Indurated vascular plaques on the legs of an 85-year-old woman.

This is a case of classic type Kaposi sarcoma occurring in an 85-year-old woman who presented with indurated vascular plaques on both legs below the knee that has been present for two years. A brief review of the literature on Kaposi sarcoma is included.

Photoletter to the editor: An erythematous folliculocentric papular lesion on the chest of a 60-year-old man: What is your diagnosis?

Folliculitis has many etiologies including bacterial, fungal, viral and parasitic. Therefore, an accurate determination of the cause is necessary to direct treatment. This is a case of a 60-year-old man who presented with an erythematous papule on his chest. Biopsy showed granulomatous inflammation, abscess formation, and the causative agent was Demodex.

Biopsy of a 5 mm cystic lesion on the right heel of a 48-year-old woman.

An excisional biopsy of an asymptomatic cystic lesion that had been present for several years on the right heel of a 48-year-old woman revealed a subcutaneous cyst lined by ciliated columnar epithelium. On immunostaining, the epithelial cells were positive for Pan-cytokeratin (CK AE 1/3), estrogen receptor (ER) and progesterone receptor (PR), but negative for carcinoembryonic antigen (CEA), suggesting Mullerian type of epithelium. Cutaneous ciliated cyst of Mullerian type occurs almost exclusively on the lower extremity of premenopausal women. The lesion is benign and excision is curative.

Clear cell Basal cell carcinoma.

Introduction. Clear cell basal cell carcinoma (BCC) is an uncommon and unusual variant of BCC, which is characterized by a variable component of clear cells. The pathogenesis of this histological variant and its clinical significance has not been clarified. Differentiation of this uncommon variant of BCC from other clear cell tumors is important for the treatment. Case Presentation. A 65-year-old male presented with a 0.9 cm dome-shaped lesion on his upper chest. A shave biopsy revealed a dermal basaloid tumor that comprised nests with a peripheral palisading pattern, retraction artifacts, and striking clear cell changes. Histopathologic examination, along with findings from immunohistochemical studies and special staining of the clear cells, supports the diagnosis of clear cell basal cell carcinoma. Conclusion. Clear cell BCC is a rare and unusual variant of BCC. The underlying pathogenesis of this subtype is unclear; however, accurate identification may affect treatment and prognosis.

A woman with a lower lip nodule: what is your diagnosis?

Angiolymphoid hyperplasia with eosinophilia (ALHE), also known as epitheliod hemangioma is an uncommon benign vascular tumor of the skin. It usually presents as nodules and erythema over the ears, forehead, or scalp. Histologically, the lesion is composed of a combination of immature blood vessels, endothelial cells with distinct epitheliod appearance and chronic inflammatory cell infiltration with numerous eosinophils. Such a case occurring on the lower lip of a 55-year-old woman is presented. The lesion was completely excised with clear margins. Surgical resection is the preferred mode of treatment and is curative.

Rapidly growing hemorrhagic papule on the cheek of a 54-year-old man.

A 54-year-old man sought medical attention for a growth on his right cheek that had been present for three months. The growth began as a small, brown "pimple" that gradually increased in size over time. Physical examination revealed a 9 mm well-circumscribed erythematous nodule with a hemorrhagic crust. On dermoscopy, the lesion was completely vascular appearing, with no pigment visualized. A clinical diagnosis of pyogenic granuloma was made. The lesion was biopsied and histopathologic examination revealed a 2.8 mm thick, Clark level IV, ulcerated, amelanotic nodular melanoma. Because the literature contains reports of nodular melanoma mimicking the presentation of a pyogenic granuloma, all such lesions should be biopsied for histopathologic diagnosis.

A man with an umbilicated papule of the hand: what is your diagnosis?

Introduction. Ecthyma contagiosum is a zoonotic disease caused by the parapoxvirus that causes "sore mouth" in sheep and goats and orf in human. Case Presentation. A 61-year-old sheep farmer presented with a painful non-pruritic lesion on the left hand that had been present for approximately 5 weeks. Physical examination demonstrated a 1 cm pearly, umbilicated papule with raised borders. A biopsy showed an asymmetrical nodule with parakeratotic crust and acanthosis with thin epidermal strands extending deeply in the underlying dermis. Marked edema, capillary proliferation and extensive lymphocytic infiltration was also present. One red intranuclear inclusion was identified in an epidermal keratinocyte. A diagnosis of human orf (ecthyma contagiosum) was made. Conclusion. Infected sheep and freshly vaccinated sheep or goats are the reservoir for human infection. After an incubation period of 3-7 days, parapoxvirus infections produce 1-3 painful lesions measuring 1-2 cm in diameter. The natural history of the disease is complete resolution and no treatment is indicated. Prevention of echthyma contagiosum in ruminants through vaccination is thought to be the best way to control infection.

An unusual clinical presentation of merkel cell carcinoma: a case report.

Introduction. Merkel cell carcinoma is a rare, aggressive neuroendocrine cell carcinoma arising in the sun-exposed skin of elderly patients. Most of these tumors are located in the dermis. An unusual clinical presentation of such a tumor in the subcutis, if not biopsied, may be easily mistaken as a benign lesion. Case Presentation. An 83-year-old white woman presented with a several-month history of a painless 7 mm subcutaneous mass that was initially thought to be a lipoma. A conservative follow-up was planned. At the insistence of the patient, an excisional biopsy of the mass was performed revealing a subcutaneous Merkel cell carcinoma. The tumor cells stained positively for CK 20, chromogranin, and synaptophysin. No other primary or metastatic tumors found after a thorough work-up. The patient was treated with local irradiation. She remains disease free at her six-month follow-up visit. Conclusion. When a new growth is encountered in the sun-exposed skin of elderly patients, a biopsy is warranted even if the lesion clinically appears benign.

Poorly differentiated squamous cell carcinoma arising in tattooed skin.

Introduction. Tattoos have increasingly become accepted by mainstream Western society. As a result, the incidence of tattoo-associated dermatoses is on the rise. The presence of a poorly differentiated squamous cell carcinoma in an old tattooed skin is of interest as it has not been previously documented. Case Presentation. A 79-year-old white homeless man of European descent presented to the dermatology clinic with a painless raised nodule on his left forearm arising in a tattooed area. A biopsy of the lesion revealed a poorly differentiated squamous cell carcinoma infiltrating into a tattoo. The lesion was completely excised and the patient remains disease-free one year later. Conclusion. All previous reports of squamous cell carcinomas arising in tattoos have been well-differentiated low-grade type or keratoacanthoma-type and are considered to be coincidental rather than related to any carcinogenic effect of the tattoo pigments. Tattoo-associated poorly differentiated invasive carcinoma appears to be extremely rare.

'Lint ball' omphalitis, a rare cause of umbilical discharge in an adult woman: a case report.

INTRODUCTION: Umbilical discharge in adult is rare and is usually induced by foreign material, most commonly hair. Rarely, it may be due to embryonal anomalies. We are reporting an unusual case of umbilical discharge in adult secondary to an impacted lint ball. CASE PRESENTATION: A 55-year-old obese woman presented with a 4-month history of hemorrhagic discharge from the umbilicus. Deep from the base of the umbilicus, a 0.8 cm gray-tan mass was removed that on microscopic examination revealed a lint ball. CONCLUSION: An impacted lint ball may be a rare cause of umbilical discharge in adult.

Poroma of the hip and buttock.

Poroma is a benign adnexal skin tumor seen in middle aged individuals with no sex predilection. The acral sites are the most commonly affected regions. Hip or buttock as a location of origin has rarely been reported. We report two cases of poroma, one located on the hip of a 75-year-old man and the other on the buttock of a 60-year-old man.

Acquired trichostasis in postoperative site: a case report.

INTRODUCTION: Usual causes of a papule or nodule in a post-operative site after resection of a skin tumor are residual or recurrent tumor, proliferative scar, or suture granuloma with inflammation and granulation tissue. Inverted or trapped hair, an acquired trichostasis, has not been implicated as a cause in such cases, this is probably the first case reported in literature. CASE PRESENTATION: A 31-year-old woman underwent an excision of a ruptured epidermal cyst of the left axilla. One month later, the previous excision site was re-excised secondary to a non-healing, inflamed papule in order to exclude recurrent epidermal cyst formation. Microscopic examination revealed that the cause of the papular lesion was acquired trichostasis, rather than a recurrent epidermal cyst. CONCLUSION: A papular or nodular lesion at a postoperative site may rarely be caused by acquired trichostasis and should be considered as one of the differential diagnosis.

Infiltrating syringomatous eccrine adenoma of the nipple: a case report.

BACKGROUND: Differential diagnosis for a nodule in the nipple or subareolar area of woman includes both primary neoplasms of breast as well as those from skin and adnexae. CASE PRESENTATION: A 32-year-old woman presented with a painless 0.5 cm subareolar nodule of her left nipple that she had noticed for several months, with no associated nipple discharge. A biopsy revealed an infiltrating adnexal neoplasm with features similar to those seen in syringomas commonly occurring in locations such as upper face and pubis. The infiltrating syringomatous adenoma of the nipple occurs almost exclusively in women of all ages and is cured by simple excision. Microscopic appearance of such a rare benign infiltrating neoplasm of eccrine duct origin occurring in woman's breast should not be misinterpreted as more common infiltrating primary breast carcinoma. CONCLUSION: Infiltrating eccrine syringomatous adenoma should be included in the differential diagnosis of a nipple or subareolar nodule occurring in woman.

Melanoma in-situ arising in seborrheic keratosis: a case report.

BACKGROUND: Seborrheic keratosis is a very common benign skin tumor in man. Melanoma is rare but is the most dreaded of all malignant skin tumors. A melanoma arising in a seborrheic keratosis is distinctly rare. We are reporting such a case occurring in an 86-year-old man. CASE PRESENTATION: An-86-year-old male with a history of multiple actinic keratoses and seborrheic keratoses of the head and trunk presented with a mid-back skin lesion. The lesion was poorly circumscribed, flat, and gray, with a pink-tan, well-circumscribed scaly nodule within it. The biopsied lesion was composed of the usual features of hyperkeratotic seborrheic keratosis, but with focal atypical melanocytic proliferation with nesting along the dermal-epidermal junction. We interpreted this lesion as a melanoma in-situ arising within a seborrheic keratosis. CONCLUSION: It is not uncommon for many physicians to remove a typical seborrheic keratosis without a confirmatory microscopic confirmation. We urge that all such lesions be examined by the pathologist to avoid missing another concomitant malignant lesion such as melanoma which needs adequate resection and close follow-up.

Perianal squamous cell carcinoma in-situ: a report of two human papilloma virus-negative cases.

We are reporting two cases of perianal squamous cell carcinoma in-situ, negative for high-risk (HR) and low-risk (LR) human papilloma viruses. A brief review of anal and perianal squamous cell carcinoma and the role of HPV are presented.

Primary squamous cell carcinoma of lung in a 13-year-old boy: a case report.

We are reporting a very rare case of primary bronchogenic squamous cell carcinoma (SCC) with bone metastasis in a 13-year-old boy. A brief review of the English literature on this rare neoplasm in childhood is presented.

Angiosarcoma of the scalp mimicking a sebaceous cyst.

A 58-year-old Caucasian woman presented with a cystic lump behind the right ear that was clinically diagnosed as an infected sebaceous cyst. The lesion was treated with incision and drainage followed by antibiotics for 3 months. Because there was no resolution, a biopsy was performed that revealed a high grade angiosarcoma. She expired 2 months later. Cutaneous angiosarcoma is an extremely aggressive tumor. Therefore early diagnosis and management is crucial in providing better patient care.

Possible implantation carcinoma of the scalp following craniotomy for metastatic renal cell carcinoma.

We report a case of a 50-year-old man who developed a possible implantation carcinoma of the scalp within the craniotomy scar 19 months after a metastatic renal cell tumor nodule was removed from the brain. The English literature on the implantation carcinoma is briefly reviewed.