Detlef K. Goette

Basal cell carcinomas and basal cell carcinoma-like changes overlying dermatofibromas.

Three patients had pigmented nodular basal cell carcinomas overlying dermatofibromas and 19 patients had basal cell carcinoma-like changes. We agree with the view generally held that acanthosis, pseudoepitheliomatous hyperplasia, basal cell buddings, and hair follicle-like proliferations of basal cells represent reactive changes of a spectrum of epidermal alterations overlying dermatofibromas. Contrary to the general opinion, however, we believe that basal cell carcinoma-like changes, superficial multicentric basal cell carcinomas, and nodular basal cell carcinomas represent neoplastic changes of such a spectrum.

Successful treatment of keratoacanthoma with intralesional fluorouracil

Forty-one keratoacanthomas (KA) occurring in thirty patients were treated with weekly intralesional injections of 5-fluorouracil (5-FU). Forty lesions cleared after an average of three injections in an average of 3.4 weeks (range, 2 to 6 weeks). This response suggests that intralesional injections of 5-FU are the treatment of choice for KAs.

Chondrodermatitis nodularis chronica helicis: A perforating necrobiotic granuloma

Seventeen cases of clinically and histologically characteristic chondrodermatitis nodularis chronica helicis (CNCH) are presented. Thirteen histologic specimens revealed transepidermal elimination (TE) of necrobiotic material from the dermis. This elimination occurred through transepidermal channels, slits, or erosions overlying a dermal necrobiotic granuloma. The granuloma was surrounded by granulation tissue composed of histiocytes and lymphocytes. Telangiectasia and peripheral solar elastosis were common findings. The histologic features and clinical characteristics found predominantly in white men over 40 years of age suggest that CNCH etiologically and pathogenetically represents an actinically induced perforating necrobiotic granuloma.

Acne Keloidalis Nuchae.: A Transepithelial Elimination Disorder

ABSTRACT: In four cases of acne keloidalis nuchae, varying stages of transepithelial elimination were observed histologically, suggesting that acne keloidalis represents a transepithelial elimination disorder akin to perforating folliculitis.

Transepithelial elimination of granulomas in cutaneous tuberculosis and sarcoidosis

Transepithelial elimination of granulomas was observed in histologic specimens taken from involved skin of a patient with disseminated tuberculosis and two patients with sarcoidosis. This phenomenon, previously also observed in other granulomatous disorders, represents one of the skins several mechanisms to rid itself of endogenous or exogenous waste material.

Immunofluorescent findings and clinical overlap in two cases of follicular lichen planus.

Two cases of follicular lichen planus are reported. Clinically, Case 1 fits the Graham Little- Piccardi-Lassueur syndrome (GLPLS), whereas Case 2 fits lichen planopilaris (LPP). The immunofluorescent findings and the clinical overlap of these two cases support the concept that GLPLS and LPP are variants of lichen planus.

MULTIPLE CUTANEOUS GRANULAR CELL TUMORS

A he.ilthy, 16-year-old white woman had multiple nodules of the skin, some dating; l>ack to infancy and others continuin^ to appear, A few resolved spontaneously without scarring. Several nodules were pruritic, .md one was tender. There wds no family history of simiLir lesions. Thirty-five noduLir lesions were scattered primarily about the arms and back, with single lesions located on the lower lip, [perineum, and neck. One lesion, on the deltoid region of the left shoulder, had a verrucous surface with moderate hyperpiginentation. The remaining nodules were the color and texture ot normal skin. All lesions were attached to the skin but Ireely movable above underlying structures. Nodules measured 0.5 cm to 3.0 cm In diameter. A biopsy specimen was obtained from the left arm. The patient declined further evaluation. Histologic examination of the specimen revealed an epidermal hyperplasia and sharply delineated tumor in the mid and lower dermis composed of large, round-to-oval, lightly eosinophilic staining, well-demarcated cells with granular eosinophilic cytoplasm and small, round, centrally placed, monomorphic nuclei (Fig. IA and B). The cells had a balloonlike appearance and were sharply delineated from surrounding collagen. In some areas, however, infiltration of these cells could be observed Ijetween collagen bundles. Hair follicles and sweat glands appeared undisturbed amidst tumor cells (Fig. 1 A). A second biopsy specimen yielded identical findings.

Epidermolytic hyperkeratosis as an incidental finding in normal oral mucosa: Report of two cases*

Epidermolytic hyperkeratosis was noted as an incidental finding in normal mucosa in a histologic specimen taken during wide excision of basal cell and squamous cell carcinomas of the lip and adjacent cheek.

Review of erythroplasia of Queyrat and its treatment

EQ (erythroplasia of Queyrat) manifests itself by single or multiple asymptomatic papules or plaques on the glans penis, or periurethrally, predominantly in uncircumcised men, age range from twenty to eighty years of age. The bright red lesions may be ulcerated. The disease progresses slowly, and the interval between onset and diagnosis may be years. The cause is unknown. Diagnosis is confirmed only by histologic examination. A therapeutic regimen of 5 per cent 5-fluorouracil cream applied to lesion(s) twice daily for four to five weeks has produced a high cure rate and maintained penile integrity and function.

The mucocutaneous marker of pseudoxanthoma elasticum

A patient with angioid streaks discovered ophthalmoscopically was evaluated in the dermatology clinic for pseudoxanthoma elasticum (PXE). Cutaneous markers for PXE did not appear in the usual locations; mucosal involvement of the lower lip was the only clinically ascertainable clue. The presence of the disease was confirmed by histologic examination of the oral mucosa. This case stresses the importance of familiarity with the mucocutaneous markers of PXE by members of the dental profession.