Eccrine-Centric Melanocytic Nevus.

Benign melanocytic neoplasms present with a diverse array of well-known histopathologic patterns. It is imperative to recognize the benign patterns to render accurate diagnoses. We describe here an interesting and hitherto not described low-power architectural pattern of a benign melanocytic lesion: eccrine-centric melanocytic nevus. The patient was a 50-year-old African American woman who noticed a new mole on her foot that began as a dark speck but quickly grew larger. The lesion was excised to exclude the possibility of melanoma. Upon review of the specimen, the lesion was noted to demonstrate a distinctive pattern consistent with a melanocytic nevus of possible congenital onset. Remarkably, the ducts of eccrine glands were increased in density and the nests of melanocytes were found solely in a peri-eccrine distribution without melanocytes in any other locations (ie, interstitial, perifollicular). Additionally, all melanocytes in the nevus were rather heavily pigmented. Although this pattern demonstrated no atypical features that would cause one to consider it malignant to the trained eye, this presentation could implicate a metastatic disease (well-delineated nests in the dermis without concomitant interstitial component) and it is important to recognize.

Successful Treatment of Recalcitrant Hidradenitis Suppurativa with Adalimumab.

Hidradenitis suppurativa is a chronic disease that affects the apocrine gland-bearing regions of the body. The etiology of this disorder is poorly understood, but most likely is a complex process involving follicular apocrine occlusion with subsequent perifolliculitis. Many treatment options have been reported with varying degrees of success, including topical and oral therapy and surgical procedures. Recently, TNF-alpha antagonists have been reported as effective therapy in a few patients. We report here a patient who initially responded to infliximab but developed an infusion reaction to this medication. After subsequent treatment with adalimumab, the patient's disease improved dramatically and has been maintained under excellent control for over 15 months. We propose that TNF-alpha inhibitors, particularly monoclonal antibody based agents, are a viable treatment option in patients with severe, recalcitrant HS and that a patient may be safely and successfully treated with the fully human monoclonal antibody adalimumab in cases in which the chimeric monoclonal antibody infliximab therapy is not tolerated.