Elizabeth K. Satter

Tumors composed of malignant epithelial and melanocytic populations: a case series and review of the literature

Over the last 30 years, there have been approximately 49 case reports of tumors composed of both malignant epithelial and malignant melanocytic populations. Herein, we present four additional cases of combined tumors that consist of two phenotypically distinct but intermingled populations of malignant cells. Each tumor was composed of an invasive melanoma closely associated with either a basal cell carcinoma or a squamous cell carcinoma. We review all previous case reports in the English literature and attempt to clarify the terminology and summarize what is currently known about these unique tumors.

Non-bullous neutrophilic dermatosis within neonatal lupus erythematosus

To the Editor We read with interest the article by Gleason et al. detailing the occurrence of a non-bullous neutrophilic dermatoses as a dermatologic manifestation of lupus. In our own practice, we recently observed two cases of neonatal lupus erythematosus (NLE) that presented chiefly with a neutrophilic infiltrate and nuclear debris confined to the upper dermis, and wish to suggest that this may also be a dermatologic manifestation within this subcategory of disease.

Congenital Tufted Angioma

Abstract: A 7‐year‐old Filipino girl presented to the dermatology clinic with a slowly enlarging plaque on the inner aspect of her upper left arm. Although she had this lesion since birth, it had gradually enlarged and become indurated and slightly painful. The histopathologic examination showed a vascular proliferation within the dermis, with a “cannonball” appearance consistent with a tufted angioma. We review the literature and discuss the clinical presentation of this rare vascular tumor.

Synchronous onset of multiple cutaneous neuroendocrine (Merkel cell) carcinomas localized to the scalp

Merkel cell carcinoma (MCC) is a rare aggressive neoplasm that typically presents as a solitary nodule or plaque on sun‐exposed skin of the elderly. Although multiple MCC have been described, they are rare, and metastases must be excluded. We report a case of a 59‐year‐old white male who presented with abrupt onset of multiple small bluish papules on his frontal scalp. On low power, the tumor had the overall histological silhouette of a nodular basal cell carcinoma. However, because of the lack of an epithelial connection and the cell’s cytomorphological features, a MCC was considered and was subsequently confirmed using immunohistochemical stains. The MCC described in this report is unusual in that it presented as multiple cutaneous lesions that arose synchronously, along with micrometastases to sentinel lymph nodes.

Third-degree burns incurred as a result of interferential current therapy.

As an ancillary part of physical therapy, ice, heat, transcutaneous electrical nerve stimulation, and interferential currents are often used as nonpharmacological modalities to treat pain and reduce edema. Although medical electrical stimulation devices are touted as having few side effects, cutaneous irritation, contact dermatitis, and burns have been noted. The following article describes a patient who incurred third-degree burns in an area treated with interferential currents.

Solitary superficial angiomyxoma: an infrequent but distinct soft tissue tumor

Superficial angiomyxoma (SA) is a distinct soft tissue tumor characterized by a circumscribed collection of spindled and stellate fibroblasts that are admixed with thin‐walled blood vessels and embedded in a mucinous stroma. Because of its relative infrequent occurrence, the purpose of this article was to present a classical example of an isolated superficial angiomyxoma and discuss the differential diagnosis.

A case report of an omphalopagus heteropagus (parasitic) twin

Heteropagus twin refers to a type of conjoined twin in which an incomplete smaller (parasitic) twin is attached to and dependent upon an otherwise normal host twin. The majority of cases have complete or partial duplication of the pelvis and/or lower extremities. The case depicted herein is unusual in that only isolated case reports have described an attached amorphous mass without identifiable limbs.

Adrenocortical carcinoma with delayed cutaneous metastasis.

Adrenal cortical carcinoma (ACC) is an uncommon and aggressive malignancy. Patients often have metastatic disease at initial presentation, with the most common sites being the liver, local lymph nodes, lungs, peritoneum and bone. Despite a high frequency of metastases, there are only isolated reports of ACC that have metastasized to the skin. Herein, we report a case of an 82‐year‐old woman who presented with a cyst‐like lesion on her back, which on biopsy proved to be ACC metastatic from a primary tumor diagnosed 30 years previously.

An interstitial granulomatous pattern in localized lichen myxedematosus with associated monoclonal gammopathy.

To the Editor, We read the article regarding granulomatous scleromyxedema by Rongioletti et al.1 with interest, as we encountered a similar case. Our case differed in that the patient had localized lichen myxedematosus associated with a monoclonal gammopathy and in that the histopathological findings varied over time. Initial biopsies showed an interstitial granulomatous infiltrate, while subsequent biopsies more closely resembled classical scleromyxedema but with increased histiocytes. This is the third case report of scleromyxedema with granulomatous features, and the first in a patient with localized disease. A 42-year-old Filipino male initially presented in 1997 with several erythematous-yellowish 2-mm papules behind his posterior ears. Histopathological evaluation revealed numerous multinucleated histiocytes, a few of which were Touton type, and admixed foamy histiocytes, lymphocytes and eosinophils, consistent with a xanthogranuloma (Fig. 1A,B). There were no increased fibroblasts or mucin. Because of the unusual clinical appearance and a suspicion that the process might represent early necrobiotic xanthogranuloma, laboratory evaluation was performed. The patient had normal electrolytes, liver function tests, thyroid function tests, complete blood count and antinuclear antibodies and mildly elevated serum lipids. Serum electrophoresis showed an IgG monoclonal gammopathy with λ light chains. Urine electrophoresis was normal. As the monoclonal proteins were below 2 g/dl and the patient was asymptomatic, oncology opted to follow the patient clinically and serologically. In 2000, because the papules continued to enlarge, a repeat biopsy was obtained and showed similar findings to the original biopsy. Electron microscopy was performed to exclude other histiocytic disorders but simply showed multiple histiocytes, some of which contained numerous primary lysosomes (Fig. 2A). Others contained secondary lysosomes with non-specific amorphous electron dense material (Fig. 2B). The patient presented the following year with new 2–4 mm erythematous waxy papules on his bilateral arms and upper back that morphologically differed from the lesions observed behind the ears. Two biopsies were performed and showed an interstitial infiltrate composed of factor XIIIa-positive spindled and CD68-positive epithelioid cells associated with increased mucin deposition in the upper to mid-dermis (Fig. 3A,B). A sparse perivascular lymphoplasmocytic infiltrate was also appreciated. Initially, the biopsy was interpreted as interstitial granuloma annulare; however, the clinical examination and associated monoclonal gammopathy were not consistent with that diagnosis. The biopsies were sent for a second opinion, and a diagnosis of granulomatous lichen myxedematosus was made. In subsequent years, the patient was followed serologically with no appreciable change in the level of monoclonal proteins. The eruption involving the back and posterior ears ultimately resolved, but lesions involving the arms slowly expanded and became more confluent (Fig. 4). A new biopsy was recently obtained that showed features

Depth of tissue ablation and residual thermal damage caused by a pixilated 2,940 nm laser in a swine skin model.

The purpose of this study was to assess the effects of fluence, pulse stacking, and multiple passes on the depth of injury caused by a fractionated Er:YAG laser in an in vivo farm pig model.