Pediatric hematidrosis - A case report and review of the literature and pathogenesis.

Hematidrosis is a disorder in which blood-tinged fluid exudes from uninjured skin or mucosa. It is often classified as an eccrine sweat disorder, though the precise mechanism-including involvement of sweat glands-has yet to be proven. In contemporary case reports, hematidrosis appears most frequently in the pediatric population, with 83% of cases in the literature since 2008 occurring in individuals 18 years old or younger. We present here a case of a 10-year-old girl with hematidrosis followed by a review of the literature, with an emphasis on the features of this condition in the pediatric population.

Surgical Margin Mapping of Melanoma In Situ Using In Vivo Reflectance Confocal Microscopy Mosaics.

BACKGROUND: Melanoma in situ (MIS) can have poorly defined borders and subclinical extension that makes margin control challenging. Reflectance confocal microscopy (RCM) is a promising noninvasive technique that can be used to assess subclinical spread. OBJECTIVE: To optimize surgical margins of histology-proven MIS using RCM mosaics. MATERIALS AND METHODS: Prospective review of 22 patients with histology-proven MIS who underwent RCM margin mapping prior to staged excision, between August 1, 2018, and August 13, 2020, at the Department of Dermatology, University of New Mexico, School of Medicine. RESULTS: Twenty patients (91%) had tumor clearance on the first stage using a 3-mm surgical margin after confocal margin mapping. CONCLUSION: Reflectance confocal microscopy margin mapping using the mosaic device tends to clear MIS in one stage, and the use of the handheld device may improve the accuracy for difficult anatomic areas. Current Procedural Terminology codes for RCM do not reflect the time required and complexity of the procedure. Reflectance confocal microscopy margin mapping prior to excision has the potential to decrease the number of stages needed for melanoma removal, reduce treatment time, and cost.

Nevus of Ota associated with a primary uveal melanoma and intracranial melanoma metastasis.

Nevus of Ota is a blue, hyperpigmented, benign dermatosis of the skin and mucosae that most often occurs unilaterally in the distribution of the ophthalmic (V1) and maxillary (V2) branches of the trigeminal nerve. Although uncommon, association with malignant melanoma is a complication that must be considered in the evaluation of patients with nevus of Ota. Mutations in the GNAQ and BAP1 genes in patients with nevus of Ota place them at higher risk for malignant melanoma and metastasis. We report the case of a 29-year-old woman with a long-standing history of nevus of Ota who presented acutely with an intracranial melanoma as an extension of a primary uveal melanoma.

Desmoplastic melanoma presenting as primary alopecia neoplastica: a report of two cases.

Desmoplastic melanoma is an uncommon form of melanoma characterized by atypical spindled melanocytes and abundant collagen deposition. It typically presents in sun-damaged skin of the elderly as an amelanotic, indurated lesion. It has a higher tendency for local recurrence but lower risk of lymph node metastasis vs. conventional malignant melanoma. We report two cases in women aged 59 and 66 who presented with small scalp lesions clinically suggestive of alopecia. The differential diagnosis included alopecia areata, lupus erythematosus and lichen planopilaris. Biopsies performed according to alopecia protocol were reviewed at our institutions. Biopsies revealed atypical spindled and nested epithelioid melanocytes set in a sclerotic dermis with scattered lymphoid aggregates and immunohistochemical expression of S100 protein, features diagnostic of combined desmoplastic melanoma. Wide local excision with skin graft was performed on the older patient. Excision showed combined desmoplastic melanoma with a Breslow thickness of 8.5 mm with melanoma in situ identified in the adjacent epidermis. The other patient sought treatment elsewhere and was lost to follow up. These cases illustrate desmoplastic melanoma as an unusual etiology and dangerous clinical pitfall in patients with scar-like alopecia. To the authors' knowledge, these represent the second and third reported cases of desmoplastic melanoma presenting as primary alopecia neoplastica.

Nuclear factor XIIIa staining (clone AC-1A1 mouse monoclonal) is a highly sensitive marker of sebaceous differentiation in normal and neoplastic sebocytes.

BACKGROUND: Sebaceous proliferations are common and may be confused with other cutaneous neoplasms. Few useful or specific immunohistochemical markers for sebaceous differentiation are available. We incidentally observed strong factor XIIIa (Ventana clone AC-1A1 on Ventana Benchmark Ultra stainer) nuclear staining in normal sebaceous glands and hypothesized that this might be a useful marker in sebaceous proliferations. METHODS: Immunohistochemistry for factor XIIIa (AC-1A1) was performed on seven sebaceous hyperplasias, eight sebaceous adenomas, five sebaceomas, seven sebaceous carcinomas. RESULTS: Strong nuclear factor XIIIa (AC-1A1) staining was present in 100% of normal sebaceous glands, 100% of sebaceous hyperplasia, adenoma and carcinoma, and 80% of sebaceoma. Moderately or poorly differentiated squamous cell carcinomas (SCCs) (n = 26) were also stained for factor XIIIa (AC-1A1); two showed focal strong staining (8%), but the remainder showed only weak or negative staining (92%). In contrast, factor XIIIa clones from Abcam, Cambridge, MA, USA (EP3372) and Vector Laboratories, Burlingame, CA, USA (E980.1) were negative in sebocyte nuclei. CONCLUSIONS: We report the novel finding of consistent nuclear factor XIIIa (AC-1A1) staining in normal, hyperplastic and neoplastic sebocytes. Factor XIIIa (AC-1A1) is a highly sensitive marker of sebaceous differentiation. It may have potential clinical utility as a specific marker to distinguish sebaceous carcinoma from poorly differentiated SCC.

Characterization of dermatopathology fellowship applicants: a 5-year single institution experience.

BACKGROUND: Although much data have been documented on the characteristics of medical school applicants for dermatology and pathology residency programs in the United States and select medical and surgical fellowship applicants through the National Residency Matching Program, little is known about the dermatopathology applicant demographics. METHODS: We examined a 5-year pool of dermatopathology fellowship applicants from a single institution (University of Arkansas for Medical Sciences) and compiled background profile data of the applicants to characterize an 'average dermatopathology fellow' applicant. RESULTS: A total of 229 applicants over a 5-year period were included in the assessment. The majority were of pathology background with medical school and residency training based in the southern United States. One-third of the applicants had original research publications, case reports or had given an oral or poster presentation in the field of dermatopathology. CONCLUSIONS: Knowledge regarding the average applicant statistics for a dermatopathology fellowship will allow prospective applicants to evaluate their own applications for strengths and weaknesses. This will also provide institutions information regarding anticipated statistics for a competitive applicant pool.