Basal cell carcinoma associated with non-neoplastic cutaneous conditions: a comprehensive review.

Basal cell carcinoma (BCC) can be a component of a collision tumor in which the skin cancer is present at the same cutaneous site as either a benign tumor or a malignant neoplasm. However, BCC can also concurrently occur at the same skin location as a non-neoplastic cutaneous condition. These include autoimmune diseases (vitiligo), cutaneous disorders (Darier disease), dermal conditions (granuloma faciale), dermal depositions (amyloid, calcinosis cutis, cutaneous focal mucinosis, osteoma cutis, and tattoo), dermatitis, miscellaneous conditions (rhinophyma, sarcoidal reaction, and varicose veins), scars, surgical sites, systemic diseases (sarcoidosis), systemic infections (leischmaniasis, leprosy and lupus vulgaris), and ulcers. The relationship between the BCC and the coexisting non-neoplastic condition may be coincidental or possibly related to the development of the BCC; alternatively, the development of the BCC may be unrelated to the coexisting non-neoplastic conditions and secondary to either a Koebner isomorphic response or a Wolf isotopic response in an immunocompromised district of skin. This paper reviews several of the case reports and studies that describe the association of BCC with these non-neoplastic cutaneous conditions.

The nail flag sign in heart transplant recipients: case reports and review of the patients with the flag sign of the nail.

The nail plate flag sign is a distinctive nail plate change that appears as white, red, white, and red sequential transverse bands beginning at the proximal nail fold. This distinctive nail change was initially described in patients with diabetes mellitus and leprosy; indeed, it was considered to be characteristic, but not diagnostic of leprosy. Subsequently, the flag sign was observed in patients with vitiligo. The flag sign has recently been noted in two men following heart transplantation. In summary, the flag sign is a unique nail change that has occurred in patients with autoimmune disorders, infection, and post transplantation surgery associated with immunosuppressive therapy to prevent organ rejection.

Macrolunula: Case Reports of Patients with Trauma-associated Enlarged Lunula and a Concise Review of this Nail Finding.

The lunula refers to the visible portion of the distal nail matrix that extends beyond the proximal nail fold. Macrolunula, or enlarged lunula, is not only a physiologic variant but also has been associated with a variety of local and systemic disorders. Macrolunula has been described in congenital conditions including hereditary onycho-osteodysplasia, neoplasms such as superficial acral fibromyxoma, as well as iatrogenic causes as in the topical administration of hydrocortisone; it can also occur in systemic disorders including hyperthyroidism, ischemia, leprosy, and scleroderma. While macrolunula has been described in self-induced trauma secondary to habit-tic deformity, we observe in this case report that any mechanism of trauma to the nail unit may produce enlargement of the lunula.

The Nail Flag Sign: Case Report in a Man with Diverticulitis and Review of Dermatology Flag Sign of the Hair, Skin, and Nails.

A sign is a physical feature or microscopic change which can be observed when the patient or their tissue specimen is evaluated. An astute clinician or pathologist may be able to diagnose a patient's condition by recognizing this unique morphologic feature or pathological change. In dermatology, the flag sign-alternating transverse bands of the skin or its adnexal structures that are analogous to the alternating colors of the stripes of a flag-has been associated with distinctive disorders of the hair, skin, or nails. The hair flag sign is characterized by alternating horizontal bands of hypopigmentation of the hair (in children with kwashiorkor type of protein-calorie malnutrition) or hyperpigmentation of the hair (in a male child who has intravenously received several cycles of high-dose methotrexate). In skin, the flag sign can be observed microscopically in actinic keratosis, and demonstrates by alternating parakeratosis and orthokeratosis of the stratum corneum-corresponding to the type of hyperkeratosis occurring above the interadnexal epidermis or the ostea of the acrosyringia and acrotrichia. The nail flag sign-noted in some individuals who have diabetes mellitus, diverticulitis, leprosy, or vitiligo-presents with alternating white and pink-red horizontal bands beginning at the proximal nail fold and extending distally to the free edge of the nail plate. A man with chronic diverticulitis and the nail flag sign is reported; he also has a history of congenital leukonychia, actinic keratoses, basal cell carcinoma and psoriasis. In addition, the features of hair, skin, and nail flag signs are reviewed. The detection of the dermatology flag sign can prompt a pathologist to consider the diagnosis of actinic keratosis. Alternating horizontal bands of hair color can indicate protein-calorie malnutrition or an effect of chemotherapy in a child. Certain autoimmune, inflammatory, or infectious conditions in individuals present with white and pink-red horizontal bands on their nails.

Dapsone-associated fixed drug eruption.

INTRODUCTION: Dapsone is a sulfone drug used to treat infectious conditions and also numerous dermatologic diseases. Fixed drug eruption is a distinctive adverse cutaneous reaction associated with the initial administration and subsequent delivery of a specific agent. Areas covered: The authors preformed a literature search using the following keywords: dapsone, fixed drug eruption, and adverse cutaneous drug reaction. Bibliographies were also reviewed for pertinent articles. The results were combed for relevant papers and reviewed. Articles pertaining to dapsone-associated fixed drug eruption were included. Expert commentary: The majority of cases of dapsone-associated fixed drug eruption in the literature come from Africa or India where there is a high prevalence of patients treated for leprosy. Characteristics of these cases are similar to fixed drug eruption described in the western literature, with differences in frequency of multiple versus solitary lesions. Dapsone-associated fixed drug eruption should be considered when reviewing the drug history of a patient with fixed drug eruption. In the case of darker pigmented individuals, multiple fixed drug eruption lesions may be more common. Multiple lesions may mimic Kaposi's sarcoma in human immunodeficiency virus positive patients. Dapsone-associated fixed drug eruption should be considered in the differential diagnosis of multiple hyperpigmented lesions.