Topical nitrogen mustard for the treatment of granulomatous slack skin.

Granulomatous slack skin (GSS) is a rare variant of mycosis fungoides in which inflammation leads to elastolysis manifested by pendulous skin folds with a predilection for flexural areas. Histologic findings include many multinucleated giant cells with large numbers of nuclei and loss of dermal elastic tissue. Definitive therapy has yet to be established, but recently interferon-alpha and radiation, interferon-gamma, and pentostatin have shown some success in the treatment of GSS. We present two cases of GSS treated with topical nitrogen mustard (chlormethine; mechlorethamine; mustine), one of whom has long-term remission and the other partial remission. Topical nitrogen mustard appears to be an effective skin-directed therapy for this rare condition.

Epidermodysplasia verruciformis occurring in a patient with human immunodeficiency virus: a case report.

Epidermodysplasia verruciformis (EV) is an uncommon dermatosis associated with human papillomavirus (HPV) infection in association with defects in cell-mediated immunity. Malignant transformation to squamous cell carcinoma has been associated with lesions caused by HPV-5, HPV-8, and HPV-14. Clinically, the disease may be confused with verruca plana, seborrheic keratosis, and pityriasis versicolor. We present an unusual case of EV occurring in a human immunodeficiency virus (HIV)-positive man and discuss the clinical and histologic findings. Clinically, the patient had 1- to 3-mm hypopigmented smooth macules covering the entire body. Histopathologic examination of the skin biopsy results demonstrated enlarged keratinocytes with prominent blue-gray cytoplasm and clumping of keratohyalin granules within the granular layer of the epidermis. Although EV typically is viewed as a disease of childhood, sometimes presenting in patients with a family history of the disease, it rarely may be seen in immunocompromised adults.

Immunohistochemical staining of CD10 in atypical fibroxanthomas.

BACKGROUND: The histologic diagnosis of atypical fibroxanthoma (AFX) may be difficult at times with a differential diagnosis including spindle cell/desmoplastic melanoma and a poorly differentiated squamous cell carcinoma (SCC). While there are immunohistochemical stains that may be used to support a diagnosis of either melanoma or carcinoma, the diagnosis of AFX tends to be one of exclusion. METHODS: A total of 35 cases including 16 AFXs, 10 poorly differentiated SCCs and nine spindle cell/desmoplastic melanomas were stained with the antibody against CD10. RESULTS: There was strong (3+) diffuse expression of CD10 in 15/16 (94%) AFXs, weak (1+) to moderate (2+) patchy expression of CD10 in 5/10 (50%) SCCs and weak (1+) expression of CD10 in 3/9 (33%) spindle cell/desmoplastic melanomas. CONCLUSION: CD10 expression is helpful in distinguishing between AFXs, carcinomas and melanomas and will be useful in a panel of antibodies when distinguishing between these entities.