Margaret Gray Wood

Wrinkles due to idiopathic loss of mid-dermal elastic tissue

Widespread areas of fine wrinkling of the skin had been noted for 2 years by a 42‐year‐old healthy white woman. Histological study disclosed a selective absence of elastic tissue strictly limited to the mid‐dermis ofthe involved areas. It was postulated that an antecedent urticarial process may have led to such a specific zonal destruction of elastic tissue. The elastolytic process did not change or extend, and no urticarial lesions were seen dtiring a year of observation.

Transformation of the common wart into squamous cell carcinoma in a patient with primary lymphedema

A patient is reported in whom treatment‐resistant periungual and subungual warts underwent malignant transformation into squamous cell carcinoma. Similar changes were observed in multiple warts of the vulvar, perianal, and intravaginal as well as cervical area. The tumors that developed were in many instances microinvasive but did not metastasize. The remarkable conversion of a common wart into a squamous cell carcinoma further implicates the human papovavirus in oncogenesis. The specific factors accountable for the malignant change remain completely unknown, but the patients lymphedema praecox, as well as her severe reaction to vaccinia, and her development of a disseminate systemic Mycobacterium scrofulaceum infection suggest that the critical factor may be one of immunity.

A zosteriform network of spiradenomas

A patient is presented with an extensive and unusual area of tumor formation involving the left side of her neck and chin. Clinically, differential diagnosis included neurofibroma, nevoid growths, and fibroma with angiomatous elements. Microscopic examination of biopsy specimens revealed typical spiradenomas.

Occult Bowen's disease in keratinous cysts

Bowens disease (intra‐epidcrmal squamous cell carcinoma) was found in the walls of two cysts excised from the forehead of an 81‐year‐old man. The inapparent nature of the malignant change underscores the need for routine histological study of rapidly growing cysts.

Observations on occult malignant lymphomas in the skin

Six patients with malignant cutaneous lymphomas are described to show the diversified clinical patterning that may occur. None of the lesions, which ranged from solid nodules, through inflammatory infiltrative lesions, to gangrene, could be identified as malignant lymphoma at the time these patients sought medical attention. Histologic diagnosis of the lymphoma came much later. Pain was a particularly prominent symptom in three of the six patients. The clinician should discard the dictum that malignant lymphoma is a painless process and should not neglect the consideration of malignant lymphoma because of the presence of pain. The skin lesions described provide a model for recognition of extranodal lymphomas elsewhere in the body. Lymphoma should be considered in the presence of unexplained chronic inflammatory processes that affect any organ containing lymphoreticular or epithelial structures.

Subacute bacterial endocarditis presenting with necrotic skin lesions

Classical lesions associated with subacute bacterial endocarditis include petechiae, splinter hemorrhages, Oslers modes and Janaway lesions. We describe a patient with subacute bacterial endocarditis, whose sole cutaneous findings were bullous necrotic lesions of the lower extremities. The vessels were occluded by acidophilic material and coccal bacteria were identified in the vessels. Immunofluorescent studies revealed Igm and C3 in the vessel walls.

Malignant pilomatricoma in a dog

A malignant pilomatricoma is described in a dog. The primary tumor apparently developed in the metatarsal area where there were multiple intradermal skin nodules. Lymphatic invasion by tumor cells resulted in metastasis to the mammary glands, lymph nodes and lungs. The tumor is compared to the pilomatricoma in man where no metastasizing types have been identified.

The stratum corneum biopsy for instant visualization of fungi

Ultrathin specimens of infected stratum corneum taken with a flexible razor blade provide instant visualization of fungi on immersion in zylene.

New technic for instant visualization of fungi in hair

Physical fragmentation of hair specimens by hammering permits immediate direct visualization of any fungi present.

Surgical conversion of herpes simplex from an epidermal to a dermal disease

A new post‐surgical form of recurrent herpes simplex is described. It appeared as an erythematous bulla at sites of recurrent herpes from which the prior epidermal lesion had been transversely excised. Histologically, it was characterized by a lesion‐free epidermis, a large subepidermal bulla, and a marked inflammatory response in the uppermost dermis, complete with diagnostic multinucleate giant cells. It is postulated that epidermal surgery leaves the area immune to future direct herpetic involvement of the epidermis because it denervates the epidermis. The possibility is raised that such dermal forms of herpes may also occur in the natural course of the disease.