Multiple cranial neuropathies associated with leprosy.

We report on a Samoan man with dysphagia, voice hoarseness, facial erythema, and edema. Neurologic examination revealed hypesthesia at the site of the facial rash, enlarged auricular nerves, a right facial palsy, decreased gag reflexes, and voice hoarseness. Laryngoscopic examination showed paralysis of the left vocal cord, and a barium swallow revealed a possible compressive lesion. A skin biopsy specimen was diagnostic of tuberculoid leprosy. This patient has an unusual case of leprosy with multiple cranial neuropathies.

Primary cutaneous adenoid cystic carcinoma treated with Mohs micrographic surgery toluidine blue technique.

A patient with primary cutaneous adenoid cystic carcinoma treated with Mohs surgery is presented. This tumor is characterized clinically by frequent local recurrences and infrequent metastases. Histologically it demonstrates cribiform islands of tumor cells with an abundance of mucin. Because toluidine blue stains this mucin metachromatically, it may be superior to hematoxylin and eosin for identifying the presence of this tumor. We recommend Mohs micrographic surgery with toluidine blue staining technique for the treatment of adenoid cystic carcinoma.

Scar sarcoidosis in pseudofolliculitis barbae.

A man with hilar adenopathy had smooth firm purplish papules (lupus pernio) on his face and pseudofolliculitis barbae (PFB) in his beard area. Biopsies of papules of both the lupus pernio and the PFB revealed non-caseating granulomas consistent with sarcoidosis. This is the first case report of sarcoidosis infiltrating lesions of PFB and the first of lupus pernio co-existing with scar sarcoidosis. In persons with suspected sarcoidosis, enlarged lesions of PFB are sites suitable for confirmatory biopsy. In addition, persons who develop keloid-like papules within their PFB may be providing an early cutaneous clue to undiagnosed systemic sarcoidosis.

Infiltrating lipomas of the upper extremities.

The typical lipoma is an encapsulated subdermal tumor, usually easily removed if necessary. We recently encountered two lipomas that infiltrated muscles of the forearm. Excision of infiltrating lipomas may be complicated by their deep location and potential involvement of vascular and neural structures. This paper should increase dermatologists' awareness of this uncommon variant and facilitate appropriate referral for definitive treatment. We believe that this is the first report in the dermatologic literature of infiltrating lipoma of the upper extremity.