A Rare Case of Trichilemmal Carcinoma: Histology and Management.

Trichilemmal carcinoma (TC) is a rare cutaneous tumor thought to be derived from the follicular outer root sheath (ORS). It often manifests as a nondescript skin-colored or pink papule on the hair-bearing, sun-exposed anatomic sites of elderly patients. Trichilemmal carcinoma shows many histologic features reminiscent of follicular ORS-notably, its glycogen-rich clear cells, trichilemmal keratinization, and similar immunostaining profile. Historically, it has been described as following a relatively indolent clinical course, but cases of recurrence, local aggression, and distant metastases have recently been elucidated. Here, we report the case of a 66-year-old male patient who presented with an asymptomatic, erythematous plaque on his neck; biopsy confirmed a diagnosis of TC. The patient deferred Mohs micrographic surgery in favor of wide local excision and was treated successfully with 3-mm margins. Salient histopathologic features, treatment modalities, and management recommendations are discussed.

A Rare Case of Oral Mucosal Amelanotic Melanoma in a 77-year-old Immunocompromised Man.

Primary mucosal melanomas are rare neoplasms that occur in the mouth, esophagus, nasopharynx, larynx, and anogenital mucosa. Mucosal melanomas are rare, accounting for approximately one percent of all melanomas. Of the mucosal melanomas that occur in the head and neck, oral mucosal melanomas compose approximately 25 percent. Here, we present a case of an amelanotic oral mucosal melanoma of the mucosal lip in a 77-year-old male patient with a history of non-Hodgkin's lymphoma and multiple basal and squamous cell carcinomas. The patient presented with a pink, nonpigmented, pedunculated mass on the left superior mucosal lip. Histopathologic examination of the biopsy specimen revealed a diagnosis of a superficial spreading type of malignant melanoma with a nodular component. The patient was referred to a tertiary care center for further management. Multiple risk factors exist for developing melanoma, including immunosuppression. Lymphoproliferative disorders, such as non-Hodgkin's lymphoma, lead to inherent immunosuppression, which can be exacerbated by chemotherapy treatments. Cases of oral mucosal melanoma have a poor prognosis due to delayed diagnosis, anatomic location, and aggressive behavior. Surgical resection is first-line therapy, with regional lymph-node dissection of the neck is recommended in most cases. Radiotherapy and targeted molecular therapy, such as c-KIT inhibitors, can also be used.

Not Your Average Skin Cancer: A Rare Case of Pilomatrix Carcinoma.

Pilomatrix carcinoma is a rare malignancy stemming from aberrant proliferation of matrical cells found in developing hair. This neoplasm demonstrates a bimodal age distribution and a proclivity for developing on the head or neck. Clinically, a firm, painless, violaceous nodule with overlying ulceration is commonly described. Pilomatrix carcinoma is considered a variable-grade malignancy that tends to be locally aggressive, though metastatic disease occurs in 10 to 16 percent of cases. Mortality rates range from 7 to 9 percent. Although there is no definitive treatment protocol, surgical intervention in the form of local excision or via Mohs micrographic surgery can be considered, with radiotherapy adopted as an effective alternative for nonsurgical, recurrent, or metastatic disease. Here, we describe the case of a 62-year-old man who presented for evaluation of a red, enlarging lesion on his forehead which became tender and started to bleed shortly before the patient presented to our clinic. The patient was ultimately referred to a tertiary care center for surgical excision and, at the time of this pubilcation, has been tumor-free for more than one year. This case of a rare and often unconsidered neoplasm underscores the importance of clinical suspicion and close patient follow up to prevent local recurrence, metastasis, and death.

Acral Lentiginous Melanoma: A Rare Variant With Unique Diagnostic Challenges.

Acral lentiginous melanoma (ALM), named for its location and histological growth pattern, is a rare variant of melanoma. ALM presents on palms, soles, or in association with the nail unit. While ALM accounts for approximately 5% of melanomas diagnosed each year, it is the most commonly diagnosed subtype of melanoma in non-Caucasian patients, and it is most likely to be diagnosed in the seventh decade of life. We present a case of a 72-year-old, Fitzpatrick skin type (FST) 5 female who presented to our clinic with a chief complaint of a slowly enlarging dark brown patch with a variation of pigment changes that had been present for 10 years on her right plantar surface. Biopsy obtained for hematoxylin and eosin (H&E) revealed malignant melanoma in situ, acral lentiginous type. Here, we will discuss the unique pathogenesis of ALM, as well as, its characteristic clinical and histological findings. Furthermore, this case underscores the importance of physician and patient education to raise awareness of this rare type of melanoma, specifically in patients with skin of color in hopes of decreasing time to diagnosis and improving prognosis.

Drug-induced anti-Ro positive subacute cutaneous lupus in a man treated with olmesartan.

A 66-year-old man presented to the outpatient dermatology clinic with a chief complaint of a pruritic rash on his upper trunk and proximal upper extremities, which had been present for three weeks. Upon examination, he was found to have an erythematous, annular, and polycyclic eruption on the chest, upper back, and proximal extremities. A clinical diagnosis of subacute cutaneous lupus erythematosus (SCLE) was made. The patient was found to have a positive anti-nuclear antibody (ANA) in a speckled pattern and a positive anti-Ro antibody. A biopsy revealed an interface and lichenoid dermatitis with dermal mucin deposition, consistent with subacute cutaneous lupus erythematosus. The patient reported that he had recently been diagnosed with hypertension and began treatment with olmesartan, a potassium-sparing diuretic that blocks the angiotensin II receptor, commonly used as an antihypertensive or in patients with heart failure. Cutaneous reactions to olmesartan are rare and reported in <1% of patients in post-marketing surveillance. The patient discontinued use of olmesartan and the rash completely resolved within three weeks. To date, there are no other reported cases of drug induced SCLE in patients taking olmesartan to our knowledge.

Cutaneous angiosarcoma of the leg.

Angiosarcomas are malignant neoplasms arising from endothelial cells. Cutaneous angiosarcoma is the most common form, typically occurring in the setting of chronic lymphedema or previous radiation. The head and neck are the most common locations for cutaneous angiosarcoma, with rare occurrence on the trunk and extremities. Herein, we present a case of angiosarcoma on the lower extremity in an elderly man. This 71-year-old man presented with a two-year history of red-yellow discoloration of the left lower leg with subsequent development of black nodules over the past several months prior to presentation. He denied any itching, bleeding, or ulceration. Past medical history included diabetes, hypertension, and non-melanoma skin cancer. Physical examination showed erythematous, violaceous, non-blanchable papules with yellow atrophic regions and overlying black crusted nodules and plaques. Biopsies were taken and the patient was diagnosed with angiosarcoma and referred to a tertiary care center for further evaluation.

A Rare Case of Cutis Verticis Gyrata with Underlying Cerebriform Intradermal Nevus.

Cutis verticis gyrata (CVG) is an uncommon condition of the scalp known for redundant, thickened folds, which emulate the cerebral gyri of the brain. This unusual finding is catalogued as primary essential, primary non-essential, and secondary. While primary essential CVG is an isolated and idiopathic condition, primary non-essential CVG is deemed to be related to neurological, ophthalmological, or psychiatric disorders. Secondary CVG may be due to a variety of systemic disorders, inflammatory dermatoses, or cutaneous neoplasms or infiltrates. This report serves as an example of secondary CVG due to a cerebriform intradermal nevus, with specific focus on clinical course, treatment options, and critical screening guidelines for these patients.

Melanoma Masquerading as a Zosteriform Rash.

BACKGROUND Primary care physicians and internal medicine specialists frequently encounter a variety of rashes. Many of these cases look and feel typical of common entities, resulting in the potential for misdiagnosis. CASE REPORT This is a case of a zosteriform rash where the surprising true diagnosis of metastatic melanoma was confirmed with bedside skin punch biopsy. Possible mechanisms involve direct cutaneous injury, neuronal, and dorsal root ganglia involvement in metastases. CONCLUSIONS Skin biopsy is indispensable especially when there is a lack of clinical response or deterioration in the clinical condition. The pathophysiology of zosteriform metastasis is unclear.