Epithelioid sarcoma of the penis: report of an unusual case and review of the literature.

Epithelioid sarcoma is a rare, slowly growing soft tissue tumor that uncommonly involves the penis, with only 11 previously reported cases. We present a case of penile epithelioid sarcoma in a 39-year-old man that mimicked Peyronie's disease, which was diagnosed 13 years following initial presentation. Preoperative magnetic resonance imaging showed multiple peripherally enhancing low signal intensity nodules involving the corpora cavernosa bilaterally. Following penectomy, histologic examination showed the typical features of epithelioid sarcoma, with a prominent pseudogranulomatous pattern. Immunohistochemically, the neoplastic cells demonstrated strong and diffuse staining for cytokeratins (AE1/AE3 and CAM 5.2), vimentin, epithelial membrane antigen, and CD34. Stains for S-100 protein, desmin, smooth muscle actin, and CD31 were negative. Electron microscopy demonstrated abundant intracytoplasmic intermediate filaments, scattered tonofilaments, and interdigitating filopodia. The present study is the first to describe magnetic resonance imaging and comprehensive immunohistochemical findings in penile epithelioid sarcoma. The majority of cases reported in the literature have demonstrated features similar to those typically found in epithelioid sarcoma involving the distal extremities. Consideration of epithelioid sarcoma in the differential diagnosis of a penile nodule or obstructive urinary symptoms may lead to early diagnosis and treatment.

Cutaneous presentation of posttransplant lymphoproliferative disorder.

Posttransplant lymphoproliferative disorder (PTLD) is a known complication of solid organ and bone marrow transplantation. However, cutaneous manifestation is an extremely rare phenomenon of this disorder. We describe a lung transplantation patient with cutaneous PTLD who presented with bilateral extremity nodules and fever.

Basal cell carcinoma of the vermilion zone of the lower lip: a report of 3 cases.

Three cases of basal cell carcinomas (BCCs) of the vermilion zone of the lower lip are reported. The possible histopathogenesis of these BCCs is discussed. All lesions were treated by Mohs micrographic surgery.

Oral malignant melanoma treated with Mohs micrographic surgery by fixed-tissue technique.

We describe a 77-year-old man with stage III oral malignant melanoma (Breslow thickness, 4.0 mm) treated with Mohs micrographic surgery by fixed-tissue technique, elective lymph node dissection, and postoperative radiation therapy. This treatment plan permitted complete excision of the melanomatous field, sparing the need for radical resection. Although the patient later died of widespread metastases, there was no evidence of local or regional recurrence and his quality of life was preserved. We believe that Mohs micrographic surgery by fixed-tissue technique followed by radiation therapy offers a safe and alternative treatment option for deep melanomas in the oral cavity.

Cutaneous malignant melanoma treated by Mohs surgery. Review of the treatment results of 179 cases from the Mohs Melanoma Registry.

BACKGROUND: There has been much debate regarding the efficacy of the Mohs chemosurgery fixed-tissue technique vs the fresh-tissue technique in the treatment of cutaneous melanoma. OBJECTIVE: To review the treatment results of the 179 cases of melanoma registered with the Mohs melanoma tumor registry from 1981 to 1991, accumulated from nine referring Mohs surgeons. METHODS: Review of the two treatment techniques using a case presentation format. There were 113 cases treated by the hybrid fixed-tissue technique and 61 cases treated by the fresh-tissue technique. The data compared technique of treatment vs degree of invasion by both Clark level and Breslow thickness determinations. Analysis of the data using Kaplan-Meier graph. RESULTS: Five-year survival data for melanomas treated by either the fresh-tissue or fixed-tissue method appear concordant. CONCLUSION: For thin and intermediate melanoma thicknesses treatment by either method appears to be equally efficacious. For deep melanomas, the number of cases were insufficient to evaluate. Further study of this high-risk category is warranted.

Tumors of the nasal columella treated by Mohs micrographic surgery.

Primary nasal columellar tumors are rare but can exhibit aggressive clinical behavior, often leading to devastating outcomes if these tumors are not completely removed. Eleven patients with nonmelanoma nasal columellar lesions were evaluated. All lesions were excised by obtaining tumor-free margins with Mohs micrographic surgery. Seven of eight cases with basal cell carcinoma have been tumor free for more than 5 years, the eighth case remains tumor free at 4 years. The primary squamous cell carcinoma lesions treated in this study have fared well; one patient has been tumor free for the past 4.3 years. No local recurrence or distant metastasis has occurred to date for all cases. We conclude that intervention with Mohs micrographic surgery for the treatment of early nasal columellar tumors may lead to improved outcomes.

Basal-cell carcinoma of the finger: a case report and review of the literature.

Basal-cell carcinoma (BCC) of the digit is a very uncommon entity. Various modalities have been used to treat it, including amputation, radiotherapy, excision, and Mohs micrographic surgery. This article presents the fourteenth reported case of BCC of the finger, which involved treatment by Mohs micrographic surgery. A review of the literature is also provided.

Percutaneous absorption of hydrocortisone and testosterone on the vulva and forearm: effect of the menopause and site.

The percutaneous absorption of hydrocortisone and testosterone was studied following their application to the vulvar and ventral forearm regions of pre- and post-menopausal women. Percutaneous absorption of hydrocortisone was significantly greater in vulvar skin than forearm skin in both pre- and post-menopausal women (P < 0.05, respectively), whereas the percutaneous absorption of testosterone was significantly increased (P < 0.01) on the vulva compared with the arm only in post-menopausal women. The effect of age on the percutaneous absorption of hydrocortisone and testosterone was evaluated by using the menopause as a biological chronometric end point. It is a common misconception that older skin has a diminished barrier capacity, and that percutaneous absorption is therefore greater. Our studies showed that absorption of hydrocortisone vulval skin of pre-menopausal women was significantly greater (P < 0.01) than in post-menopausal women. The ventral forearm skin of pre-menopausal women tended to show increased absorption compared with post-menopausal women, but statistical significance was not reached. No significant differences (P > 0.05) in the percutaneous absorption of testosterone in vulval or forearm skin were observed between the two age groups.

Malignant cylindroma of the scalp.

Malignant cylindroma may develop via malignant transformation of cylindroma in rare instances or may develop de novo in others. We present a case of malignant cylindroma located on the left parietal-occipital scalp that was treated twice by Mohs micrographic surgery in an attempt to excise the tumor completely and to minimize the excision of normal tissue. Our case is the sixteenth reported case of malignant cylindroma in the world literature.

Reticulate nonmelanocytic hyperpigmentation anomaly. A probable variant of Dowling-Degos disease.

A 26-year-old white woman had reticulate nonmelanocytic hyperpigmentation anomaly characterized by partially blanching red-brown papules and macules and a histologic picture of digitate epithelial budding proliferation with lightly pigmented rete ridges. Except for the classically described hyperpigmentation at the rete ridge tips, the patient has Dowling-Degos disease. This case of a reticulate nonmelanocytic hyperpigmentation anomaly is probably a variant of Dowling-Degos disease.

Disseminated cutaneous fungal infection and AIDS.

We report a case of recalcitrant generalized cutaneous polydermatophyte and Candida infection in an AIDS patient who responded very poorly to topical, oral, and intravenous therapy. The patient died of respiratory arrest secondary to pneumonia 14 months after a cutaneous fungal infection developed and 12 months after AIDS was diagnosed. Extensive cutaneous fungal infections refractory to treatment may be a presenting sign of HIV infection.

Transepidermal potassium ion, chloride ion, and water flux across delipidized and cellophane tape-stripped skin.

The skin barrier was evaluated as a function of transepidermal water loss (TEWL) and electrolyte loss. Combination electrodes for chloride and pH determinations and a potassium ion electrode were utilized. Delipidization of the skin did not impair the electrolyte barrier, but did damage the epidermal water barrier. Cellophane tape stripping of normal stratum corneum resulted in an increase in outward transepidermal potassium and chloride ion flux, an increase in skin surface pH, and an increase in TEWL. It appears that damage to the epidermal water barrier does not necessarily result in damage to the epidermal electrolyte barrier. We found the potassium electrode facile to use and believe that a combination potassium electrode would be useful for investigating and assessing the epidermal electrolyte barrier.

[Physiology of the skin of the vulva: new aspects]. / Physiologie der Haut der Vulva: neue Aspekte.

Using noninvasive bioengineering skin technology, the vulvar skin has been partially characterized as having unique properties. The reduction in stratum corneum barrier function and the increase in basal blood flow in the vulvar skin may explain the high rate of percutaneous absorption and the increased reactivity to irritants. The vulvar microbial flora represents a unique combination of contaminants from the vagina and the perianal area and a resident flora that is typical for intertriginous skin, together with a high carrier rate of Staphylococcus aureus. The long-term goal of vulvar physiology is to understand better how this more specialized skin differs from less specialized areas in the hope of using this information clinically.

Vulvar transepidermal water loss (TEWL) decay curves. Effect of occlusion, delipidation, and age.

The kinetics of water desorption after water loading was evaluated by means of transepidermal water loss (TEWL) decay curves. The effects of delipidation and ageing on the desorption of the water biomolecule was investigated in the vulva and on the forearm. All decay constants were analysed by curve stripping analysis and found to fit a bi-exponential decay. There was no significant difference in decay constant when compared by site. However, the terminal decay constant differed significantly after delipidation in both vulva and on forearm (p less than 0.02, p less than 0.04, respectively) in premenopausal women. Significant differences were also noted at post-menopausal forearm and vulva sites after delipidation for the terminal decay constant (p less than 0.006, p less than 0.02, respectively). Delipidation probably alters bound water in the process of sorption. Differences in decay constant when compared between pre- and post-menopausal women were noted only at the vulva for beta 1 decay constant (p less than 0.05). beta 2 of the forearm was not affected by menopause. Data are also presented to support the notion that structural lipids of the stratum corneum may have a water-holding property.