Unilateral telangiectasia macularis eruptiva perstans of the breast.

We report a case of a 22-year-old female with an asymptomatic telangiectatic rash involving her left breast of 10 years' duration. Biopsies revealed cularis findings consistent with telangiectasia m a eruptiva perstans (TMEP). Telangiectasia macularis eruptiva perstans most often presents in a symmetric fashion; our patient represents an unusual case of unilateral TMEP involving the breast. Therefore, TMEP should be considered when a patient presents with telangiectasia, even if the presentation is unilateral.

Advances in immunostains used in Mohs surgery.

In recent years, Mohs micrographic surgery (MMS) has become a widely utilized method of removal for a variety of cutaneous neoplasms. Certain clinical scenarios, however, make it difficult to visualize residual tumor cells, potentially decreasing the efficacy of the Mohs procedure. Immunohistochemical (IHC) stains are now available and are being utilized to delineate cells of interest intraoperatively when routinely stained slides are equivocal. While useful, IHC stains have not gained wide acceptance as an adjunct to MMS, particularly due to increased processing time, cost and workload required. There have been multiple recent advances, however, in the utilization of IHC stains in MMS. In this article, the authors discuss recent advances in IHC stains used in MMS for the treatment of melanoma as well as nonmelanoma skin cancers, potentially making their routine use in select cases more feasible.

Immunohistochemical stains in Mohs surgery: a review.

BACKGROUND: During Mohs surgery, there are instances in which residual tumor cells may be difficult to detect, thereby increasing the risk of incomplete excision and tumor recurrence. It is possible to employ immunohistochemical techniques as an adjunct to routine hematoxylin and eosin staining to aid in ensuring negative margins. OBJECTIVE: To review the literature regarding the use of immunostains in Mohs surgery. RESULTS: Various immunostains have proved useful in detecting tumor cells in various malignancies, including melanoma, basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, extramammary Paget's disease, primary cutaneous mucinous carcinoma, granular cell tumor, and trichilemmal carcinoma. CONCLUSIONS: In this article, we review immunohistochemical stains that have been employed in Mohs micrographic surgery and evaluate their utility in enhancing detection of residual tumors with respect to tumor type, particularly in situations in which detection of residual tumor may be difficult.

The role of intradermal skin testing and patch testing in the diagnosis of autoimmune progesterone dermatitis.

Autoimmune progesterone dermatitis is a rare clinical condition in which patients display hypersensitivity to endogenous progesterone. It manifests as a cyclical cutaneous eruption that flares during the luteal phase of the menstrual cycle, when progesterone levels peak, and resolves partially or completely a few days after menses. Its cutaneous manifestations are variable and include urticaria, eczematous eruptions, vesiculopustular eruptions, fixed drug eruptions, stomatitis, erythema multiforme, and anaphylaxis. Autoimmune progesterone dermatitis has been diagnosed previously with intradermal skin testing or intramuscular progesterone challenge. Treatment of progesterone hypersensitivity generally consists of ovulation inhibition with pharmaceutical agents or oophorectomy; other therapies (eg, thalidomide) have also been used with success. We report a case of cyclical erythema multiforme (EM) induced by hypersensitivity to endogenous progesterone in a patient with a history of past oral contraceptive use. After herpes simplex virus was ruled out as an etiologic factor, a diagnosis of progesterone hypersensitivity was confirmed with intradermal skin testing. Results of subsequent patch testing with various progesterone derivatives were negative. The EM outbreaks were suppressed temporarily by continuous administration of Loestrin (ethinyl estradiol plus norethindrone), which also increased the responsiveness of the outbreaks to prednisone tapers.