Trends in Cancers of the Skin: Insights from a Three-year Observational Cohort in Manhattan Beach, California.

Background: There exists significant heterogeneity in the presentation of "common" skin cancers such as cutaneous melanoma (CM), cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC). Meaningful differences are often observed among the trio concerning age, sex, site at presentation and laterality. Objective: In this paper, we endeavor to elucidate such heterogeneity, reaffirm burgeoning trends in skin cancer incidence, and offer new insights in the presentation of common skin cancers. Results: While agreement with current consensus was achieved with regard to various aspects of sex, age, and site-specific findings, several novel results emerged: (1) the percentage of subjects presenting with CM was demonstrably higher than population averages would estimate; (2) melanoma exhibited a pronounced right-side bias; (3) cSCC was not head and neck preferring as other reviews have documented (4) cSCC exhibited greater female bias. Conclusion: In this study, we documented insights from 663 cases (397 unique subjects) across a range of factors including age, laterality, site of presentation, and sex specific differences in incidence. The results of our analysis generally accord well with previous findings, replicating several of the most prominent results.

Acne Keloidalis Nuchae is Associated with Cutis Verticis Gyrata.

Purpose: Both acne keloidalis nuchae (AKN) and cutis verticis gyrata (CVG) are scalp conditions predominantly affecting men. Both are characterized by dermal thickening and fibroblast hyperactivity. AKN typically occurs in the nuchal area, often involving the naturally occurring folds in the occipital region. The aim of this study was to determine the relationship between excessive scalp folding (CVG) and AKN. Patients and methods: A total of 108 patients with AKN seen over 11 years from July 2009 and November 2020 were retrospectively evaluated. Patients with AKN concomitant with CVG were selected for analysis. Results: Seven of the 108 AKN patients had scalp-wide (widespread) AKN lesions, including 4 with CVG. In 3 of the 4 patients with concomitant AKN and CVG, the AKN was widespread, and its onset had preceded CVG by 1-2 years. In the fourth CVG patient, AKN lesions were confined to the nuchal area, and the CVG preceded AKN onset by several years. All patients were male, with a mean age of 35.8 years (overall) and 38.0 years (CVG group). Conclusion: We describe a previously unreported relationship between widespread AKN and CVG, with the development of AKN preceding CVG formation.

Findings of osseous sclerotic bodies: a unique sequence of cutaneous bone formation in nephrogenic systemic fibrosis.

Nephrogenic systemic fibrosis (NSF) is a progressive and potentially fatal fibrosing skin disorder found mainly in patients with renal insufficiency. NSF is characterized by thickened and hyperpigmented skin lesions with or without systemic involvement. In essentially all patients, this disease entity has been associated with the administration of gadolinium contrast agents for imaging purposes. Microscopic recognition of this entity remains challenging, as the diagnosis is based on various clinical and histopathologic features that overlap with other fibrosing disorders. No single feature is absolutely specific for NSF. We report a finding of osseous sclerotic bodies with elastin trapping appearing on histopathology in the clinical setting of NSF with hemodialysis-dependent renal failure. Our report of an additional attribute indicative of NSF may aid in making the diagnosis.

Multicentric reticulohistiocytosis and urologic carcinomas: a possible paraneoplastic association.

Multicentric reticulohistiocytosis (MR) is a rare non-Langerhans histiocytosis that is characterized by cutaneous nodules and severe destructive arthritis. Although 25-30% of reported cases have been associated with internal malignancies, the pathophysiology of MR is unknown. Herein, we report two cases of MR that were associated with urologic neoplasms. Because the tumor suppressor gene p53 may play a role in the biology of other histiocytoses, we investigated its p53 immunoexpression in these two cases. Both cases were positive immunohistochemically, but it remains to be seen whether this finding is truly important in the pathogenesis of MR associated with underlying visceral neoplasms.

Cutaneous CD4+ CD56+ hematologic malignancies.

BACKGROUND: Hematologic malignancies expressing CD4 and CD56 are most commonly associated with the recently described CD4(+) CD56(+) hematodermic neoplasm. METHODS: Thirteen cases of CD4(+) CD56(+) hematologic malignancies were prospectively encountered in the routine and referral practices of the authors. RESULTS: Patients 1 and 2 were elderly men exhibiting an acute onset of skin, bone-marrow, and peripheral blood involvement, both dying of their disease within less than 12 months. CD3(+) phenotype and a clonal T-cell receptor beta rearrangement indicated categorization as a CD4(+) natural killer T-cell lymphoma. Patient 3 developed a CD56(+) anaplastic large cell lymphoma and is without disease after excision and radiation. Indolent CD4(+) CD56(+) poikilodermatous mycosis fungoides defined case 4. There were 7 patients with CD123(+) CD4(+) CD56(+) hematodermic neoplasm, 4 dying within 18 months of presentation with peripheral blood/marrow involvement in 6 of the 7 cases. Two patients with granulocytic sarcoma dying within 100 days of presentation defined the last two cases. LIMITATIONS: There were relatively small numbers in each of the categories and the follow-up was limited in those cases where death was not reported. CONCLUSION: Cutaneous malignancies composed of CD4(+) CD56(+) hematopoietic cells define a varied group and oftentimes have an aggressive clinical course although not in every case.

Molecular classification of melanomas and nevi using gene expression microarray signatures and formalin-fixed and paraffin-embedded tissue.

Melanoma may be difficult to identify histologically and relatively high rates of misdiagnosis leads to many malpractice claims. Currently separation of melanomas from nevi is based primarily on light microscopic interpretation of hematoxylin and eosin stained sections with limited assistance from immunohistology. To increase the accuracy of discrimination of benign and malignant melanocytic lesions we identified DNA microarray-derived gene expression profiles of different melanocytic lesions and evaluated the performance of these gene signatures as molecular diagnostic tools in the molecular classification and separation of melanomas and nevi. Melanocyte-derived cells were isolated by laser capture microdissection from 165 formalin-fixed and paraffin-embedded melanocytic nevi and melanoma tissue sections. RNA was isolated, amplified, labeled, and hybridized to a custom DNA microarray. In all 120 samples were used to identify differentially expressed genes and generate a gene expression classifier capable of distinguishing between melanomas and nevi. These classifiers were tested by the leave-one-out method and in a blinded study. RT-PCR verified the results. Unsupervised hierarchical clustering identified two distinct lesional groups that closely correlated with the histopathologically identified melanomas and nevi. Analysis of gene expression levels identified 36 significant differentially expressed genes. In comparison with nevi, melanomas expressed higher levels of genes promoting signal transduction, transcription, and cell growth. In contrast, expression of L1CAM (homolog) was reduced in melanomas relative to nevi. Genes differentially expressed in melanomas and nevi, on the basis of molecular signal, sub classified a group of unknown melanocytic lesions as melanomas or nevi and had high concordance rates with histopathology. Gene signatures established using DNA microarray gene expression profiling can distinguish melanomas from nevi, indicating the feasibility of using molecular classification as a supplement to standard histology. Our successful use of a standard formalin-fixed and paraffin-embedded tissue further supports the practicability of combining molecular diagnostic testing with histopathology in evaluation of difficult melanocytic lesions.

Discohesive malignant melanoma simulating a bullous dermatoses.

A variety of clinical and histological presentations can accompany the evolution of malignant melanoma. Unusual cytological variants of malignant melanoma include balloon cell, signet ring cell, myxoid and other metaplastic changes. With the exception of a case of pemphigus-like changes associated with malignant melanoma in paraneoplastic pemphigus, acantholysis is not a common histopathological feature of malignant melanoma. We present two unique cases of malignant melanoma with varying degrees of extensive melanocytic discohesion in an acantholytic pattern mimicking pemphigus vulgaris, further referred to in this article as 'discohesive melanoma'. Routine direct immunofluorescence studies for pemphigus-related antibodies (IgG and C3) were negative. In one case, indirect immunofluorescence for desmoglein autoantibodies characteristic of pemphigus were negative, although positive antibodies to desmoglein 1 was detected using immunosorbent assay. The differential diagnoses and pitfalls in recognition of this unusual presentation of malignant melanoma along with possible pathogenetic mechanisms are discussed.

A novel glass slide filing system for pathology slides.

The availability of a collection of microscope glass slides for review is essential in the study and practice of pathology. A common problem facing many pathologists is the lack of a well-organized filing system. We present a novel system that would be easily accessible, informative, protective, and portable.

Practical and Sustainable Teledermatology and Teledermatopathology: Specialty Care in Cameroon Africa.

Teledermatology is a rapidly expanding niche within telemedicine still in its infancy. It has become increasingly more feasible in recent years with the expansion of information and communication technologies. Here, the authors present the details of their collaboration and propose a model for constructing a teledermatology network. In the year 2014, the authors' Dermatopathology institute in Torrance, California, partnered with Mbingo Baptist Hospital, a tertiary referral center in Cameroon, Africa. During this time, 145 cases were received. The authors present highlights of specific cases as well as the strengths and challenges encountered. They have found the use of the store and forward method to be an effective tool with an acceptable concordance rate. With basic bandwidth speeds and images taken with smart devices shared via email, providers are given the unique opportunity to provide specialty care and alleviate disease burden where dermatology and dermatopathology resources are scarce.

Keloidal Atypical Fibroxanthoma: Case and Review of the Literature.

Keloidal atypical fibroxanthoma (KAF) has recently been categorized as a variant of atypical fibroxanthoma. This paper will emphasize the importance of including KAF in both clinical and histological differential diagnosis of benign and malignant lesions which exhibit keloidal collagen and will also review the current literature on epidemiology, pathogenesis, histology, immunochemistry and treatments.

Eccrine poromatosis: case report and review of the literature.

Eccrine poroma (EP) is a benign tumor of the eccrine duct. Multiple EPs are defined as eccrine poromatosis (EPS), an uncommon phenomenon. To date there are only eight reported cases of EPS. This review exemplifies the epidemiology, pathogenesis, differential diagnosis, and histology of EP, while reviewing the eight cases of EPS. Six of the eight cases of EPS had a history of immunosuppression from either radiation or chemotherapy. This paper will also emphasize the importance of excision to avoid possible malignancy. Here we present a 73-year-old gentleman with EPS who was also treated with radiation and chemotherapy prior to the onset of the lesions.

Lymphocytic thrombophilic arteritis induced by minocycline.

Lymphocytic thrombophilic arteritis is an entity only recently defined in the literature. This term describes a distinctive histopathological combination of lymphocytic vascular inflammation associated with a hyalinized fibrin ring in the vessel lumina, changes reflecting a thrombophilic endovasculitis. The authors present the case of a woman who developed lymphocytic thrombophilic arteritis coinciding with the use of minocycline. In addition to these histopathological findings, the cutaneous manifestations of this case reflect previously reported clinical findings of progressive localized livedo racemosa characterized by reticular patchy hyperpigmentation predominately affecting the lower extremities.

Lip augmentation with liquid silicone.

BACKGROUND: Many fillers have been used to augment the lips. One of these that has provided long-term satisfactory results is liquid silicone. OBJECTIVE: To demonstrate the efficacy and safety of lip augmentation with liquid silicone. METHOD: Following a discussion of the benefits and risks of the procedure and the benefits and risks of alternatives and after answering all of the patients' questions, an informed consent form was signed. After obtaining anesthesia with a regional nerve block of the infraorbital and mental nerves, 0.25 to 0.5 cc of liquid silicone (1,000 centistokes) was injected using the microdroplet technique into the vermilion border of both the upper and lower lips. Depending on the desire of the patient, the procedure was repeated monthly. The augmentation of the lips was documented with histology, micrometry, and digital photography. RESULTS: Lip augmentation was achieved gradually during the months following liquid silicone injections into the vermilion border of the lips in the 608 patients studied. Most of the patients requested a second and third injection session. The results were most dramatic in the patients with type I and type II lips and less satisfactory in patients with type III lips. Bruising occurred in the majority of the patients. Eleven patients (2%) developed small palpable granulomas. These granulomas either required no treatment, responded to steroid injections, or were excised. CONCLUSION: The use of liquid silicone remains an effective method of lip augmentation. It returns the adolescent vermilion curl to the lips.