James M. Shehan

Purpura annularis telangiectodes of Majocchi: case report and review of the literature.

Background  Purpura annularis telangiectodes of Majocchi is an uncommon form of pigmented purpuric dermatosis which may present a therapeutic challenge. Given the rare nature of this condition, there is limited anecdotal information available regarding optimal therapy. Although pigmented purpuric dermatoses are generally innocuous, in some cases they may cause patients significant distress, and there is a need to exclude cutaneous T‐cell lymphoma.

An Unusual Clinical Presentation of Merkel Cell Carcinoma: A Case Report

Introduction. Merkel cell carcinoma is a rare, aggressive neuroendocrine cell carcinoma arising in the sun-exposed skin of elderly patients. Most of these tumors are located in the dermis. An unusual clinical presentation of such a tumor in the subcutis, if not biopsied, may be easily mistaken as a benign lesion. Case Presentation. An 83-year-old white woman presented with a several-month history of a painless 7 mm subcutaneous mass that was initially thought to be a lipoma. A conservative follow-up was planned. At the insistence of the patient, an excisional biopsy of the mass was performed revealing a subcutaneous Merkel cell carcinoma. The tumor cells stained positively for CK 20, chromogranin, and synaptophysin. No other primary or metastatic tumors found after a thorough work-up. The patient was treated with local irradiation. She remains disease free at her six-month follow-up visit. Conclusion. When a new growth is encountered in the sun-exposed skin of elderly patients, a biopsy is warranted even if the lesion clinically appears benign.

Agminated Papules and Pustules on the Flank—Quiz Case

A 41-year-old man presented with a 5-month history of progressively “rough skin” on his face. He had also developed a painful hemorrhagic lesion on his legs, a fever, and an 8-kg weight loss over the past 6 weeks. Physical examination revealed yellowish filiform follicular spicules with a horny appearance on the face, predominantly on the nose and ears (Figure 1 and Figure 2) but also on the scalp and upper trunk area. Retiform purpura and localized necrotizing livedo were also present on both legs. Laboratory tests showed an elevated level of C-reactive protein (34 mg/L [to convert to nanomoles per liter, multiply by 9.524]; reference range, 0-6 mg/L) and normocytic anemia (hemoglobin, 11.3 g/dL [to convert to grams per liter, multiply by 10.0]; reference range, 13.4-17.0 g/dL); electrolyte levels and liver and renal function test results were normal. Serum protein electrophoresis detected a visible paraprotein band, and serum immunoelectrophoresis revealed an IgGmonoclonal gammopathy. A skin biopsy of cutaneous spicules on the back was performed (Figure 3). What is your diagnosis?