Sean O'Loughlin

Suspected skin malignancy: a comparison of diagnoses of family practitioners and dermatologists in 493 patients

Abstract

Labial melanotic macule: A clinical, histopathologic, and ultrastructural study

BACKGROUND The labial melanotic macule (LMM) is a recently described pigmentary anomaly that may simulate malignant melanoma. OBJECTIVE Our purpose was to define the LMM clinically, histologically, and immunohistochemically in a large group of patients. METHODS We describe the clinical features of 36 LMMs in 29 patients (aged from 4 to 79 years, 4 male, 25 female) seen during the past 4 years. Histopathologic findings in 21 of these patients are discussed. Seventeen lesions were immunostained with HMB-45 monoclonal antibody, and electron microscopy was performed on eight lesions. RESULTS The majority of patients were women and had solitary lesions on the lower lip with the mean age of onset of 30 years. Histologically prominent basilar hyperpigmentation accentuated at the tips of the rete ridges was present without atypia or nevoid formation. Immunohistochemical studies showed that all intralesional melanocytes were HMB-45 negative, supporting their benign nature. Ultrastructurally, numerous stage III and IV melanosomes clustered within basal keratinocytes and papillary dermal melanophages were found. CONCLUSION The LMM is a clinically and histologically distinctive benign pigmentary anomaly.

Cutaneous Mycobacterium Malmoense Infection in an Immunocompromised Patient

P positive chronic myeloid leukaemia was diagnosed in a 48-year-old previously healthy mother of four in December 1980, which remitted after a short course of busulphan. Nine months later fhe pafienf presented again with a 3-week history of recurrent night sweats, anorexia, lethargy, and weight loss. She was febrile (38G), but there was no evidence of lymphadenopathy, hepatosplenomegaly, or cutaneous lesions. Investigations revealed an elevated erythrocyte sedimentation rate of 57 mm/hour (Westergren), a white blood cell count of 6.8 X 1 O V L with a differential count of polymorphonuclear leucocytes 82%, lymphocytes 3%, eosinophils 1%, basophils 1%, metamyelocytes 1 %, and myelocytes 10%. Liver function tests were abnormal: serum alanine transaminase, 107 lU/l (normal, 5-40 lU/l); serum aspartate transaminase, 1 28 lU/l (normal, 5-35 lU/l); gamma glutamyl transferase, 147 lU/l , (normal, 0-35 lU/l).

Mycosis fungoides - : a review of the management of 28 patients and of the recent literature

Background  Mycosis fungoides is an uncommon cutaneous T‐cell lymphoma characterized by malignant monoclonal proliferation of T‐helper lymphocytes. Its course is variable with a potential for lymphatic and hematogenous involvement. We report the investigations, staging, treatment, follow‐up, and outcome of 28 patients. This is the first such study reported from Ireland.

Pruritic urticarial papules and plaques of pregnancy (PUPPP): a clinicopathological review of 35 patients

The clinical features of 35 cases of Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) seen over an 8 year period were reviewed with regard to age and gestational stage of onset, evolution and severity of disease and response to therapy. The histologic features in biopsies from 15 patients were analysed for pattern and extent of inflammatory change and the composition of the inflammatory cells were studied with a panel of monoclonal antibodies. This study confirmed PUPPP to be a well defined clinical entity mainly occurring in young primagravidas in the third trimester and usually responsive to topical treatments. Histologically, perivascular upper and mid‐dermal inflammatory changes were present in all biopsies with epidermal spongiosis and vesiculation a prominant feature in many cases. The inflammatory infiltrate was composed of an admixture of T lymphocytes and macrophages.