David Weedon

Pustular vasculitis of the hands.

BACKGROUND Several patients were observed with a peculiar cutaneous eruption limited to the dorsa of the hands and fingers. Clinically the lesions had some resemblance to those seen in Sweets syndrome, but biopsy specimens showed severe leukocytoclastic vasculitis. OBJECTIVE Our purpose was to characterize this eruption clinically and histologically and compare it with previously described diseases. METHODS Six patients observed since 1977 are described. Skin biopsy specimens were obtained. RESULTS In six women (age, 41 to 79 years) a symmetric eruption of papules and plaques limited to the dorsa of the radial sides of the hands and first three digits developed. The lesions resembled those of Sweets syndrome and were associated with fever, sterile culture, blood neutrophil leukocytosis, nonresponse to antibiotic therapy, and rapid response to prednisone. Biopsy specimens showed a severe leukocytoclastic vasculitis. CONCLUSION These patients appear to have a distinct entity that we have termed pustular vasculitis of the hands.

Unusual features of nevocellular nevi

The microscopic examination of benign pigmented nevi is often cursory, with the result that interesting secondary changes within those nevi arc sometimes disregarded. Because the descriptions of these histologic variations in nevi are scattered through the literature of the last 30 years, it seems timely to review them. Age‐related changes (Maize & Foster 1979), the epidermal architecture of nevi (Bentley‐Phillips & Marks 1976) and general aspects of melanocytic nevi (Bhawan 1979) have all been reviewed in recent years and will not be considered further.

Eccrine tumors: a selective review

There is still sotne debate about wbieh tumors should be ineluded under tbe terms eeerine and apocrine. Using bisloehemistry and eleetron mieroseopy, it is possible to identify varying degrees of differentiation towards normal apocrine or eeerine struetures. Some would argue that this does not establish eertain origin frotn these struetures, as reserve eells or pluripotential eells eould give rise to tumors with intermediate features, or ebaraeteristies different from those of tbe gland in which they were resident. Tbese problems are not yet eompletely resolved, although tbe development of monoelonal atitibodies direeted against eeerine or apocrine antigens may help elucidate this tnatter. The following elassifieation of eccrine tutnors is proposed. Tbe emphasis will be placed on reeetit papers, and those aspeets of tnorphology diseussed in standard textbooks will be dealt witb only briefly.

Eosinophilic globules in the Spitz nevus.

Eosinophilic globules were found in the epidermis of 86% of Spitz nevi, 12% of malignant melanomas, and 8% of benign compound nevi. Globules were difficult to find in the melanomas and compound nevi and were usually smaller than those occurring in Spitz nevi, where the globules often coalesced to form larger bodies. We did not find the staining characteristics of these globules by the periodic acid-Schiff and trichrome methods to be reliable for distinguishing melanomas from Spitz nevi.