The inadequacy of punch-excised melanocytic lesions: sampling through the block for the determination of "margins".

BACKGROUND: Dermatopathologists often are asked by clinicians to report margins on punch excisions of melanocytic lesions. OBJECTIVE: We sought to determine the adequacy of surgical margins on melanocytic lesions submitted with intention of complete excision using punch removal technique. METHODS: We conducted prospective analysis of surgical margins on 266 consecutive patients who underwent attempted complete removal of 405 melanocytic nevi submitted as punch and fusiform excisions. RESULTS: Of 206 nonbisected punch excisions, 127 (62%) had final positive margins. Of 159 bisected punch excisions, 76 (48%) had final positive margins. Of 40 elliptical excisions, two (5%) had final positive margins. LIMITATIONS: Information on the perilesional rim of nonpigmented skin included in the excision was not available. CONCLUSIONS: Of punch excisions, 56% had positive margins. Importantly, 30% of these punch excised specimens were negative on initial levels but had positive margins after extensive sectioning, affirming that fusiform excisions are the preferred method to evaluate margins in melanocytic lesions.

Localized hypertrichosis in a pediatric patient--what is the mechanism for excess hair growth?

Localized hypertrichosis is an uncommon complaint among pediatric dermatology patients. We highlight an instance of localized hypertrichosis due to an underlying diffuse neurofibroma in a patient with known neurofibromatosis 1. The classification and possible underlying pathogenic mechanisms of localized hypertrichosis in pediatric patients is discussed.

Lipidized dermatofibromas and their relationship to serum lipids.

BACKGROUND: Lipidized dermatofibromas represent a rare variant of dermatofibroma that has been regarded as an incidental finding with no particular clinical significance. OBJECTIVE: The goal of this study was to investigate the relationship between lipidized dermatofibromas and patient age, anatomic location, and serum total cholesterol. METHODS: A retrospective case control format was used with an experimental group containing patients with biopsy-proven lipidized dermatofibromas and a control group containing patients with nonlipidized dermatofibromas. RESULTS: Ages in the experimental group ranged from 35 to 75 years with a mean value of 53 years whereas ages in the control group ranged from 27 to 72 years with a mean value of 48 years. A comparison between the mean of the ages between the two groups using the t test method showed no statistically significant difference (P = .09). Lesion location on the body was grouped into 4 sites: leg, thigh, trunk, and upper extremity. Of the 23 patients in the experimental group, 10 had lesions on the legs, 5 had lesions on the thighs, 2 had lesions on the trunk, and 5 had lesions on the upper extremities. Of the 41 patients in the control group, 15 had lesions on the legs, 7 had lesions on the thighs, 9 had lesions on the trunk, and 10 had lesions on the upper extremities. A comparison between the two groups showed no statistically significant difference (P = .60). In all, 16 of the 23 patients in the experimental group and 24 of the 41 patients in the control group were considered to have high cholesterol. A comparison showed no statistically significant difference between the cholesterol levels of the two groups (P = .38). LIMITATIONS: Limitations that we encountered during the study included the relative infrequency of lipidized dermatofibromas, limiting the number of patients in the study. In addition, medication histories and lipid levels on patients were not always available. In addition, we formed a control group from people who had their cholesterol checked often, which may cause them to have a higher average cholesterol than that of the general population. CONCLUSIONS: Our data show that lipidized dermatofibromas do not differ clinically from nonlipidized dermatofibromas in age distribution of patients, tumor location, or underlying serum lipid levels.

Benign lymphangiomatous papules of the skin.

Benign lymphangiomatous papules of the skin are benign lymphatic proliferations that may arise in the skin after operation or radiation therapy. We report a case of benign lymphangiomatous papules of the skin that occurred in a patient 4 years after undergoing radiation therapy to the chest for adenocarcinoma of the breast.