Metastasis of Conjunctival Melanoma to the Cardiac Atrium: A Case Report.

The authors present an unreported case of malignant conjunctival melanoma with metastasis to the right cardiac atrium. A 67-year-old woman with history of conjunctival melanoma of the OS presented with asymptomatic recurrence with new extension to the fornix. Surgical management was planned; however, the patient was admitted to the hospital with symptoms of heart and respiratory failure. She was found to have a large mass in the right atrium. The mass was resected and was found to be metastatic conjunctival melanoma. The patient received chemotherapy and her symptoms have improved. This case highlights the high recurrence rate of conjunctival melanoma and the importance of tumor surveillance.

Genital verruciform xanthoma: lessons from a contemporary multi-institutional series.

AIMS: Verruciform xanthoma (VX) is an uncommon lesion, seen in the oral mucosa and rarely occurring at cutaneous genital sites. Reports of exceptional VX presentations dominate the literature; herein, we assess the clinical and histological features of a cohort of routine, consecutive cases. METHODS AND RESULTS: Clinicopathological features of genital VXs from four academic centres were reviewed. A cohort of 25 lesions from 24 patients (22 male, two female; median age = 62 years), occurred on the scrotum (84%), penis (8%) and perineum/vulva (8%). VX was never suspected clinically; considerations ranged from fibroepithelial polyps to squamous cell carcinoma. Classic diagnostic criteria were present at least focally in each lesion, including verrucous architecture, prominent wedge-shaped parakeratosis extending between exophytic epidermal projections and neutrophils in the stratum corneum. Xanthomatous cells were present in all cases, but scattered to rare in 24%. CONCLUSIONS: Consecutive genital VXs reliably exhibited classic histopathological features, although the essential finding of xanthomatous cells may be scarce. Our comparison to meta-analyses of published cases found relatively fewer penile and vulvar examples. Additionally, the median age was older than in published series, which have emphasised syndromic associations.

Necrolytic acral erythema in an adolescent.

In 1996 el Darouti and Abu el Ela described seven Egyptian patients with similar cutaneous lesions and proposed necrolytic acral erythema (NAE) as a distinct entity of the necrolytic erythema family. Since then, NAE has emerged as a cutaneous manifestation of hepatitis C virus infection and taken its place in the literature as a marker for systemic disease. NAE initially presents with burning, pruritic eruptions of circumscribed, erythematous papules with flaccid vesiculation on the acral surfaces universally affecting the dorsum of the feet. The presenting papules of acute NAE evolve over time into confluent, velvety, hyperkeratotic plaques with decreased central erythema but a characteristic dark erythematous rim and adherent scale. Although mostly misdiagnosed as psoriasis or inflammatory dermatitis, NAE can be definitively placed among the necrolytic erythema family as a distinct entity based on clinical and histopathologic characteristics. We report a case of necrolytic acral erythema in a 17-year-old followed by a review of the literature.

Intravascular Papillary Endothelial Hyperplasia of the Orbit: A Case of Masson's Tumor.

Herein, we present a case of a 64-year-old male presenting with diplopia that was found to have a left orbital Masson's tumor. It is necessary to differentiate it from malignant angiosarcoma as complete excision is often curative. The following case emphasizes the modalities that can be used for diagnosis as well as the appropriate treatments.

Primary cutaneous B-cell lymphoma, leg type restricted to the subcutaneous fat arising in a patient with dermatomyositis.

Until now, cutaneous lymphoma limited to the subcutaneous fat has been described as being derived only from T cells. Subcutaneous panniculitis-like T-cell lymphoma has been reported as a rare, postthymic neoplasm with various associations, including dermatomyositis. Furthermore, primary cutaneous B-cell lymphoma of the leg is defined by a diffuse dermal infiltrate of neoplastic B cells with extension to both the papillary dermis and the subcutaneous fat. We report a case of a patient with dermatomyositis who developed a cutaneous lymphoma of B-cell origin restricted to the subcutis, the first of its kind reported in the literature. This malignancy spared the dermis and epidermis, and we suggest that this is a unique variant of primary cutaneous B-cell lymphoma of the leg.

Dermatomyositis presenting with focal scleroderma-like skin changes.

OBJECTIVE: To describe an unusual focal scleroderma-like skin changes in patient with dermatomyositis. METHODS: Review of clinical records, laboratory investigations, and muscle and skin biopsies. RESULTS: The patient developed unusual skin lesions characterized by symmetrical atrophy and hardening of focal skin and muscle over the lateral upper arms and posterior shoulders, and the left temporal and pectoral areas. Extensive blood work-up for scleroderma and other connective-tissue diseases was negative. A skin biopsy showed distinct pathologic features including increased interstitial mucin, hyperpigmentation, and perivascular lymphocytic inflammation without severe fibrosis. The scleroderma-like skin changes and muscle weakness improved with immunotherapy. CONCLUSIONS: Dermatomyositis can manifest with focal scleroderma-like skin changes clinically and reticular erythematous mucinosis-like changes pathologically, and these distinct skin changes represent a new variant of skin lesions of dermatomyositis.

Paget's disease of the breast areola mimicking cutaneous melanoma.

Paget's disease of the breast nipple and areola complex represents a cutaneous manifestation of an underlying breast malignancy. The typical skin changes characteristic of breast Paget's disease are usually easily distinguished from those found of malignant melanoma. The rare finding of a pigmented cutaneous breast lesion mimicking melanoma presents a diagnostic dilemma. This case presentation describes a pigmented mammary lesion involving the areola that had undergone changes in diameter and pigmentation. The lesion was not associated with nipple drainage, nipple excoriation, dermal ulceration, or a palpable breast mass. The areola lesion was highly suggestive of a dermatologic malignancy such as malignant melanoma. As such, a biopsy was performed with initial findings suggestive of cutaneous melanoma. Upon more detailed analysis of a larger excision specimen, immunohistochemical staining was highly supportive of the diagnosis of breast Paget's disease. A total mastectomy with sentinel lymph node evaluation was performed along with immediate reconstruction. The final pathology revealed a small focus of ductal carcinoma in situ of the breast associated with the areola changes. Histologic and immunohistochemical analysis of a biopsy specimen were paramount in differentiating these two lesions.