Melanoma arising in nevus spilus.

Nevus spilus is a pigmented skin lesion composed of a pigmented macule on which darker lesions appear at a later stage. There are an increasing number of reports of malignant melanoma occurring within these lesions, leading to greater concern regarding the malignant potential of these lesions. We describe the case of a fatal malignant melanoma arising in a congenital nevus spilus.

Vulvar melanosis.

Vulvar melanosis is a condition in which intensely pigmented irregular macules, clinically mimicking malignant melanoma, appear on the vulva. A biopsy specimen shows only marked lower epidermal pigmentation without any melanocytic atypia or nesting. The process is benign, and reassurance is the only treatment.

Mid dermal elastolysis.

Mid dermal elastolysis is an exceedingly rare condition. Only three cases have been reported previously. The disease manifests as sharply marginated plaques of fine wrinkles of various size that give the skin an aged appearance. It is characterized histologically by a complete absence of mid dermal elastic fibers and lack of any inflammatory infiltrate. Two new cases are reported, and the other cases are reported.

Subungual basal cell carcinoma presenting as longitudinal melanonychia.

Subungual basal cell cancers are extremely rare, and a case is presented herein. This cancer had as its only manifestation the unique presence of a deeply pigmented streak in the nail for many years. Longitudinal melanonychia can signal baleful or banal conditions, and basal cell cancer must now be added to this list.

Hairy elbows.

Hairy elbows (hypertrichosis cubiti) represent an uncommon variety of localized hypertrichosis not associated with significant medical problems. This hypertrichosis occurs in young children and may occur sporadically or possibly be genetically determined. The process is of cosmetic concern alone, and reassuring the parents is the only therapy necessary.

Facial sporotrichosis in an infant.

Sporotrichosis is usually considered a fungal infection affecting adults, but it can also affect children. A case of sporotrichosis in an 18-month-old boy is presented which is unusual in that the patient was extremely young and had a relatively atypical clinical presentation. His condition responded rapidly to potassium iodide therapy at a very low dosage. A brief review of childhood sporotrichosis in the American literature is included.

Acrokeratoelastoidosis.

Acrokeratoelastoidosis is a very rare entity of unknown etiology, characterized by small, firm, yellowish, translucent papules which usually appear on the margins of the hands and feet between the junction of the dorsal and palmar/plantar skin. Histologically, the most characteristic features are hyperkeratosis, mild acanthosis, and, most strikingly, fragmentation of coarse elastic fibers within the reticular dermis. This eruption is variable in terms of its onset, may be sporadic or familial, is generally asymptomatic, and has a prolonged course.

Lichen aureus.

Lichen aureus is one of the rarest of the pigmented and purpuric dermatoses. The eruption consists of lichenoid papules and plaques with a golden to purplish color, and the histology reveals a dense and bandlike infiltrate hugging the epidermis. It consists of lymphocytes and histiocytes, often with extravasation of red cells. The eruption is asymptomatic and has a prolonged course. A case is presented which is unusual for its widespread localization, peculiar location, and rather dramatic response to topical therapy.

Oral vitamin A in acne vulgaris. Preliminary report.

Oral vitamin A (retinol) is generally not considered useful in the treatment of acne vulgaris. We conducted a study which showed that retinol was indeed ineffective at the usual doses of 50,000 to 100,000 IU daily. Retinol was highly efficacious in doses of 300,000 units for women and 400,000 to 500,000 units for men, toxicity was slight and limited mainly to skin (xerosis) and mucous membranes (cheilitis). The danger of hypervitaminosis A in this dosage range has been exaggerated. Retinol is a valuable drug for treating stubborn, severely inflammatory acne vulgaris. It is administered until the disease is brought under control, usually within three to four months. Then the dosage is progressively reduced relying on conventional drugs to keep the disease in abeyance.

Persistent purple plaques of the face caused by gingival hyperplasia.

Persistent plaques that develop primarily on the face may be caused by a variety of conditions, but rarely is purely intraoral infection the primary cause. A case report is presented in which massive prolonged gingival hyperplasia resulted in a persistent and peculiar purple facial lymphedema. The condition resolved only after the intraoral disease had been successfully treated.

Pulmonary manifestations of tuberous sclerosis.

Lung involvement in tuberous sclerosis is rare. Those patients with lung involvement differ from the usual tuberous sclerosis patient in that they are predominantly women, are of normal intelligence, and are less likely to develop epilepsy. The lung disease is often fatal, with cor pulmonale and pneumothorax as the major causes of death. A review of the radiologic and pathophysiologic findings of the lung process are also presented in the following case report.