Outer root sheath acanthoma.

The term "outer root sheath acanthoma" is proposed to specify a distinctive keratosis exhibiting outer root sheath differentiation. This lesion features anastamosing columns of keratinocytes emanating from the undersurface of the epidermis that respectively demonstrate, with progressive descent into the upper dermis, outer root sheath differentiation characteristic of the infundibulum, isthmus, stem and anagen bulb. In our patient, the lesion was solitary, and no associated systemic disease was evident. Outer root sheath acanthoma is a unique keratosis displaying all four types of tricholemmal differentiation, thus representing a true neoplasm of the entire outer root sheath.

Eccrine syringofibroadenoma surrounding a squamous cell carcinoma: a case report.

A 91-year-old man presented with a 9.0 x 7.0 cm exophytic mass on the dorsum of the right foot, surrounded by a scaling hyperkeratotic plaque-like lesion that had been present for many years. He had similar long-standing hyperkeratotic plaque-like lesions on both legs. Histopathologic examination of the exophytic mass revealed a well-differentiated squamous cell carcinoma surrounded by an eccrine syringofibroadenoma (ESFA). Histochemistry, immunohistochemistry and electron microscopy support this diagnosis. To our knowledge, this is the only reported case of ESFA being intimately associated with a malignant neoplasm.

Papular mucinosis and human immunodeficiency virus infection.

Cutaneous mucin deposition occurs both as an isolated phenomenon and in patients with various systemic disorders. Among these are endocrinopathies (eg, hypo- and hyperthyroidism), malignancy (mycosis fungoides), connective tissue disorders (lupus erythematosus), and infectious diseases (scleredema associated with upper respiratory tract infection). We present a case of papular mucinosis in a patient infected with the human immunodeficiency virus. This case represents the third report of these disorders coexisting.

The histopathology of dysplastic nevi. Continued controversy.

The histopathologic criteria used in the diagnosis of dysplastic nevi have been a source of controversy, as has the clinical significance of these lesions. Several dermatopathologists noted for their work on dysplastic nevi were asked to contribute responses to questions regarding the architectural and cytological criteria used to classify a melanocytic nevus as dysplastic, the terminology used to describe these lesions, and the role of dysplastic nevi as precursors of melanoma. Although no consensus has been reached regarding the cytologic features required for diagnosis of dysplastic nevi, there is substantial agreement regarding the architectural features of these lesions.

Clinical characteristics of malignant melanomas developing in persons with dysplastic nevi.

A total of 452 patients with dysplastic nevi (DN) were followed prospectively by repetitive, complete cutaneous examinations in order to determine the clinical features of early malignant melanomas (MM) arising in them. Sixteen patients (3.5%) developed 18 newly diagnosed MM during an average follow-up period of 27 months. Twelve of the 18 MM were in situ and all of the primary invasive MM diagnosed prospectively in this follow-up were less than 0.89 mm in Breslow thickness, implying an excellent prognosis. The principal clinical clue to the diagnosis of MM was change in a preexisting pigmented lesion. Total-body photographs were very useful in helping to identify the early MM in these patients.

Dysplastic nevi. Markers for increased risk for melanoma.

A total of 452 white patients, classified into four dysplastic nevi groups, were followed prospectively by repetitive, complete cutaneous examinations using total-body photographs taken on entry into the study. Sixteen patients (3.5%) developed 18 newly diagnosed malignant melanomas (MM) during an average follow-up period of 27 months. Twelve of the 18 MM were in situ, and all of the six primary invasive MM diagnosed prospectively in this follow-up were less than 0.89 mm in Breslow thickness, implying an excellent prognosis. Compared with reference populations, the number of MM detected significantly exceeded the number estimated to occur in the comparable age-matched control groups. These data support the concept of repetitive follow-ups of all groups of patients with dysplastic nevi.

The relationship between melanocytic nevi and malignant melanoma.

In conclusion, although there are data, some quite convincingly implicating dysplastic nevi and congenital nevi (particularly "giant") as "precursors" of malignant melanomas, our ability to predict the magnitude of these associations is lacking. Thus, until additional basic and clinical research data are forthcoming, any recommendation to prophylactically remove all congenital nevi or all dysplastic nevi in order to decrease the incidence of malignant melanoma is premature. In regard to congenital nevi, evidence exists that giant (larger than 20 cm in diameter) congenital nevi may have a significant risk factor so as to warrant, when feasible, prophylactic excision of such lesions. In our opinion, no uniform recommendation can be made at this time for the management of small and medium-sized congenital nevi. Patients with familial dysplastic nevus syndrome should be followed carefully and educated concerning the early detection of malignant melanoma. Patients with sporadic dysplastic nevus syndrome deserve further study to enable us to accurately determine their risk of developing malignant melanoma.

Congenital malignant melanoma.

A 6-week-old girl with congenital melanoma of the skin is reported and the literature is reviewed. We believe this to be the first case of congenital melanoma in a black infant who had no underlying giant melanocytic nevus. Because of the significant relationship between the early treatment and prognosis of malignant melanoma, we wish to alert pediatric clinicians to the existence of this rare congenital neoplasm.

The use of the computer in the dermatopathology laboratory.

On a regular basis we are upgrading and modifying our software package to meet our ever-changing needs. The day of the user-friendly computer is upon us. We have found the computer to be an ever-important extension of our own minds, truly our own electronic servant. It has relieved us of the mental tedium that in the past has eaten up so much of our time, leaving us free to accomplish the tasks that our electronic servant could never accomplish, including the creation of new ideas and the appreciation and nurturing of old ones.

The dysplastic nevus. Clinical and pathologic features.

The dysplastic nevus has not only been considered to be a "marker," but also a formal "precursor" of malignant melanoma. Therefore, these lesions are important to recognize clinically. This article presents a classification of the dysplastic nevus based upon its variable clinical presentations. It is hoped that this classification will assist the physician to recognize many of the clinical variants of this unusual melanocytic nevus and, thus, to identify patients at greater risk for the development of malignant melanoma.

Precursors of malignant melanoma. Problems in computing the risk of malignant melanoma arising in dysplastic and congenital nevocytic nevi.

It has recently been shown that both dysplastic and congenital nevi are precursors to malignant melanoma. These findings are based upon mathematical models that show an increased risk of the nevi evolving into melanoma over random choice. However, problems exist with these models that may invalidate their results. The recommendation to remove dysplastic and congenital nevi prophylactically based upon models such as these is premature.