Combined Melanocytic Nevus and Nevus Sebaceus: A Case Series and Review of the Literature.

ABSTRACT: Nevus sebaceus is a rare congenital hamartoma with clinical and histopathological features that change with puberty. It has been associated with a number of secondary neoplasms, most of which are thought to derive from follicular germ cells. In this article, the authors describe a total of 3 cases of combined melanocytic nevus and nevus sebaceus to highlight this rare finding.

An Asymptomatic Case of Invisible Mycosis Fungoides.

ABSTRACT: Mycosis fungoides has previously been reported in 'invisible' form, when biopsy of normal-appearing skin in the background of undifferentiated chronic pruritus demonstrated histopathologic findings of the malignancy. Asymptomatic cases have been reported more infrequently on biopsies of individual skin lesions. We present a case of invisible and asymptomatic mycosis fungoides, confirmed with immunohistochemical and T-cell receptor gene rearrangement studies, diagnosed on a re-excision specimen of an atypical melanocytic nevus. The case highlights the importance of alert examination of all tissue specimens for evidence of unrelated pathologic findings.

Acne Keloidalis Nuchae is Associated with Cutis Verticis Gyrata.

Purpose: Both acne keloidalis nuchae (AKN) and cutis verticis gyrata (CVG) are scalp conditions predominantly affecting men. Both are characterized by dermal thickening and fibroblast hyperactivity. AKN typically occurs in the nuchal area, often involving the naturally occurring folds in the occipital region. The aim of this study was to determine the relationship between excessive scalp folding (CVG) and AKN. Patients and methods: A total of 108 patients with AKN seen over 11 years from July 2009 and November 2020 were retrospectively evaluated. Patients with AKN concomitant with CVG were selected for analysis. Results: Seven of the 108 AKN patients had scalp-wide (widespread) AKN lesions, including 4 with CVG. In 3 of the 4 patients with concomitant AKN and CVG, the AKN was widespread, and its onset had preceded CVG by 1-2 years. In the fourth CVG patient, AKN lesions were confined to the nuchal area, and the CVG preceded AKN onset by several years. All patients were male, with a mean age of 35.8 years (overall) and 38.0 years (CVG group). Conclusion: We describe a previously unreported relationship between widespread AKN and CVG, with the development of AKN preceding CVG formation.

A Retrospective Cohort Study and Clinical Classification System of Acne Keloidalis Nuchae.

BACKGROUND: Although many treatments are available for acne keloidalis nuchae (AKN), no systematic classification scheme exists to evaluate the outcomes of these treatments. OBJECTIVE: This study aimed to propose an AKN classification scheme. METHODS: A retrospective data analysis of several parameters, including lesion distribution, lesion type, and scalp disease association, was conducted in 108 men diagnosed with AKN between July 2009 and November 2020 in an outpatient dermatology setting. A three-tier classification system was developed as follows: Tier 1, lesion distribution relative to an area demarcated by two horizontal lines on the occipital prominences and tips of the mastoid processes and lesion sagittal width defined using Classes I through IV; Tier 2, lesion types including papules/nodules (discrete/merged), plaques, and tumorous masses; and Tier 3, the presence or absence of folliculitis decalvans (FD) or dissecting cellulitis (DC). RESULTS: All patients were non-white men, with most being of African (58%) or Hispanic (37%) descent. The most prevalent Tier 1 AKN presentation was Class II (58%). The mean sagittal width for Classes I through III were 2.4cm (I), 4.5cm (II), and 8.0cm (III), with Class IV characterized by widespread scalp disease. Plaques were most common in Tier 2-type lesions. FD or DC was found in seven percent of the study participants. Patients of African descent had a greater tendency to develop tumorous masses (p<0.02). LIMITATIONS: The retrospective study design and possible selection bias. CONCLUSION: We proposed an AKN classification scheme as a tool for objectively describing AKN lesions and evaluating treatment outcomes.

Reversible acral and mucosal hyperpigmentation in a patient with B12 deficiency secondary to polyglandular autoimmune syndrome type II.

Reversible cutaneous hyperpigmentation often occurs in the setting of nutritional deficiencies and protein energy malnourishment, with atypical presentations arising from autoimmune disease. Here, we present a 52-year-old female with hypertension, type 1 diabetes, and Hashimoto's thyroiditis, under the diagnosis of polyglandular autoimmune syndrome type II, referred for evaluation of asymptomatic hyperpigmentation of the palms, soles, hard palate, and tongue for 6 months. The patient underwent a significant work-up, including esophagogastroduodenoscopy, which revealed hypertrophic gastropathy as well as evidence of acquired B12 deficiency secondary to pernicious anemia. The patient was initiated on B12 supplementation, with eventual resolution of mucocutaneous findings.