K. Didem Yazganoğlu

Tumors associated with nevus sebaceous

Background: Nevus sebaceus (NS) is a congenital hamartomatous lesion, usually involving the scalp or the face. Various benign and malignant neoplasms can develop in association with NS, the most common being trichoblastoma, syringocystadenoma papilliferum, viral warts and basal cell carcinoma (BCC).

Lipoid proteinosis: a case series from Istanbul.

Background  Lipoid proteinosis (LP) is a very rare genodermatosis. The literature on LP consists of case reports only. As we have observed 14 LP patients belonging to nine different families in the last 15 years in our practice, we decided to review all reported Turkish LP patients in this 15‐year period, and noted 37 diagnosed cases. The reasons for this relatively large number of cases, the clinical features of the patients, and the associations of LP with other clinical conditions are described in this article.

Axillary Fox-Fordyce-like disease induced by laser hair removal therapy.

REFERENCES 1. Warbick-Smith J, Hollowood K, Birch J. Dermatofibrosarcoma protuberans recurring as a hybrid dermatofibrosarcoma/giant cell fibroblastoma in an adult: A case report. J Plast Reconstr Aesthet Surg 2010;63:e785-7. 2. Sandberg AA, Bridge JA. Updates on cytogenetics and molecular genetics of bone and soft tissue tumors: dermatofibrosarcoma protuberans and giant cell fibroblastoma. Cancer Genet Cytogenet 2003;140:1-12. 3. Pascual A, Sanchez-Martinez C, Moreno C, Burdaspal-Moratilla A, Lopez-Rodriguez MJ, Rios L. Dermatofibrosarcoma protuberans with areas of giant cell fibroblastoma in the vulva: a case report. Eur J Gynaecol Oncol 2010;31:685-9. 4. Diwan AH, Skelton HG III, Horenstein MG, Kelly DR, Barrett TL, Bussian AH, et al. Dermatofibrosarcoma protuberans and giant cell fibroblastoma exhibit CD99 positivity. J Cutan Pathol 2008;35:647-50. 5. Beham A, Fletcher CD. Dermatofibrosarcoma protuberans with areas of giant cell fibroblastoma: report of two cases. Histopathology 1990;17:165-7.

Effective treatment with hydroxychloroquine in a case of annular elastolytic giant cell granuloma

Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous and elastolytic skin disease of unknown pathogenesis. Therapy for AEGCG is controversial. The data about the effectiveness of chloroquine in the treatment of AEGCG are also variable. Here, we report a case of AEGCG with significant improvement after a total treatment period of 22 weeks with hydroxychloroquine. Although a possibility of spontaneous remission cannot be ruled out, we think that chloroquine can be considered as an effective treatment of this chronic disorder.

Malignant Epithelial Tumors

Malignant cutaneous tumors arising from epithelial cells, including malignant adnexal neoplasia, will be discussed in this chapter. Malignant melanoma that derives from epidermal melanocytes is the subject of another chapter. Basal cell carcinoma and squamous cell carcinoma are referred to as non–melanoma skin cancers. Both tumors compose the great majority of skin cancers and cause significant health concerns. Their morbidity can be significantly reduced with early diagnosis. Clinical features of these tumors will be discussed broadly. In addition, there are many types of malignant adnexal skin tumors including the ones with high metastatic potential. But all of them are rare. The classic non–melanoma skin cancers can usually be diagnosed with typical clinical features, but most malignant adnexal tumors present as nonspecific bizarre nodules, plaques, or ulcerations and are usually difficult to diagnose clinically. Additionally, Merkel cell carcinoma is also discussed in this chapter.

Clinical atlas of skin tumors

BENIGN SKIN TUMORS.- Epidermal Benign Tumors.- Epidermal Precancerous Lesions and in Situ Malignancies of Skin.- Nevo-Melanocytic Benign Tumors.- Cutaneous Cysts.- Cutaneous Adnexial Tumors.- Benign Vascular Tumors Of The Skin.- Benign Neural Tissue Tumors.- Benign Fibrohistiocytic Tumors.- Mastocytosis.- Subcutaneous Fat Tissue Tumors.- MALIGNANT SKIN TUMORS.- Malignant Epithelial Tumors.- Malignant Melanoma.- Sarcomatous Tumors of Skin.- Cutaneous Lymphomas.- Histiocytosis.- Cutaneous Metastasis.- Predilection sites of skin tumors.

Superficial cutaneous hemorrhagic lesions in three mycosis fungoides patients using acitretin: BAYKAL et al.

Superficial cutaneous hemorrhage is not a well-known adverse effect of drugs. Two cases have been reported to be related with acitretin (Aydogan, Karadogan, & Tunali, 2007; Zavattaro et al., 2014). We would like to add three new cases with asymptomatic superficial cutaneous hemorrhagic lesions mainly located on palmoplantar area (Table 1, Figures 1a,b,d and 2a,b). All three patients had mycosis fungoides. Coagulation tests including international normalized ratio, activated partial thromboplastin time, prothrombin time, and blood count including platelet number, were found to be within normal range in all. Dermoscopic examination was performed in Case 1 and supported superficial hemorrhage (Figure 1c). Histopathologic examination of a punch biopsy in this case revealed intracorneal and intraepidermic red blood cell extravasation, associated with mild spongiosis and a nonspecific superficial dermatitis. Erythrocyte extravasation in dermis (classic purpura) was not observed. All three cases with hemorrhagic lesions were under acitretin and PUVA therapy. However, PUVA is not known to be associated with skin hemorrhage, and regression of the lesions was observed in two patients (Cases 2, 3) (Figure 2c,d) after cessation of acitretin despite continuing PUVA therapy. Therefore, acitretin was thought to be the probable causative agent. Patient 1 was lost to follow-up but in the other two patients acitretin was not used again, and the hemorrhagic lesions did not relapse in the three years (Case 2) and one year (Case 3) follow-up period. Acitretin has been shown to be related with cutaneous hemorrhage previously in two cases (Aydogan, Karadogan, & Tunali, 2007; Zavattaro et al., 2014) (Table 1). Different from our patients, one case was a psoriasis patient with subungual hemorrhage (Aydogan et al., 2007), and the other had Darier–White disease with red and black punctiform macules and vesicles on palmoplantar area and dorsal aspect of the fingers (Zavattaro et al., 2014). Histological examination revealed hemorrhagic vesicles in the stratum corneum in addition to the typical features of Darier–White disease in the latter case (Zavattaro et al., 2014). Similar to our patients, coagulation tests and blood count were normal in both cases. Rechallenge with acitretin in both reported patients caused activation of the lesions supporting the relation between acitretin and cutaneous hemorrhage. The exact mechanism leading to superficial cutaneous hemorrhage in the reported patients as well as in our patients is not clear. All trans retinoic acid has been shown to induce vascular endothelial growth factor gene expression in human bronchioloalveolar carcinoma cells in a study (Maeno et al., 2002), and based on this study,

Epidermal Precancerous Lesions and In Situ Malignancies

The main topic of this chapter is the skin and mucosal lesions that mainly show histologic epithelial dysplasia and pose a risk for the development of keratinocytic epidermal malignancies. Different clinical presentations include actinic keratosis, Bowen disease, erythroplasia of Queyrat, leukoplakia, and actinic cheilitis. All are accepted as in situ carcinomas and possible precursors of squamous cell carcinoma.

Skin Appendage Tumors

Skin appendages located in the dermis but that are connected with the epidermis are the hair follicle, the sebaceous gland, the arrector pili muscle, and the sweat glands. The first three and the apocrine sweat glands form a complex called the pilosebaceous (folliculosebaceous-apocrine) unit. Eccrine sweat glands are localized separately. A great number of benign tumors may originate from these structures. Some of them have malignant counterparts, which will not be discussed in this chapter. Although some benign adnexal tumors show malignant degeneration, the great majority remain benign throughout life. However, some of these tumors are markers for syndromes associated with systemic findings or internal malignancies; therefore diagnosis is essential. A number of these tumors do not have a typical clinical appearance or the clinician is not experienced enough to diagnose such very rare tumors, so they may first be diagnosed by dermatopathologists after removal. Even dermatology textbooks do not have clinical photographs of all these adnexal tumors. However, we assume that many skin appendage tumors have some clinical clues before they are diagnosed histopathologically. This chapter concentrates on the relatively common benign skin appendage tumors. Tumors are classified mostly according to their adnexal origin.

Nevomelanocytic Benign Tumors

Nevomelanocytic benign tumors are commonly encountered skin problems. The proliferation of melanocytes or the presence of nevus cells (nevocytes) is the cause of these benign tumors. Melanocytes are elements of the basal layer of the epidermis. Their increase in the epidermis causes epidermal melanocytic tumors. Melanocytic tumors also may be markers of some syndromes. Normally there are no melanocytes in the dermis. However, the presence of dendritic melanocytes in the dermis causes dermal melanocytic tumors. Melanocytic nevi (nevus cell nevi) are characterized by nevus cells that form nests in the epidermis and dermis. Different clinicopathologic variants of these nevi, either congenital or acquired, have been described. A large number of tumors of melanocytes or nevus cells and the related syndromes are the main topics of this chapter. On the other hand, lesions like ephelides only show an increase in melanin pigment (melanotic lesions) but are clinically similar to the nevomelanocytic tumors because of their brownish color. Although these lesions cannot be defined as tumors because of the lack of proliferation of melanocytes or nevocytes, they are additionally discussed in this chapter for their overlapping clinical features and differential diagnostic importance.