Harold Plotnick

Alopecia Mucinosa and Lymphoma: Report of Two Cases and Review of Literature

A total of 90 cases of alopecia mucinosa (follicular mucinosis) have been reported in the world literature since Pinkus described the entity in 1957. Alopecia mucinosa appears morphologically in any variety of three basic clinical types: grouped folliculopapules, plaque forms of folliculopapules, and as boggy nodular masses. Characteristic histochemical changes of follicular mucinosis have been demonstrated in alopecia mucinosa as well as in selected cases of mycosis fungoides and lymphoma. The majority of case reports of alopecia mucinosa have been in children and young adults (58%), and the course of the dermatosis was usually uneventful. Beyond age 40, the disease appears to behave differently in that it follows a prolonged chronic course, and of 28 cases in this category four (15%) developed into either mycosis fungoides or lymphoblastoma.

Polypoid melanoma: A virulent variant of nodular melanoma: Report of three cases and literature review

We report the cases of three patients with polypoid melanoma. In no case was there microscopic evidence of melanoma cell invasion below the papillary dermis. In the polypoid variant of nodular melanoma, melanoma cells accumulate in large volume above the skins surface. This increase in tumor volume encourages dislodgment of melanoma cells that are carried to superficial lymphatic vessels without invading the reticular dermis; this feature differentiates polypoid melanoma from the nonpolypoid nodular variant. Although polypoid melanoma is considered the most malignant form of melanoma, our findings, albeit limited to three cases, suggest that early diagnosis and prompt surgical excision may provide a favorable 5-year survival rate.

Sexually transmitted diseases: Bacterial infections

This update reviews the latest diagnostic and therapeutic methods regarding sexually transmitted diseases caused by bacteria. The following mucocutaneous bacterial disorders will be discussed: syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale, and gonorrhea.

Lichen planus and coexisting lupus erythematosus versus lichen planus-like lupus erythematosus

Abstract A middle-aged black woman presented initially with painful cutaneous plaques that were located at various sites and that were diagnosed histologically as lichen planus. Standard light microscopic examination showed histopathologic variants of lichen planus. Direct immunofluorescence of a skin lesion had negative results for any of the lupus erythematosus bands but did reveal hyaline bodies in the deep cellular layer of the epidermis and the superficial layer of the dermis. These findings were compatible with either lichen planus or lupus erythematosus. However, both the clinical course of the eruption and the antinuclear antibody tests showed that the immunofluorescent antinuclear antibody pattern of large, speckle-like threads were consistent with lupus erythematosus. Furthermore, the large, speckle-like, thready antinuclear antibody pattern, which has been shown to be a marker for a benign subset of lupus erythematosus, is not seen in lichen planus. Lichen planus-like lupus erythematosus was therefore the more likely diagnosis.

Periorbital necrobiotic xanthogranuloma and stage I multiple myeloma. Ultrastructure and response to pulsed dexamethasone documented by magnetic resonance imaging.

We observed a 40-year-old woman with necrobiotic xanthogranuloma from the inception of indurated eyelid and periorbital infiltrates and concurrent stage I multiple myeloma to resolution of infiltrates in skin and bone marrow after pulsed high-dose oral dexamethasone therapy. Ultrastructural studies revealed lipid vacuoles in epidermal keratinocytes, in dermal histiocytic macrophages, and in vascular and lymphatic endothelial cells. The presence of lipid vacuoles in epidermal keratinocytes has not been reported previously in xanthogranuloma.

Xeroderma pigmentosum and squamous cell carcinoma of the tongue: Identification of two black patients as members of complementation group C

We present the identification and characterization of two patients with xeroderma pigmentosum (XP) and squamous cell carcinoma of the tongue. Dermal fibroblasts from two black siblings with XP were shown to be hypersensitive to ultraviolet (UV) light measured by colony-forming ability. UV-induced unscheduled deoxyribonucleic acid synthesis was reduced significantly when compared with normal levels for both strains. The strains were assigned to complementation group C on the basis of cell fusion studies. Patients with XP have a marked increase over normal persons for developing skin cancer, presumably because of their extreme sensitivity to UV light. Our results may have applicability in explaining the in vivo development of epidermoid carcinoma in the partially shielded tongue of some XP patients.

Sexually transmitted diseases: Viruses and ectoparasites

This review highlights recent developments in the epidemiology, pathogenesis, diagnosis, and treatment of nonbacterial sexually transmitted infections. Genital herpes simplex, anogenital human papillomavirus disease, molluscum contagiosum, pediculosis pubis, and scabies are discussed.

Ultrastructural studies of xeroderma pigmentosum

Electron microscopic observations of both sun-exposed and sun-protected skin from a black patient with xeroderma pigmentosum (XP) revealed abnormal ultrastructural changes in the melanin pigmentary system, tonofibrillar-desmosome complexes, endoplasmic reticulum, mitochondria, and nucleoli of all keratinocytes. The difference between the cellular changes in the sun-exposed skin and that protected from sunlight was quantitative rather than qualitative in character. The most salient changes were seen in sun-exposed specimens: melanosomes limited by a membrane showed a high degree of polymorphism with a tendency to form large complexes, and many fibroblast-like cells displayed an intense phagocytic activity for melanosomes, the latter finding not previously reported. The present study supports the conclusions of other investigators that XP is a heterogeneous disease. Clarification of the XP entities by continued research may identify the defective gene and lead to methods of correction by the molecular biologist.