epidermis, was situated in the papillary dermis (Fig. 2). Many mature ectopically situated sebaceous glands unrelated to hair follicles were present in the adjacent skin. Some apocrine glandular structures were also present in these areas and there was moderate epidermal hyperplasia and papillomatosis. The appearances represented basal cell epithelioma (Fig. 3) in association with naevus sebaceus.

In-situ T lymphocyte identification in cutaneous tissue sections of benign and malignant dermatoses

An indirect immunoperoxidase technique employing a specific anti‐human T lymphocyte antiserum has been used to identify T lymphocytes in cutaneous tissue sections of various benign and malignant dermatoses. Skin biopsies from patients with histologically confirmed lichen planus, discoid lupus erythematosus, psoriasis, actinic keratosis, squamous cell carcinoma, Bowens disease, keratoacanthoma, malignant melanoma, inflamed serborrhoeic warts, sarcoidosis, follicular lymphoma and multicentric reticulohistiocytosis were examined. T lymphocytes were found to be the predominant cell type in the cutaneous infiltrates of the majority of these dermatoses. However, only few T lymphocytes were identified in sarcoidosis where they tended to be restricted to the periphery of the epithelioid cell granulomas. Similarly, in the cutaneous infiltrates of follicular lymphoma and in a patient with multicentric reticulohistiocytosis, few T lymphocytes were identified.

Cutaneous leiomyosarcoma with coexistent superficial angioleiomyoma

A 49-year-old Jamaican male presemed with a 4 month history of an enlarging lesion on the skin of his right calf. The tumour had become tender and bled in the previous 3 weeks. Six months before presentation, a new pair of boots had produced, at the same site, a traumatic ulcer which had rapidly resolved. For 14 years an asymptomatic nodule which was at the site of a cricket ball injury had been present on the right shin close to the newly developed lesion.

Familial multiple melanocytic naevi--the B-K mole syndrome.

The proband is a 39-year-old female who has a French mother and Maltese father. Since puberty it had been commented that she had an unusually large number of moles and these have continued to appear up to the present time. A number of these lesions had been excised at intervals. Of her three children, her eldest boy, aged 13 years, has during the last 5 years, also been developing pigmented lesions in a similar pattern to his mother. An 11-year-old daughter and 9-year-oId son were considered to have a normal number of moles. There is no other relevant family history except that a brother had vitiligo.

Multiple naevoid basal cell carcinoma syndrome (Gorlin's syndrome)

A 28-year-old Caucasian male presented to hospital aged i year with progressive hydrocephalus, following a morbilliform rash. Investigations revealed a posterior cranial fossa medulloblastoma which was treated by surgical excision and postoperative radiotherapy to both the cranium and spinal cord. At the age of 2, multiple flesh-coloured cutaneous papules were observed on his trunk, principally over the vertebral column, but also on his chest, face and scalp. Some enlarged and ulcerated, but the majority remained unchanged in appearance and extent until about the time he was first seen in a dermatology department when he was 12 years old. At the age of 4, he developed a lens opacity in the right eye, which subsequently became totally blind. A minor lens opacity was observed in the left eye when he was 9 years old, but this has not progressed. He developed a dental abscess at the age of 11. Subsequent radiological investigation revealed dentigerous cysts in both jaws, eight of which have been surgically removed. At his initial examination in a department of dermatology, a symmetrical distribution of smooth, round, pigmented papules on his back, chest and face was observed (Fig. i). Occasional lesions were pedunculated. In addition, larger irregular raised lesions were present over the midline area of the back and on the scalp (Fig. 2). Some of these lesions were crusted and some cystic and varied in colour from brownish red to bright pink. Multiple small pits were visible on the surface of the palms of his hands, and thesolesof his feet (Fig. 3). His facial appearance was abnormal. There was marked frontal bossing and hypertelorism and the head was hydrocephalic in shape. The lower end of the sternum was de-

Granulomatous cheilitis (Miescher)

A case of granulomatous cheilitis (Miescher) is reported. No aetiological factors could be determined and investigation failed to demonstrate evidence of sarcoidosis or of tuberculosis. The histology was not typical of these tatter conditions, but was consistent with that of Crohns disease although there was no systemic evidence for this disorder. The occurrence of labial Crohns disease preceding other manifestations has only recently been described (Carr, 1974). Careful assessment of this case and review of the literature has led us to the conclusion that granulomatous cheilitis is a distinct entity, although it can be difficult to distinguish from labial Crohns disease.

Hand-Schuller-Christian disease with secondary cutaneous involvement

A middle‐aged Arab lady presented with typical features of Hand‐Schuller‐Christian disease. In addition to diabetes insipidus and pulmonary fibrosis there was widespread bony involvement. Direct extension had occurred from the temporoparietal bone to the overlying skin with subsequent necrosis and ulceration. Such secondary cutaneous invasion has not been described previously.

A method for identification of dermatophyte antigens in situ by an immunoperoxidase technique in light and electron microscopy

A method, using an immunoperoxidase technique, to demonstrate antigenic sites on dermatophyte hyphae in light and electron microscopy is described. Specific antisera were obtained from rabbits immunized with homogenized whole mycelia.

Naevus superficialis lipomatosus

A 71-year-old female presented with an asymptomatic lesion on the lower back which had been there since birth. Excision of a nodular portion of the lesion had been performed 25 years ago. On examination, the lesion was 10 cm long and 6 cm wide situated just to the right of the midline overlying the sacroiliac joint. Three features of naevus superficialis lipomatosus (N.S.L.) were present (Fig. i): (i) a group of small, yellowish cobblestone-like papules; (ii) soft skin coloured, dome-shaped (and pedunculared) nodules; (iii) in one area the surface was verrucous.

Lupus erythematous panniculitis (Lupus profundus)

History Mrs E.C., a 33-year-oId housewife, presented with a 4-year history of erythematous nodules on the outer, upper aspects of both arms (Fig. i). A large lesion over the left deltoid region had ulcerated approximately 3 months before presentation. Corticosteroid impregnated tape seemed to have precipitated the ulceration. There were no symptoms of systemic lupus erythematosus (S.L.E.). Pulmonary tuberculosis had developed at the age of 10 years. Two relapses (at 11 years and 12 years) occurred following treatment. A diagnosis of panniculitis associated with tuberculosis was made 1 year before presentation. Antituberculous therapy, however, had no effect on the lesions.