Erin X. Wei

Alopecia in systemic amyloidosis: Trichoscopic-pathologic correlation

Alopecia in systemic amyloidosis is very rare and has been described as individual cases of diffuse nonscarring alopecia and a case of alopecia universalis. We report the trichoscopic findings in alopecia associated with systemic amyloidosis. The most prominent feature was a salmon colored halo (0.3-1 mm in diameter) surrounding the follicular ostia. Other features included broken hairs and black dots. The salmon colored halo correlated on pathology with the perifollicular deposition of amyloid. The horizontal sections showed that the sebaceous glands were preserved which supports the nonscarring pattern of the alopecia.

Unilateral, localized bullous pemphigoid in a patient with chronic venous stasis

Bullous pemphigoid (BP) is a systemic, autoimmune bullous disease that classically presents as widespread urticarial plaques or tense bullae. Localized variants of BP are rare with approximately 100 cases reported. We present a unique case of unilateral, localized BP in the setting of venous stasis.

Giant proliferating trichilemmal cyst arising from a nevus sebaceus growing for 30 years

Nevus sebaceus of Jadassohn, a congenital cutaneous hamartoma, has the potential to develop into various epidermal adnexal‐origin neoplasms. While the most common neoplasms are trichoblastoma or syringocystadenoma, proliferating trichilemmal cysts are exceptionally rare. We report a case of a 63‐year‐old Cuban male with a giant proliferating trichilemmal cyst arising from a nevus sebaceus on the right shoulder which had been growing for 30 years. Proliferating trichilemmal cysts arising from nevus sebaceus cases are difficult to diagnose clinically and histologically as they are very rare and have not been defined by exact diagnostic criteria. Our case creates awareness of this particular tumor in nevus sebaceus and shares clinical and histological diagnostic information that can be used to make a proper diagnosis.

Neonate With Cutaneous Vesicles and Respiratory Distress

A 3-day-old premature male infant, born at 26 weeks’ gestational age, presented to the dermatology department with a skin rash on the bilateral lower extremities. History was notable for preterm premature rupture of membranes for 10 days. The neonate was born via urgent cesarean delivery owing to breech positioning. The mother was otherwise in good health with normal prenatal care and had no history of sexually transmitted diseases. During the first few days of life, the neonate had recurrent hypoxic episodes. He was receiving intravenous antibiotics for suspected sepsis and bacitracin for the topical lesions. Per the primary team, the rash was first noted at 3 days of life. Physical examination demonstrated a small, ill-appearing neonate with multiple, grouped vesicles and punched-out ulcerations on his scalp, axilla, extremities, and scrotum (Figure, A-D). He also had witnessed respiratory desaturations requiring urgent intubation. Initial laboratory evaluation demonstrated a normal complete blood cell count and serum chemistry with the exception of a high lymphocyte count (34%, normal level <25% [to convert to proportion of 1.0, multiply by 0.01]) and high aspartate aminotransferase level (117 IU/L, normal level 8-39 IU/L [to convert to microkatals per liter, multiply by 0.0167]). A chest radiograph demonstrated increased pulmonary markings bilaterally. Scalp and face A

Rates of Dermoscopy Use for Melanoma Diagnosis in the Miami VA Medical Center

Author Contributions: Drs Ibrahim and Bergfeld had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Ibrahim, Piliang, Bergfeld. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Ibrahim, Bergfeld. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Ibrahim, Bayart. Administrative, technical, or material support: Bayart, Hogan, Piliang, Bergfeld. Study supervision: Piliang, Bergfeld.

Carcinoma erysipeloides due to primary cutaneous squamous cell carcinoma

Sir, Carcinoma erysipeloides is a rare variant of cutaneous metastasis. Although most commonly seen in patients with breast adenocarcinoma, it has also been associated with adenocarcinoma of the lung, tonsil, parotid, stomach, pancreas, rectum, colon, ovary, prostate and uterus.1 There has been only one case report of carcinoma erysipeloides arising from cutaneous squamous cell carcinoma (SCC) and another case from SCC of unknown origin.1,2 Clinically, carcinoma erysipeloides exhibits sharply‐defined, erythematous, inflammatory papules and plaques with significant induration due to the blockage of dermal lymphatics. Its appearance often mimics erysipelas or cellulitis and poses a diagnostic challenge. In this article, we report a case of carcinoma erysipeloides arising from cutaneous SCC and discuss the clinical, histological and immunohistochemical (IHC) features used to diagnose this condition.

Nail Changes of Systemic Amyloidosis After Bone-Marrow Transplantation in a Patient With Multiple Myeloma.

Report of a Case | A 60-year-old man presented with a 2-year history of nail dystrophy, alopecia, and blisters and milia on his hands. Review of systems revealed weight loss, hoarseness, and dyspnea on exertion. Medical history included cardiac dysfunction, gastroesophageal reflux disease, and bilateral carpaltunnel syndrome. Physical examination demonstrated atrophic scars with erosions and milia on the dorsal hands and diffuse alopecia of the scalp and eyebrows. Onychodystrophy of all 20 nails with longitudinal ridging and onychorrhexis, mimicking lichen planus, was also observed (Figure 1A and B). Skin biopsies from lesions on the hand and scalp demonstrated amyloid deposition. A longitudinal nail biopsy demonstrated amorphous pink deposits in the nail bed and nail matrix dermis and vessels; polarizing light examination revealed apple-green birefringence with Congo red staining, confirming amyloid deposition (Figure 2). The most prominent amyloid deposition was observed in the proximal nail matrix, which was associated with nail plate atrophy. Hematology was consulted, and a bone-marrow biopsy revealed multiple myeloma. The patient underwent 4 rounds of chemotherapy with cyclophosphamide-bortezomibdexamethasone before undergoing an autologous stem-cell

Abstract 1930: Trends of invasive and in-situ melanoma diagnosis in the U.S

Melanoma, accounts for about 4% of skin cancer cases, but is associated with 79% of skin cancer deaths. The number of new cases of melanoma in the US is rising dramatically. The incidence of in-situ melanoma is increasing at a more rapid rate than for melanoma overall. This may be due to better awareness, improved screening techniques and access to dermatologists that result in early diagnosis of melanoma. There is also concern that over the last few years, pathologists have had a lower threshold to diagnose in-situ melanoma due to medico-legal reasons. However, the lesions that are being called in-situ melanoma are most certainly severely dysplastic (atypical) nevi that are considered melanoma precursor lesions. The distinction is important to make an accurate diagnosis when providing medical care to a patient. We investigated the trend of diagnosis and melanoma invasive versus in situ in three national prospective cohorts of women and men: Nurses’ Health Study I (1976-2008, age at enrollment 30-55), Nurses’ Health Study II (1989-2007, age at enrollment 25-42), and Health Professionals Follow-up Study (1986-2008, age at enrollment 40-75). We accrued 940 invasive and 424 in situ cases in NHS I, 447 invasive and 326 in situ cases in NHS II, and 310 invasive and 153 in situ cases in HPFS. In each cycle of 2-year follow-up, the incidence rate of melanoma steadily increased, and the increased incidence rate of in-situ melanoma was substantially greater than invasive melanoma. These trends were similar in all three cohorts. The ratio of invasive and in-situ melanoma in each cycle 2-year follow-up decreased more than 5 folds over the follow-up period in the NHS I and II. The decrease was not apparent in HPFS. In this study, we found that in-situ melanoma incidence has continued to rise in the US in the last few decades, especially among women where the rate of in-situ melanoma increased more sharply compared to invasive melanoma incidence. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1930. doi:10.1158/1538-7445.AM2011-1930