Circumscribed palmar or plantar hypokeratosis: first report on a nonacral site with unique histologic features.

Circumscribed palmar or plantar hypokeratosis was first described by Pérez et al in 2002 as a unique entity of the skin in which they reported 10 patients who presented with well-circumscribed areas of erythematous depressed or eroded skin mostly over the thenar or hypothenar eminences of the palms and less commonly on the soles. Histologically, the lesions demonstrated an abrupt drop-off in the cornified layer resulting in a broad area of hypokeratosis. Pérez et al hypothesized that these lesions were a distinctive epidermal malformation. There have been several reports since, some of which implicate trauma as an etiologic agent; however, the exact etiology remains unclear. The authors present the first case of circumscribed palmar or plantar hypokeratosis on a nonacral site (chest of a 63-year-old man) with novel histological features, including granular parakeratosis and evidence of trauma (subepidermal fibrin and ulcerations).

Leukemia cutis (involving chronic lymphocytic leukemia) within excisional specimens: a series of 6 cases.

We present 6 cases of chronic lymphocytic leukemia (CLL) that incidentally involved 6 excisional specimens for biopsy-proven carcinoma. CLL was notably absent from all 5 biopsies that were available for review. In 2 of 6 cases, this was the patients' initial presentation of CLL. Five of 6 cases involved routine paraffin-embedded tissue specimens and 1 case involved frozen tissue sections from a Mohs surgical procedure. The mean age range of the patients was 84 years. Only one of 5 patients in which we have follow-up data, died of a CLL-related cause at the time of this submission (mean follow-up 19.8 months). On histologic examination, the most common pattern of involvement by CLL (as seen in 4 of the 6 cases) was a dense, nodular, and superficial and deep perivascular, periadnexal, and perineural infiltrate beneath the fibrosing granulation tissue of the prior biopsy site. The infiltrate involved the upper and deep reticular dermis and subcutaneous fat. The remaining 2 cases demonstrated a novel finding of a subtle infiltration of leukemic cells among extravasated red blood cells within the mid and deep reticular dermis. In all cases, leukemic cells were present as tightly packed, small, monomorphous, hyperchromatic lymphocytes and 1 case demonstrated a proliferation center. Immunohistochemical stains were performed on 3 of 6 cases, and the leukemic cells were CD5/CD20/CD23/CD3. This case series raises awareness that CLL can incidentally involve dermatopathology specimens and occasionally be the initial presentation of the patients' systemic illness. This series also highlights the unique histologic patterns of CLL in the skin, one of which has not been previously described, and illustrates how these patterns are distinct from the typical interstitial infiltration seen in other cases of leukemia cutis.

Laser treatment of congenital and acquired vascular lesions. A review.

Several quasi-continuous-wave and pulsed lasers can effectively treat a variety of vascular lesions. The pulsed dye laser and its newer variants were specifically designed to target hemoglobin and, by increasing their wavelengths slightly, have successfully achieved greater depths of penetration. When used in to compliance with the theory of selective photothermolysis, these systems have been shown to be safe and to have a low incidence of adverse sequelae. With the concomitant use of epidermal cooling systems, side-effect profiles have been further reduced. Although great progress has been made in the laser treatment of leg telangiectasias, even the newest laser systems have failed to meet patient expectations. Continuing advances in laser technology, however, will probably lead to enhanced clinical results, decreased side-effect profiles, improved hardware, and reduced costs.