Shivani P. Reddy

Apremilast for a psoriasis patient with HIV and hepatitis C

densely packed, small round blue cells (Fig. 2b), arranged in irregular nests, immunoreactive with chromogranin and Keratin 20, thus consistent with MCC. Red nodules do represent diagnostic challenges for two reasons: first, they do not display specific clinical dermoscopic criteria that allow to correctly classify a given tumour; second, nodular tumours, especially high-grade tumours (i.e. melanoma and MCC), have a fast growing attitude and thus, a prompt excision could result in better prognosis. RCM is a relatively new device that is nowadays available in tertiary referral centres in Europe and in other countries. The great opportunity to observe cellular details in vivo makes RCM useful tools for tumour diagnosis. In the present case, we reported for the first time the typical RCM findings seen in MCC. Small hyoporefrective cells arranged to form solid aggregates are seen in the context of fibrotic stroma and prominent vasculature. Although those findings could be observed in some melanoma subtype (i.e. nevoid), the monomorphous appearance favoured the diagnosis of a non-melanoma skin cancer, not basal cell carcinoma. Interestingly, RCM findings mirrored perfectly the histopathologic aspects of MCC as displayed in Fig. 2. Although our description is based on one single case report, RCM could be of help in the differential diagnosis of red nodules and in the identification of MCC. Further multicentric studies on this rare tumour are warranted to further explore RCM-specific morphology and the value of MCC confocal features in clinical practice.

The risk of melanoma and hematologic cancers in patients with psoriasis

Background The risk of melanoma and hematologic cancers in patients with psoriasis is controversial. Objective We sought to assess the risk of melanoma and hematologic cancers in patients with psoriasis, and the association with different treatments. Methods We used case‐control and retrospective cohort designs to determine melanoma or hematologic cancer risk in patients with psoriasis. Risk with treatment type was assessed using Fisher exact test. Results Patients with psoriasis had 1.53 times greater risk of developing a malignancy compared with patients without psoriasis (P < .01). There were no significant differences in malignancy risk among patients treated with topicals, phototherapy, systemics, or biologic agents. Patients with psoriasis and malignancy did not have significantly worse survival than patients without psoriasis. Limitations It is possible that patients developed malignancy subsequent to the follow‐up time included in the study. Conclusion Patients with psoriasis may experience an elevated risk of melanoma and hematologic cancers, compared with the general population. The risk is not increased by systemic or biologic psoriasis therapies.

A Rare Case of Cutaneous Oncocytic Hidradenoma

Oncocytes are epithelial cells characterized by their abundant eosinophilic and finely granular cytoplasm. Their histologic appearance is due to excessive amounts of cytoplasmic mitochondria. Oncocytes generally occur in the setting of benign neoplasms. Oncocytomas, or tumors composed primarily of oncocytes, are typically found in the kidneys. Other common sites include the salivary, thyroid, and parathyroid glands. Oncocytic metaplasia has only been rarely reported in various cutaneous neoplasms. We report a case of an elderly male presenting with a 5 mm erythematous papule on his left scalp, who underwent a shave biopsy showing a nodular, dermal‐based adnexal tumor with prominent ductal differentiation, composed of multiple small, well‐formed lumina surrounded by enlarged and bland‐appearing epithelioid cells. Cytokeratin 7 (CK7), epithelial membrane antigen (EMA) and monoclonal carcinoembryonic antigen (mCEA) immunohistochemical stains were positive, consistent with adnexal differentiation. Phosphotungstic acid‐hematoxylin (PTAH) and Luxol fast blue (LFB) stains highlighted the cytoplasmic granules, consistent with mitochondria. The overall findings were consistent with an oncocytic nodular hidradenoma. Oncocytic hidradenoma is a very rare entity, with only 1 previously reported case in the literature.