Reliable methods to evaluate the burden of actinic keratoses.

Dermatologists treat actinic keratoses to prevent non-melanoma skin cancer. Evaluation of actinic keratosis therapy depends on reliable measures of the lesions. The commonly used method of directly counting all visible lesions has been shown to be unreliable. We performed a prospective, single-blinded study to explore the reliability of body surface area involvement and direct counting of lesions measuring greater than 0.5 cm. Consecutively available subjects with >2% body surface area involvement of both upper extremities were recruited from the Albuquerque, NM Veterans Administration Dermatology Clinic upon their arrival. Blinded investigators evaluated 37 subjects during two visits, baseline and 2 weeks later, using both methods. Data were analyzed using the 26 pairs where evaluating physician was the same at both time points. Both methods correlated well when comparing the two time points. Our results did not change when we added the pairs where the evaluating physician differed in the two time points. Our study demonstrates that both methods are viable ways to evaluate actinic keratoses, even when the investigators differ at different time points, a practical matter in clinical trials. Our study provides a promising option to evaluate emerging new actinic keratoses therapies. However, given that the method was only tested on upper extremities of a veteran population, further testing must be performed in different anatomical locations and in non-veteran populations.

Fatal sporotrichosis.

Disseminated sporotrichosis is a serious fungal infection caused by the soil inhabitant Sporothrix schenckii. It is seen in immunocompromised patients, with a substantial number of recent cases involving patients with acquired immunodeficiency syndrome (AIDS). However, individuals with other conditions that affect the immune system also are at increased risk. We report a case of fatal disseminated sporotrichosis in a patient with liver disease and a diagnosis of a granulomatous condition presumed to be sarcoidosis; the patient was receiving systemic corticosteroid therapy. The various presentations of S schenckii infection, the risk of disseminated disease in immunocompromised hosts, and the importance of making accurate histologic diagnoses are reviewed.

Case reports: successful treatment of Mycobacterium marinum infection with minocycline after complication of disease by delayed diagnosis and systemic steroids.

Mycobacterium marinum, an aerobic, non-tuberculous, environmental mycobacterium, is the etiologic agent responsible for "fish tank granuloma." Found in aquatic environments, particularly where water is relatively still or stagnant, M. marinum produces infection in fish, as well as humans. Infection follows exposure to contaminated water and direct inoculation of the organism via breaks in the skin. The resulting primary lesion is usually a red-to-violaceous plaque or nodule, which can have an overlying crust or verrucous surface that may ulcerate and, in some cases, may be accompanied by satellite lesions and lymphangitic spread. We present an aggressive case of M. marinum infection with prominent lymph node involvement in an otherwise healthy 34-year-old woman whose course was complicated by delayed diagnosis and treatment with systemic steroids.

Traumatic keratoacanthoma arising in a 15-year-old boy following a motor vehicle accident.

Keratoacanthomas appear most commonly in sun-damaged skin in middle-aged and elderly people. We present a 15-year-old boy who developed a rapidly growing nodule within a hypertrophic scar that was the result of trauma suffered in a roll-over motor vehicle accident 8 months prior to presentation. Histologic analysis of a biopsy specimen of the nodule confirmed the presence of squamous cell carcinoma, keratoacanthoma type. The development of keratoacanthoma has been associated with sun exposure, chemical carcinogens, radiation therapy, genetic factors, and various forms of antecedent trauma, including surgery or grafting, thermal burns, laser resurfacing, and vaccination. This report describes the youngest patient with traumatically-induced keratoacanthoma, and is the first instance of this entity arising in a friction burn.

Giant dermatofibroma with monster cells.

We report a case of a 64-year-old woman with a giant dermatofibroma on her back with the unusual histologic feature of monster cells. The firm, exophytic, 3-cm nodule had purple and yellow components with surface telangiectasia. Histologic examination demonstrated characteristic findings of a dermatofibroma, including rete ridge flattening and bridging; a stroma containing scattered, large, round, eosinophilic collagen bundles; and a polymorphous dermal infiltrate of spindle and xanthomatous cells with scattered siderophages. Some xanthomatous cells demonstrated features consistent with monster cells, including huge bizarre nuclei and one or more nucleoli. Immunohistochemical staining for factor XIIIa was positive. A diagnosis of giant dermatofibroma with monster cells (DFMC) was made. Giant dermatofibromas are rare, with monster cells being an uncommon finding in dermatofibroma. To our knowledge, this is the first report of DFMC.

A case of primary mucinous carcinoma of the scalp treated with mohs surgery.

BACKGROUND: Primary mucinous carcinoma of the skin is a rare sweat gland malignancy that is associated with locally aggressive behavior and a high rate of local recurrence following simple excision. OBJECTIVE: A patient with primary mucinous carcinoma of the scalp, which was treated with Mohs micrographic surgery (MMS), is described. METHODS: Case report and literature review. RESULTS: The patient underwent MMS to remove the tumor. Thirty months after the procedure, the patient remains tumor free. CONCLUSION: Simple excision of primary mucinous carcinoma of the skin is associated with a high recurrence rate. Given the low rate of metastasis and characteristic histologic tumor continuity associated with primary mucinous carcinoma of the skin, as well as the tendency for the tumor to involve cosmetically sensitive areas, such as the face and eyelids, MMS appears to represent a preferable treatment alternative for this particular sweat gland tumor. MMS appears to be associated with a very low risk of tumor recurrence.