Blastomycosis-like pyoderma in association with recurrent vesicular hand eczema: good response to acitretin.

Blastomycosis-like pyoderma, also known as pyoderma vegetans, is an uncommon disease characterized by vegetating skin lesions mimicking blastomycosis or warty tuberculosis, often associated with staphylococcal and streptococcal infections. It is more commonly observed in elderly patients with impaired immunological capacity, and is often unresponsive to various therapeutic modalities. We describe a case of BLP that occurred on the palmar aspect of the left hand in an elderly female, affected with recurrent vesicular hand eczema. The disease resolved completely following the administration of oral acitretin 25 mg/day for 10 weeks.

Perineal extramammary Paget disease responsive to topical imiquimod.

Extramammary Paget disease (EMPD) is a rare neoplasm that arises in skin rich in apocrine glands, such as the axillae and anogenital region and usually affects the elderly. In most cases, EMPD is an apocrine carcinoma in situ, but it can be associated with internal malignancy spreading to overlying skin. Surgical excision with margin control is the generally accepted standard of care. A 74-year-old woman presented with a 1 year history of a pruritic eczematous eruption in perineum which on biopsy was diagnosed as EMPD. Because of the location and extent of the tumor, any surgical approach would have been problematic. Imiquimod 5 % cream applied three times weekly for 16 weeks induced complete resolution. Topical imiquimod appears to be a promising treatment option for EMPD, especially when surgery is a challenge, but only a few cases have been reported.

Primary umbilical melanoma.

We report a 72-year-old woman who presented with a primary melanoma of the umbilicus and periumbilical skin of 4 years' duration. Pathological examination of a biopsy specimen showed Clark's level IV, and tumour thickness 2.3 mm. The patient underwent preoperative lymphatic mapping followed by sentinel lymph node biopsy, and wide local excision of the primary tumour, including its attachment to the peritoneum. Because of the variations in vascularity and the residual embryonal connections of the umbilicus with the peritoneum and other intra-abdominal organs, an aggressive surgical approach is recommended in the management of malignant umbilical tumours.

Linear atrophoderma of Moulin localized to the neck.

Linear atrophoderma of Moulin (LAM) is a rare and distinct skin condition characterized by unilateral, hyperpigmented and atrophic band-like skin lesions following the lines of Blaschko. Usually the disease begins in childhood or adolescence on the trunk or limbs, with no preceding inflammation or subsequent sclerodermatous changes. Approximately 25 cases have been reported in the English language literature. We describe a case of LAM occurring in a 9-year-old Peruvian boy with exclusive involvement of the neck. To our knowledge, this is the first report of LAM with this unusual localization.

Tumour regression does not increase the risk of sentinel node involvement in thin melanomas.

Few studies have analysed the relationship between tumour regression and risk of nodal metastasis in patients with thin melanomas (Breslow thickness < or = 1 mm), and the conclusions reported have been conflicting. The aim of this study was to evaluate the role of histological regression as a predictor of lymph node metasta- sis in a selected group of patients with thin melanomas, submitted to lymphatic mapping and sentinel lymph node biopsy. From November 1999 to November 2006, 59 patients with thin melanomas (28 females and 31 males; mean age: 58.7 years) underwent lymphatic mapping and sentinel lymph node biopsy. The mean Breslow thickness was 0.60 mm (range: 0.24-1 mm). Tumour ulceration was present in 2 patients (3.4%) and histological regression in 45 (76.3%). Sentinel lymph node metastases were detected in 2 of 59 patients (3.4%), but only one patient with a positive sentinel lymph node exhibited histological regression of his tumour. Therefore, the sentinel lymph node positivity rate in thin regressing melanomas was 2.2%. Literature data and our experience suggest that tumour regression is not a predictor of sentinel lymph node metastasis in patients with thin melanomas, and therefore does not justify the routine use of lymphatic mapping and sentinel lymph node biopsy in this melanoma setting.

Tonsil metastasis from cutaneous melanoma: first clinical sign of recurrence after complete lymph node dissection.

BACKGROUND: The development of melanoma metastasis to the palatine tonsil is a very rare event, generally associated with advanced-stage disease and poor prognosis. CASE PRESENTATION: A 29-year-old man presented with a melanoma metastasis to the right palatine tonsil 6 months after the surgical excision of an ulcerated nodular melanoma (tumor thickness 1.8 mm, Clark level IV) on the left shoulder. A metastatic sentinel lymph node had been removed from the left axilla, and a subsequent complete lymph node dissection had disclosed no further metastatic lymph nodes. Although staging tests had revealed multiple visceral metastases, a palliative tonsillectomy was performed. The patient died of metastases 5 months later. CONCLUSION: The case presentation suggests that careful examination of the head and neck should be part of the routine follow-up visit in all melanoma patients.