Psoriasis associated with vulval scarring.

Psoriasis is a chronic inflammatory skin disorder which is generally not associated with scarring. We report two patients with long-standing severe anogenital psoriasis, that was associated with loss of the labia minora, thus clinically mimicking the scarring associated with lichen sclerosus. Histopathological finding were however, consistent with psoriasis with no evidence of lichen sclerosus. Elastic fibres were present and there was no evidence of abnormal collagen or fibrous tissue. The association of vulval psoriasis with scarring has not been reported previously.

A clinical study of 23 cases of female anogenital carcinoma.

BACKGROUND: Vulval carcinoma is a relatively rare disorder that may have various aetiologies. Objectives To document the features and outcome in a series of patients with this disorder. METHODS: Retrospective analysis of patients presenting to a vulval clinic over a 5-year period. RESULTS: Twenty-one women presented with a squamous cell carcinoma (SCC) and two with a verrucous carcinoma (VC). The age range was 43-83 years. Twenty-one had well-established (1-30 years) vulval symptoms prior to developing their tumour. Specific tumour-related symptoms ranged from 3 weeks to 11 months. Eight had had a prior diagnosis of lichen sclerosus (LS) or lichen planus (LP), only two of whom were on regular treatment and follow-up. At presentation, 12 patients had clinical signs of LS, three of LP, and five had some changes of both LS and LP. Two patients had multifocal vulval intraepithelial neoplasia (VIN3). Only one had no evidence of any background vulval skin disease. The commonest histological changes noted in the epithelium either adjacent to or distant from the SCC were those of atrophic LS (n = 8), LS with squamous cell hyperplasia (n = 3), LS with hyperplastic foci and lichenoid infiltrate (n = 4), and LS with differentiated VIN3 (n = 1). Four cases demonstrated the changes of LP, and three showed VIN3. All patients were treated surgically and, in those who had lymphadenectomy, four had positive nodes. There have been two deaths due to metastatic disease, and one further patient has developed a second primary SCC at a different site. CONCLUSIONS: An underlying skin disorder prior to the development of their carcinoma was found in 22 of 23 patients with vulval SCC and is therefore an important risk factor.

An unusual case of purpuric erythropoietic protoporphyria.

Erythropoietic protoporphyria (EPP) is the most common of the erythropoietic porphyrias. Recent advances in diagnostic laboratory tests have led to the discovery of a number of previously undiagnosed cases. We describe a case of EPP presenting late with a purpuric eruption and discuss the pathogenesis and significance of purpura in EPP.

Successful surgical treatment of severe pretibial myxoedema.

We report a 46-year-old man with severe and long-standing pretibial myxoedema, who responded well to local surgical treatment. This improvement has been maintained over a 12-month period, perhaps because of concomitant treatment with octreotide.

Primary systemic amyloid with nail dystrophy.

We report a patient with the classical cutaneous findings of primary systemic amyloidosis, due to myeloma. He had developed a nail dystrophy, which is a recognized, but rare, feature in systemic amyloid.

Comedonal Darier's disease.

Darier's disease is an inherited disorder with well-recognized patterns of presentation. Lesions commonly affect the trunk and flexures. The diagnosis is based on the typical clinical appearance and histology showing acantholytic dyskeratosis. We report two unusual cases with prominent nodular, comedonal lesions on the face and scalp.

The use of cytology in the diagnosis of basal cell carcinoma.

Two hundred and forty patients with basal cell carcinomas (BCCs) on the head or neck were studied. Scrapings of the lesions were taken for cytological examination, and a 3-mm punch biopsy was performed for histopathological study. The accuracy of diagnosis by each method was compared. Both methods confirmed the clinical diagnosis in 226 cases, and both were negative in 10 cases. Cytopathology gave one false negative result (0.42%), and histopathology gave two false negative results (0.83%). Cytopathology gave one false positive result (0.42%), and histopathology did not produce any false positive results. We conclude that cytological examination of skin scrapings from suspected BCCs is a rapid and reliable method of diagnosis.

Bizarre parosteal osteochondromatous proliferations of the tubular bones of the hands and feet.

A case of a rare condition with which dermatologists are unlikely to be familiar is presented. The lesions involve the tubular bones and therefore usually present to orthopaedic surgeons. This is the first case affecting a distal phalanx to be reported.

Plane xanthomatosis with chronic lymphatic leukaemia.

A case of plane xanthomatosis in a 67-year-old woman, suffering from chronic lymphatic leukaemia, who developed asymptomatic yellow plaques on the neck, upper arms and chest is reported. Histology was suggestive of xanthelasma. Development of plane xanthomata has been reported in association with various haematological malignancies and with benign monoclonal gammopathies, but not previously with chronic lymphatic leukaemia.

The tissue distribution of factor XIIIa positive cells.

Factor XIIIa has previously been used to identify a subgroup of dermal dendritic cells which co-express class II MHC antigens, intercellular adhesion molecule-1 (ICAM-1) and lymphocyte function associated antigen-1 (LFA-1), leading to the suggestion that they play a central role in skin immune responses. To examine whether these cells may also be important constituents of other organs we have performed an immunohistochemical survey of normal tissue to identify the distribution of this factor XIIIa positive subgroup of dendritic cells in humans. Routine tissue sections from a range of organs were assayed for factor XIIIa expression using a standard peroxidase-antiperoxidase (PAP) immunolabelling technique. Dendritic, factor XIIIa positive cells were observed in all tissues studied, but were most numerous in skin and mucosal tissues (gastrointestinal tract, bladder). They were also observed associated with epithelial structures in lung and kidney, but were only rarely observed in liver, thyroid, testis and spleen. The distinctive distribution of these cells is consistent with an important role for them in immune responses at those sites.