In-Transit Metastasis From Squamous Cell Carcinoma.

BACKGROUND: In-transit metastasis from cutaneous squamous cell carcinoma (SCC) is an uncommon form of metastasis through lymphatics and occurs more commonly in immunosuppressed patients. OBJECTIVE: To identify cases of in-transit SCC and determine patient characteristics, tumor features, management, and prognosis. METHODS AND MATERIALS: A multicenter case series treated by Australian and New Zealand clinicians. RESULTS: In 31 patients, median age was 72 years (range 52-99) and 68% were immunocompetent. Tumors occurred on the head and neck in 94% of cases, with 71% of all tumors occurring on the scalp, forehead, or temple. The median time to presentation with in-transit SCC from treatment of the initial tumor was 5 months. Management included surgery (94%), radiotherapy (77%), chemotherapy (10%), and reduction of immunosuppression (3%). Median follow-up was 12 months. Overall survival at 3 and 5 years were 27% and 13%, respectively. CONCLUSION: In-transit metastases are described in 31 patients, of whom the majority was immunocompetent. The scalp, forehead, and temple were the most common sites. New clinical and histological diagnostic criteria are proposed. Prognosis was poor with 5-year survival of 13%. Recommended management is a combination of surgery and adjuvant radiotherapy. Reduction of any iatrogenic immunosuppression should be considered.

Pyodermatitis-pyostomatitis vegetans of the eyelids case report and review of the literature.

OBJECTIVES: To present the first reported case of eyelid involvement in pyodermatitis-pyostomatitis vegetans (PDPSV) leading to the diagnosis of ulcerative colitis, and to review the literature. DESIGN: Interventional case report. METHODS: A 29-year-old man presented with a 4-week history of severe bilateral upper and lower eyelid margin ulceration and pustules unresponsive to topical and systemic broad-spectrum antibiotic treatment. Further questioning revealed the existence of skin and oral lesions. MAIN OUTCOME MEASURES: Clinical course, histological findings, and response to treatment. RESULTS: The histological and immunofluorescence studies were suggestive of PDPSV. Colonoscopy showed significant chronic active ulcerative colitis. Treatment with systemic steroids and sulfasalazine resulted in complete resolution of eyelid, oral, and skin lesions. However, stopping the steroids resulted in recurrence of eyelid and oral lesions and required recommencement of treatment. CONCLUSION: It is important to be familiar with this pustular skin condition, as correct diagnosis may lead to the diagnosis of inflammatory bowel disease. Although periocular involvement is probably rare, the combined typical skin and oral lesions and the characteristic histological and immunofluorescence tests should suggest the correct diagnosis.

Rapid onset bilateral palmar keratoderma in a psoriasis patient wearing orthopaedic hand splints.

A 37-year-old man with a history of chronic stable plaque psoriasis fractured both hands during a fall on his outstretched hands. Ten days later, following surgery and the application of tight fitting orthopaedic hand splints, the splints were removed because of a 7-day history of painful and pruritic palms. It was evident that the injury to his hands and the firm application of his splints had resulted in a dramatic flare of his psoriasis. This manifested in two clinical forms that he had not developed previously. He had a strikingly symmetrical palmar keratoderma that had köbnerized maximally in the regions where the splints apposed his palms firmly. In addition, he had pustular psoriasis affecting the fingertips of both hands. After removal of the splints he responded to a combination of oral acitretin, and 6% coal tar and 6% salicylic acid in aqueous cream applied topically.

Metastatic Bowen carcinoma.

A 72-year-old man presented with basaloid squamous cell carcinoma metastatic to both lungs that was morphologically similar to recurrent, invasive moderately to poorly differentiated carcinoma arising from persistent Bowen's disease of the right cheek. The original lesion of invasive moderately differentiated squamous cell carcinoma arising in Bowen's disease had been excised 11 years previously. Mohs' surgery was performed for the recurrent lesion on the cheek 12 months prior to detection of lung metastases. He died of respiratory failure 19 months following diagnosis of his metastatic disease. Our case reflects the potentially aggressive nature of invasive squamous cell carcinoma arising from Bowen's disease and highlights the importance of approaching this entity with a view to complete surgical excision with adequate margins.

Allopurinol induced generalized eosinophilic pustular folliculitis.

A 71-year-old Cambodian man who was commenced on allopurinol for the treatment of gout developed a generalized papulopustular follicular eruption 8 weeks following introduction of the drug. The skin biopsy findings were consistent with that of eosinophilic pustular folliculitis. Resolution of the rash took place during the 8 weeks following cessation of allopurinol and treatment with oral and topical corticosteroids.