[But...was there ever a Clark classification of melanomas?]. / Pero...hubo alguna vez una clasificación de Clark de los melanomas?

For the past 40 years, the Clark classification of cutaneous melanoma has been accepted and used by the vast majority of dermatologists and pathologists throughout the world. However,after careful rereading of the most relevant articles by Clark and his collaborators, we can affirm that the classification was only ever of passing validity. Today, the possible morphological differences between one case of cutaneous melanoma and another are of no proven prognostic implication. In addition, the morphological differences that can be found are much more closely related to the different localization that to the tumor itself.

Primary cutaneous large B-cell lymphoma: the relation between morphology, clinical presentation, immunohistochemical markers, and survival.

The histogenesis, morphology, immunophenotype, and clinical behavior of cutaneous large B-cell lymphomas (CLBCL) are largely a matter of controversy. We performed an investigation to determine whether CLBCL have features that differentiate them from other large B-cell lymphomas and whether CLBCL is itself a heterogeneous group. To this end, we reviewed the main characteristics of a series of 32 cases of LBCL found in the skin. We reviewed the clinical findings and paraffin sections of the tumors from these 32 patients. The immunohistochemical study performed included p53, MIB1, Bcl2, Bcl6, and CD10 markers. We carried out statistical analysis of these data (univariate and multivariate), seeking an association between the features of the tumors and clinical outcome, as defined by failure-free survival time. Only one patient died as a consequence of the lymphoma. Nevertheless, the accumulated probability of survival without failure at 48 months was 0.46. The number, type, and localization of the lesions were not associated with variations in either survival or failure-free survival. The expression of p53 was negative in this group of CLBCL, whereas Bcl-2 expression or localization in the lower leg did not relate to any other significant feature. Histologic examination of the cases disclosed three different groups: Grade III follicular lymphomas (FLs), monomorphous large B-cell lymphomas (LBCL type I), and LBCL with an admixed component of small B-lymphocytes (LBCL type II). Grade III FL (11 cases) tended to be found in the head and neck and showed CD10 expression in a majority of cases. A higher probability of lymph node relapses was associated with cases located in the head and neck and with CD10+ tumors. Cutaneous large B-cell lymphomas are indolent tumors, but follow an insidious course. Our data support the interpretation that CLBCL is a heterogeneous condition; comprises some LBCL derived from CD10+ germinal center cells which manifests more frequently as tumors in the head and neck region, with an increased probability of relapse in lymph nodes [1] and has some distinctive morphologic features. The existence of a component of small B-cells within the other CLBCL could lend support to the theory that some of these tumors, more than arise de novo, may have originated in preexistent small B-cell lymphomas, but no firm evidence of this is provided in this study.

Erythema elevatum diutinum in a patient with acquired immunodeficiency syndrome. Another clinical simulator of Kaposi's sarcoma.

Several types of vasculitis have been described in patients with human immunodeficiency virus infection. Erythema elevatum diutinum is a rare variant of cutaneous leukocytoclastic vasculitis which, with the exception of the case reported herein, has been described only once in human immunodeficiency virus-infected patients. Our male patient, a longtime intravenous drug abuser, had cutaneous lesions, closely resembling Kaposi's sarcoma, on the extensor surfaces of the lower extremities. Cutaneous biopsy specimens, however, demonstrated leukocytoclastic vasculitis with fibrinoid necrosis of the vessel walls and areas of basophilic degeneration of collagen bundles in early lesions, whereas late lesions showed dense diffuse fibrosis with proliferation of dermal spindle cells and some foci of residual leukocytoclastic vasculitis. Oral therapy with dapsone resulted in marked clearing of the cutaneous lesions within few days. This case raises the necessity of histologic confirmation for all cases of suspected Kaposi's sarcoma in patients with acquired immunodeficiency syndrome. We discuss the possible pathogenesis of leukocytoclastic vasculitis in human immunodeficiency virus-infected patients.

The histopathology of closed and open comedones of Favre-Racouchot disease.

OBJECTIVE: To determine the distinction between a comedo and an infundibular cyst of Favre-Racouchot disease. SETTING: A university hospital. PATIENTS: From the 8 patients included in the study, 19 cysts and comedones were evaluated. MAIN OUTCOME MEASURE: The distinguishing features between the cysts and comedones of Favre-Racouchot disease. RESULTS: All lesions were histologically indistinguishable from the primary comedones of acne vulgaris, except for the presence of a marked actinic elastosis in the surrounding dermis. The presence of a variable number of hair shafts and an abundant amount of bacteria, which was positive in the results of Gram staining and periodic acid-Schiff reaction and intermingled with sebum and eosinophilic laminated horny material within the dilated infundibulum, characterizes a comedo and differentiates it from an infundibular cyst. CONCLUSIONS: The cysts and comedones of Favre-Racouchot disease are closed and open comedones. They can be easily differentiated from an infundibular cyst by the histopathologic features rather than by the connection to the surface.

Congenital segmental dermal melanocytosis in an adult.

BACKGROUND: Dermal melanocytosis is characterized by the presence of melanocytes in the dermis. There are several morphologic forms, such as the blue nevus, the mongolian spot, the nevus of Ota, and the nevus of Ito. In this article, we report an unusual case of dermal melanocytosis. OBSERVATIONS: A 28-year-old white woman was referred to us, as she had an extensive, speckled gray-blue pigmentation on the right aspect of her trunk that was in a segmental pattern. The lesion had been present at birth. Histologic and ultrastructural examinations revealed sparse, elongated dermal melanocytes. CONCLUSIONS: We comment on the differential diagnosis with classic recognized forms of dermal melanocytosis. We also review other isolated cases of unusual dermal melanocytosis. This is a distinct case, clinically different from previously reported cases in the literature; we propose the term "congenital segmental dermal melanocytosis" to name this case.

Lupus erythematosus with an erythema multiforme-like eruption.

We describe a patient diagnosed with lupus erythematosus (LE) who developed an acute generalized eruption characterized by erythema multiforme (EM)-like lesions. Biopsy specimen showed foci of vacuolar alteration at the dermo-epidermal junction and frequent necrotic keratinocytes. Laboratory tests disclosed a speckled-homogenous antinuclear antibody titer of 1:640, leucopenia and hypocomplementemia. Anti-Ro/anti-La antibodies and rheumatoid factor were negative. Treatment with high-dose oral prednisone and azathioprine led to complete remission of the cutaneous lesions, although eruption recurred two years later. We believe that this patient presented a subacute cutaneous lupus eythematous with a distinctive erythema multiforme-like eruption. This case could be included in the so-called Rowell's syndrome, although it does not fit all the immunological characteristics reported in the original description, as in many of the previously reported cases. At the present time there seems to be enough evidence to classify Rowell's syndrome within the subacute cutaneous lupus erythematosus subset. Finally, a coexistence of LE and EM can not be completely discarded in our patient, although no causative factor was found.

Trichostasis spinulosa within an intradermal melanocytic nevus.

A thirty-six-year-old man presented with a melanocytic nevus on his left shoulder. The lesion was excised and histopathologic examination showed an intradermal nevus with several infundibular cysts among the nevus cells. These cysts showed a cyst wall with epidermoid keratinization and a lumen filled by many cross-sectioned hair shafts. These findings were consistent with a diagnosis of trichostasis spinulosa within an intradermal melanocytic nevus. We note the relationship between these two disorders in the same lesion.

Elastotic nodules of the ears.

A case of bilateral elastotic nodules of the ears is reported. This distinctive entity occurs on the ears in response to chronic actinic damage and is seen infrequently. Elastotic nodules of the ears may therefore be misdiagnosed clinically as basal cell carcinoma or some infiltrative process such as gout or amyloid. Although the lesions are usually found on the anthelix, they may also arise on the helix, and can then simulate chondrodermatitis nodularis helicis.

Vesicular pemphigoid.

A patient with a pruritic vesicular eruption closely resembling dermatitis herpetiformis is described. Histopathologic examination of a biopsy specimen showed a subepidermal blister containing abundant eosinophils and neutrophils, whereas results of direct immunofluorescence studies demonstrated linear and homogeneous deposition of IgG and C3 along the basement membrane zone. Prednisone therapy was necessary to control the clinical symptoms. Similar cases have been described as "vesicular pemphigoid."

Nevus elasticus and lichen sclerosus et atrophicus on the vulva.

A sixty-seven-year-old woman had complained of vulvar pruritus and vaginal soreness for eight months. Clinical and histologic examination showed an admixture of two different entities: nevus elasticus and lichen sclerosus et atrophicus.

Reiter's syndrome and human immunodeficiency virus infection: case report and review of the literature.

The concurrence of Reiter's syndrome and human immunodeficiency virus infection has recently been noted. In this report the evolution of Reiter's syndrome (arthritis, urethritis, and conjunctivitis) in a patient with a history of intravenous drug abuse and positive results of serologic tests for human immunodeficiency virus is described and the literature is reviewed.

Multiple epidermoid cysts in a renal transplant recipient taking cyclosporine A.

A forty-two-year-old male recipient of a cadaver renal transplant showed multiple nodulocystic lesions on his back and lateral aspects of his neck four months after beginning immunosuppressive therapy with cyclosporine A and prednisone. Results of histopathologic studies revealed that they were epidermoid infundibular cysts. We note the relationship between this clinical appearance and cyclosporine A, as well as this agent's cutaneous side effects.

Norwegian scabies in a patient with AIDS: report of a case.

A severe form of crusted scabies is described in a patient with acquired immunodeficiency syndrome. He was treated with 1 percent lindane lotion and 5 percent sulfur ointment with 2 percent salicylic acid, which resulted in the clearing of the skin lesions.

[Topical, intratumor and intravenous nitrogen mustard in the treatment of mycosis fungoides (author's transl)]. / Tratamiento de la micosis fungoide con mostaza nitrogenada tópica, intratumoral e intravenosa.

Topical nitrogen mustard (NH2) is recommended in mycosis fungoides stages 1 or 2 (eczematous premycotic phase and plaque stage), intratumor infiltration in stage 3 (tumor stage) and intravenous administration in stages 4 and 5 (widespread disease). Following these criteria ten patients with mycosis fungoides have been treated with NH2. Six cases were included in stages 1 or 2 and complete remission was achieved in four of them. Therapy had to discontinued in one case due to allergic hypersensitivity. The remaining patient experienced clinical improvement after 27 months of continued treatment. There were three patients in stages 4 and 5 and all their plaques disappeared after topical NH2, but tumor regression was completely achieved in one case adn partially in the remaining two. A case with Sezary's syndrome was treated in addition with chlorambucil. Association of newer palliative measures (topical NH2, high energy electron beam therapy, nitrosourea derivatives) offer a hope of cure for patients in stages 1 or 2. Tumor stage requires systemic chemotherapeutic agents (chlorambucil tablets and intravenous nitrogen mustard).

[Prognosis and current treatment of dermatomyositis]. / Pronóstico y tratamiento actual de la dermatomiositis.

The present revision has been carried out in order to final out to what extent corticosteroids have improved the vital and functional prognosis of dermatomyositis. Over the sixties and in the early seventies, statistical tables have not shown any substantial differences compared with those of the pre-steroid era. It has been observed since 1973 that early treatment with high doses (1-2 mg of prednisone per kg per day) clearly improves the vital prognosis of infantile dermatomyositis, but not the functional one. In adults, there is less experience and the problem always exists of a possible underlying neoplasm. In cases with resistance to corticosteroids, the association of immunosuppressors, particulary methotrexate, has begun to be tested. There is no proved effective treatment of calcinosis which results in functional recovery.

[Clear cell acanthoma with dendritica cells charged with melanine and fat]. / Acantoma de células claras con células dendríticas cargadas de melanina y grasa

A Clear Cell Acanthoma is presented, located in the abdominal region, in a 60-year old man, who had had it all his life. The lesion was warty in appearance and brown in colour. Histologically, among the clear cells, numerous dendrytical cells were found which simultaneously contained melanine grains and small drops of neutral fat. These findings are discussed.

[Superficial elastic nevus of the face. Its possible identification with "Elastome en nappe" of Dégos]. / Nevus elástico superficial de la cara. Su posible identidad con el "elastome en nappe" de Dégos

An Elastic Nevus is presented in the form of a solitary plate located in the cheek of a 24-year-olf woman, which had developed over the period of one year. Its histology very much resembles that of a solar elastosis. Its identity is discussed with a very similar case described by Larrotcha and Contreras and with those published by Dégos et al. as "Elastome en nappe du nez".

[Skin alternariosis in a patient with nephrotic syndrome]. / Alternariosis cutánea en un paciente con síndrome nefrótico.

A case of cutaneous alternariasis with appeared during the treatment with corticosteroids in a patient having a nephrotic syndrome, is presented. The diagnosis was verified by histological and mycological examination, isolating Alternaria alternata. The etiopathogenic mechanisms and the clinical and histological aspects of the lesions are discussed. Good results of treatment with ketoconazole and topic ciclopirox are reported.

[Candida folliculitis in heroin addicts. Histological study]. / Foliculitis candidiásica en heroinómanos. Estudio histológico.

Results of histopathologic study of five parenteral heroin users with candida folliculitis are exposed. Candida was found in four, pseudohyphae were observed within the hair, on the keratin of the infundibulum, within the abscess surrounding the hair follicle and horny layer. Blastospores were observed into one arteriole of the dermis.