Edward Abell

The reliability of frozen sections in the evaluation of surgical margins for melanoma

As the width of surgical margins declines, histologic evaluation of the margins is needed to assess the completeness of excision of a malignant melanoma. We studied 221 specimens in 59 patients and compared the interpretations of frozen and paraffin sections from the same block. Frozen sections had a sensitivity of 100% in detecting melanoma when present and a specificity of 90%.

Histologic patterns of congenital nevocytic nevi and implications for treatment

The therapeutic problems associated with congenital nevocytic nevi (CNN) have lead to a flurry of interest in neonatal dermabrasion. This is based on the theory that nevus cells at birth are superficial and accessible to dermabrasion and that they later migrate into the deeper dermis. We studied twelve patients with CNN, including seven patients less than 3 months of age, with serial biopsies taken over a period of 15 months. In addition, four neonates with giant CNN underwent dermabrasion, and biopsies were obtained pre- and postoperatively. The histologic features of CNN and the implications for treatment are discussed. Our results are inconsistent with the idea of migration of nevus cells into the dermis during infancy. Dermabrasion of giant CNN at an early age may improve the cosmetic appearance; however, it will not remove most nevus cells and is not recommended as an effective treatment for the prevention of melanoma.

Intralesional interferon in the treatment of early mycosis fungoides

Twelve patients with early mycosis fungoides were enrolled in a randomized, double-blind, placebo-controlled study. Isolated plaques were injected three times a week with recombinant alpha 2-interferon in nine patients and with the vehicle in three patients. Two additional plaques were evaluated in each patient; one was left untreated, and another was treated topically with either placebo ointment or betamethasone ointment. Biopsies were taken from an untreated, representative plaque prior to treatment and from all test sites following treatment for light microscopy and T lymphocyte subsets. Three of the nine lesions injected with interferon cleared, and all showed improvement. Thirteen of eighteen noninjected lesions improved in patients who received interferon, showing a systemic effect. In the control group, none of the injected lesions improved and only two of the noninjected lesions showed any change. Histopathologic changes confirmed the clinical impression. This study shows that intralesional interferon may be given safely and has a beneficial effect, both locally and systemically.

Eosinophilic spongiosis: A clinical, histologic, and immunopathologic study

BACKGROUND Epidermal spongiosis with exocytosis of eosinophils (ES) has been reported in biopsy specimens from patients with various dermatoses. Its diagnostic value and the patients outcome remain poorly understood in those cases in which ES is not associated directly with diagnostic features of a bullous dermatosis. OBJECTIVE We evaluated the clinical, histopathologic, and immunopathologic findings and their clinical correlation in patients who had ES in a biopsy specimen but who had no evidence of a bullous dermatosis. METHODS A retrospective study of 150 cases with ES was performed. Clinical, histopathologic, direct immunofluorescence, and subsequent follow-up data were collected to assess final diagnosis and outcome. RESULTS A total of 144 patients had generalized eruptions; of these, 34 (24%) had autoimmune bullous disease. Fourteen (41%) of those patients had neither a bullous nor a vesicular eruption. Other diagnoses included eczematous dermatitis, arthropod bites, scabies, and drug eruption. CONCLUSION The majority of patients whose biopsy specimen revealed only ES had either dermatitis or autoimmune bullous disease, often in the prodromal phase. Direct immunofluorescence is often necessary to distinguish these diseases, and repeated testing may be needed for final diagnosis.

Ulcerative syphilis in acquired immunodeficiency syndrome: A case of precocious tertiary syphilis in a patient infected with human immunodeficiency virus

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Prodromal bullous pemphigoid

Background  Prodromal bullous pemphigoid (PBP) can be difficult to diagnose. Early recognition in its early stages may decrease the morbidity and progression of the disease. Clinical presentations and current treatments available for PBP will be described.

Necrolytic migratory erythema: Dyskeratotic dermatitis, a clue to early diagnosis

A 57-year-old woman with a 6-year history of a dermatitis that evolved into typical necrolytic migratory erythema is reported. Four biopsy specimens were obtained in 5 years. The early lesions revealed superficial perivascular inflammation in the dermis, minor epidermal spongiosis, and scattered dyskeratotic cells in the upper epidermis. The differential diagnosis of this pattern of dyskeratotic dermatitis, particularly in a chronic eruption, should include consideration of hyperglucagonemia and the possibility of an associated pancreatic islet cell tumor.

Histologic response to topically applied minoxidil in male-pattern alopecia

Abstract The histopathology of androgenetic alopecia is characterized by reductions in follicular size and mean hair shaft diameter without significant reduction in follicular density. 1 The proportion of hairs found in anagen is diminished with a corresponding increase in hairs in normal telogen, plus a marked increase in a persistent stage of telogen. The telogen germinal unit is the term given by Headington 2 to the structure that represents a persistence of telogen after shedding of the club hair but in which anagen has not been re-established. Regrowth of scalp hair following topical application of minoxidil has been demonstrated in both primates 3,4 and humans 5,6 suffering from androgenetically determined alopecia. As part of a nationwide multicenter trial of topical minoxidil in male-pattern alopecia, scalp biopsy specimens were obtained before and after treatment to determine what histopathologic changes might be found and if this might help us understand the way in which the clinically observed regrowth of hair might occur.

Eccrine-angiomatous nevus, a new variant.

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Linear and punctate porokeratosis associated with end-stage liver disease

A periodic eruption of porokeratosis developed in a 31-year-old black woman with chronic idiopathic hepatitis requiring liver transplantation. The clinicopathologic features were chiefly those of linear and punctate porokeratosis but overlapped those of porokeratosis plantaris, palmaris et disseminata and hyperkeratotic or verrucous porokeratosis. Typical cornoid lamellae were visible on histologic examination. Outbreaks of the lesions occurred during exacerbations of the liver disease. The skin condition rapidly improved after operation, with concomitant improvement in liver function.