Chronic myelomonocytic leukemia can present with diffuse planar xanthoma.

There is a documented association between diffuse planar xanthoma and chronic myelomonocytic leukemia. Previous accounts have hypothesized that patients with multiple lesions or extensive cutaneous disease are more likely to have an underlying abnormality of the reticuloendothelial system. However, we document a 62-year-old woman with a large pruritic yellow-orange plaque on the chest and lower anterior neck consistent with planar xanthoma that was discovered to have chronic myelomonocytic leukemia. Solitary large plaques of planar xanthoma should be considered in the same fashion as diffuse planar xanthoma and warrant a prompt hematologic evaluation.

Tender growth on toe.

A 50-year-old Caucasian man came to the dermatology clinic with a tender growth on his great toe. He first noticed it a year earlier after sustaining trauma to the area. The growth had been getting bigger and had intermittently bled. It had also oozed, so his primary care physician treated it as an infection with topical antibiotics, followed by several courses of oral antibiotics. Despite therapy, the lesion continued to grow and the patient was referred to us. The patient had a 3.4-cm-by-1.8-cm exophytic erythematous nodule on the left lateral great toe. What is your diagnosis? How would you manage this condition?

Posttransplant Epstein-Barr virus related lymphoproliferative disorder with a primary cutaneous presentation.

Posttransplant lymphoproliferative disorder is a rare and often difficult diagnosis in patients with only cutaneous symptoms. A stepwise approach to diagnosis and classification can lead to successful treatment. We report a case of an EBV-associated posttransplant lymphoproliferative disorder (PTLD) occurring on the face with a primary cutaneous presentation. The appropriate diagnosis was made only after multiple biopsies and special stains. There was near complete resolution with decreased levels of iatrogenic immunosuppression. The diagnosis of Posttransplant lymphoproliferative disorder can be difficult to establish. A proper workup will aid in making an accelerated diagnosis and choosing appropriate treatment options.

Laser treatment of pediatric vascular lesions.

Since its introduction in 1967, laser therapy has benefited patients and physicians alike. After the first clinical application by Goldman (Anderson RR, Parrish JA. Science 1983;220:524-527), laser therapy has become indispensable in the management of vascular birthmarks. In selecting a proper balance of wavelength, pulse duration, and energy density (fluence), the physician can mold laser energy to effectively manage lesions once considered untreatable. Now, the vast array of lesions amenable to laser therapy continues to expand. By advancing our understanding of both laser technology and vascular lesion biology, the goal of providing optimal clearance with minimal morbidity moves ever closer.