Dario Batolo

Melanocytic nevi of the breast: a histologic case‐control study

Background:  Melanocytic nevi in the genital, acral, and flexural sites often display clinical and histologic features that may simulate melanoma. We verified whether this is the case also for nevi of the breast.

Histological features used in the diagnosis of melanoma are frequently found in benign melanocytic naevi

Aims: The histological features used in the diagnosis of melanoma may be present in benign naevi, but quantitative data are not available. The aim of this study was to establish the real prevalence of such features in naevi. Methods: Ten dermatopathologists, from nine Italian institutions, studied a series of naevi. Eleven histological parameters currently used in melanoma diagnosis were analysed: asymmetry, poor circumscription, predominance of single melanocytes, irregular confluent nests, suprabasal melanocytes, hair follicle involvement, absence of maturation, cytological atypia, dermal lymphocytic infiltrate, mitoses, and necrosis. Results: Ninety one naevi were examined: 22 junctional, 59 compound, and 10 intradermal. None of the studied parameters was seen in 22 of the benign naevi studied. One or more investigated features were found in 69 naevi. Poor circumscription was found in 49 cases, single melanocytic predominating in 42, asymmetry in 41, irregular confluent nests in 16, cytological atypia in 14, suprabasal melanocytes in seven, and hair follicle involvement in seven; absence of maturation, mitoses and necrosis were not found. Conclusions: The histological features used for the histological diagnosis of melanoma are often present in benign melanocytic naevi. This suggests a critical, non-mechanical use of them in melanoma diagnosis.

Interobserver reproducibility of histological features in cutaneous malignant melanoma

Aims: To assess the interobserver reproducibility of certain histological features proposed for the diagnosis of melanoma. Methods: In a series of melanomas, 13 histological parameters were analysed: dimension > 6 mm, asymmetry, poor circumscription, irregular confluent nests, single melanocytes predominating, absence of maturation, suprabasal melanocytes, asymmetrical melanin, melanin in deep cells, cytological atypia, mitoses, dermal lymphocytic infiltrate, and necrosis. Results: The agreement (reproducibility) between the nine observers was excellent (κ > 0.75) for 10 of the 13 examined features (dimension > 6 mm, poor circumscription, irregular confluent nests, single melanocytes predominating, absence of maturation, suprabasal melanocytes, asymmetrical melanin, melanin in deep cells, mitoses, and necrosis). The agreement for asymmetry was very close to excellence (κ  =  0.74), and that for cytological atypia (κ  =  0.65) and dermal lymphocytic infiltrate (κ  =  0.47) was slightly lower, but in the fair to good agreement range. The κ values obtained by comparison with the majority diagnosis were generally high (⩾ 0.85); the mean value of κ was lower (0.70) for only one parameter (dermal lymphocytic infiltrate). Conclusions: The parameters investigated showed an overall good reproducibility.

ACE-Inhibitor-Induced Drug Eruption Resembling Lymphocytic Infiltration (of Jessner-Kanof) and Lupus erythematosus tumidus

A 40-year-old man under treatment for hypertension for almost 1 year with an angiotensin-converting enzyme (ACE) inhibitor (enalapril) presented with recurrent chronic dermatitis of the face and trunk for several months. Physical examination revealed 2 nonpruriginous, erythematous, arciform plaques located in the thoracomammary region (fig. 1). A less infiltrated oval plaque was located in the left preauricular region. The lesions resolved after interruption of enalapril and application of topical steroids. A relapse was observed in the same region after reintroduction of the drug. Discontinuation of the treatment with enalapril was followed again by resolution of the lesions. The subsequent administration of valsartan, an angiotensin II receptor antagonist similar to enalapril, caused the appearance of similar lesions within few weeks. We performed a 5-mm punch biopsy from one of the chest lesions. Histology showed micronodular inflammatory infiltrates scattered in the dermis around the small vessels and the adnexal structures, with a pattern typical of the so-called lymphocytic infiltration of Jessner-Kanof (fig. 2). The cells were T lymphocytes, mainly CD8 positive, and histiocytes scattered and in small clusters, with sporadic fragmentation of the collagen fibers. The direct immunofluorescence and the iron staining for mucin were negative. The ACE inhibitor therapy was discontinued, and the hypertension was treated with an ·-blocker medication. Complete resolution of the dermatitis was observed within a couple of weeks, and at 6 months of follow-up no signs of relapse were observed. A 48and 72-hour patch test reading with enalapril did not show any positive reaction. This clinical case is an example of druginduced cutaneous reaction (specifically by ACE inhibitors) with a histological pattern resembling lymphocytic infiltration of JessnerKanof. There are several reports in the literature regarding skin disorders following treatment with ACE inhibitor drugs, especially enalapril. In the cases reported, the clinical diagnoses were granuloma annu-

Milia-like idiopathic calcinosis cutis: An unusual dermatosis associated with Down syndrome

Summary We describe two boys affected by Down syndrome (DS), who showed milia‐like idiopathic calcinosis cutis (MICC). The clinical diagnosis was confirmed by histological examination. All reported cases are reviewed and compared. Syringeal structures play a significant part in the pathogenesis of this dermatosis. MICC appears to be a poorly recognized condition which, rarely, is associated with DS.

White fibrous papulosis of the neck in three Sicilian patients

Three patients, two females and one male, presented with white fibrous papulosis of the neck. This condition is characteristically located on both sides of the neck; however, it also appears on the upper sternal region, with a necklace‐like configuration, in the two female patients, aged 72 and 78 years, respectively. A differential diagnosis was carried out with respect to other dermatoses that show a similar skin aspect, and to the pseudoxanthoma elasticum‐like papillary dermal elastolysis. This is because this condition, as well as fibrous papulosis, can be interpreted as a clinical‐histological variant of the same process of cutaneous ageing. However, environmental factors can play a role in the aetiopathogenesis of fibrous papulosis in the Sicilian population.

Tenascin expression in actinic keratosis.

Background:  Tenascin is an extracellular matrix protein frequently expressed around neoplastic and non‐neoplastic lesions of the skin. Actinic keratoses (AKs) are intraepidermal neoplastic lesions of the sun‐exposed skin. They are classified according to the extension of dysplasia in four stages; they also present different histological varieties.

Standardized AgNOR analysis in actinic keratosis.

To assess if the quantity of silver-stained nucleolar organizer region (AgNOR) proteins predicts the behavior of actinic keratosis (AK), we performed a standardized AgNOR analysis on 51 cases of AK; in addition, 10 cases of squamous cell (SCC) and 10 cases of basal cell (BCC) carcinomas and 10 normal skin samples were also studied. AgNOR analysis was performed on formalin-fixed and paraffin-embedded sections according to the guidelines of the Committee on AgNOR Quantification (1995), evaluating the mean area (&mgr;m 2 ) of AgNORs per nucleus (NORA). A highly significant P value (< 0.001) was found in the comparison among NORA values of normal skin (1.869 &mgr;m 2 ; SD + 0.332), AK (3.988 &mgr;m 2 ; SD + 0.914), BCC (3.044 &mgr;m 2 ; SD + 0.254), and SCC (5.286 &mgr;m 2 ; SD + 0.920). In AK, a progressive increase of mean NORA values was observed moving from Stage I (3.161 &mgr;m 2 ; SD + 0.600) to Stage II (3.455 &mgr;m 2 ; SD + 0.562), Stage III (4.360 &mgr;m 2 ; SD + 0.295), and Stage IV (5.168 &mgr;m 2 ; SD + 0.694); highly significant differences (P < 0.001) were noted when Stages I or II were compared with Stage III or Stage IV or between these latter stages. The AgNOR quantity may identify AKs with high proliferative activity and increased tendency to develop into invasive SCC.

Rubinstein-Taybi syndrome with epidermal nevus: A case report

Abstract: We describe an 8‐year‐old boy with Rubinstein–Taybi syndrome, a multiple congenital anomaly/mental retardation syndrome characterized by broad thumbs and great toes, peculiar facies, and mental retardation caused by mutations in the transcriptional coactivator CREB binding protein (CBP). He had on his right side yellowish papular lesions organized in narrow bands according to Blaschko lines, later confirmed by histology as an epidermal nevus. Epidermal nevus syndrome has been ruled out because the patient failed to meet the criteria for inclusion under this designation. This association may be coincidental.

The papulokeratotic type of solitary benign lichenoid keratosis

A 67‐year‐old housewife was referred to us for a papulonodular keratotic lesion on the left side of the left eyebrow ( Fig. 1 ). The lesion had started to develop 6 months earlier and had gradually reached a size of 2 cm in diameter. It was firm, nonitching, and painless on pressure.