Thelda Kestenbaum

Granulomatous slack skin without evidence of a clonal T-cell proliferation

Granulomatous slack skin is a rare cutaneous disorder with less than 50 cases presented in the English-language literature. The disease is characterized by circumscribed erythematous lax skin accentuated most commonly in the axillary and inguinal areas. A strong association with a preceding or evolving diagnosis of mycosis fungoides or Hodgkins disease has been reported. Previous reports describe the entity as a lymphoproliferative disease in the same spectrum as mycosis fungoides and Hodgkins disease with a monoclonal T-cell population. Our case, without an evident beta-T-cell receptor rearrangement, suggests that not all cases of granulomatous slack skin are a result of an indolent lymphoma. Granulomatous slack skin probably represents a spectrum of diseases that can eventuate into a lymphoproliferative process.

Neuroendocrine differentiation of a metastatic basal cell carcinoma in a patient with basal cell nevus syndrome

A 48 year‐old white male with basal cell nevus syndrome presented with a metastatic basal cell carcinoma with neuroendocrine features. The tumor manifested aggressive behavior, having deep local invasion and metastases to para‐aortic lymph nodes and bone. Neuroendocrine differentiation has rarely been associated with basal cell carcinoma. The histologic, immunohistochemical, and electron microscopic studies of this rare tumor are described.

Intraoral vesicles occurring after alginate impressions

In 47 of 227 dental students intraoral vesicles developed after multiple alginate impressions. The lesions were generally solitary and clear, and appeared within 24 to 48 hours after the impression. They were most frequently located inside the vermilion border of the lips and resolved spontaneously in 2 to 5 days. The purpose of this study was to determine the cause of these reactions. Histopathologically one lesion was suggestive of a contact allergy. Cutaneous patch tests, which proved negative, were performed on 14 students to determine whether an allergy to the alginate flavoring existed. The surface of three lesions were cultured and the organisms identified. Contamination studies were carried out on seven unopened containers of the alginate powder and resulted in the isolation of some organisms similar to the mucosal cultures; however, no relationship can be proved. These findings indicate that the cause of the vesicles remains unknown, and further studies are necessary to establish the cause.

Diffuse Hyperkeratosis in a Deaf and Blind 48-Year-Old Woman—Quiz Case

An 83-year-old man with a history of diabetes and chronic obstructive pulmonary disorder (COPD) (taking prednisone, 5 mg/d) was admitted to our facility with a monthlong history of persistent right arm swelling, erythema, and pain. He had multiple prior admissions for this issue and was treated with oral and intravenous antibiotics for a suspected “cellulitis.” His skin symptoms worsened despite treatment, and he developed an extensive superimposed pustular eruption with sinus tracts involving the entire forearm and a portion of the upper arm (Figure 1). Workup included ultrasonography, which showed no fluid collection, and magnetic resonance imaging, which showed soft-tissue swelling without evidence of any underlying myositis or osteomyelitis. A Tzanck smear failed to show multinucleated giant cells. Punch biopsy specimens for culture and histopathologic analysis were obtained (Figure 2 and Figure 3). What is your diagnosis?

Perifollicular erythematous papules on the scalp

From the School of Medicine, Division of Pathology and Laboratory Medicine, and Division of Dermatology, University of Kansas Medical Center, Kansas City. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Ryan Fischer, MD, Division of Dermatology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160. E-mail: rfischer3@kumc.edu. J Am Acad Dermatol 2016;74:e23-4. 0190-9622/

Cutaneous Mycobacterium chelonae in a liver transplant patient

36.00 a 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.08.066From the School of Medicine, Division of Pathology and Laboratory Medicine, and Division of Dermatology, University of Kansas Medical Center, Kansas City. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Ryan Fischer, MD, Division of Dermatology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160. E-mail: rfischer3@kumc.edu. J Am Acad Dermatol 2016;74:e23-4. 0190-9622/

Cutaneous in a liver transplant patient

36.00 a 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.08.066