Atypical presentation of cutaneous lupus mucinosis.

OBJECTIVE: To describe the epidemiological, clinical, and serological features of cutaneous lupus mucinosis and its relationship to systemic lupus erythematosus as well as elucidate the histopathological features of cutaneous lupus mucinosis and describe how these features differ from tumid lupus erythematosus. DESIGN: Case review and assessment of the literature. SETTING: University academic setting. PARTICIPANT: One patient. RESULTS: The authors report a case of antinuclear antibody negative cutaneous lupus mucinosis in a patient without systemic involvement who responded to hydroxychloroquine and intralesional triamcinolone. A review of the literature found 30 reported cases of cutaneous lupus mucinosis, three of which were antinuclear antibody negative and the majority had systemic lupus erythematosus. The most common therapy reported is systemic corticosteroids; however, the patient described in this case had significant improvement of the lesions with only intralesional steroid injections and hydroxychloroquine. Considering the proportion of patients with cutaneous lupus mucinosis who progress to systemic lupus is uncertain, the authors suggest following these patients closely for evidence of multisystem disease. CONCLUSION: The authors report a case of antinuclear antibody-negative cutaneous lupus mucinosis in a patient without systemic lupus erythematosus who responded to hydroxychloroquine and intralesional triamcinolone. Given the rarity of this condition and reported association with systemic lupus erythematosus, it is important to follow these patients clinically for any signs or symptoms of systemic involvement.

Frontalis midline dehiscence: an anatomical study and discussion of clinical relevance.

HYPOTHESIS: The frontalis muscle has a midline dehiscence that has not been well described. The anatomic characteristics of the muscles of the central forehead are important to effectively treat rhytids in this area, e.g. with botulinum toxin. METHODS: Anatomical dissections of 21 cadaver foreheads. RESULTS: For males, the midline attenuation point occurred in a range from 1.4 to 6 cm above the horizontal orbital rim plane, with the mean being 3.5+/-1.6 cm. The mean angle of the left muscle belly in the male cadavers was 26.0+/-17.4 degrees off the midline, while the right was 36.4+/-14.9 degrees. Overall average angulation was 62.4 degrees (Figure 4). The mean distances between left and right muscle bellies at 4 cm, 5 cm and 6 cm superior to the orbital rim were 1.2 cm, 1.9 cm and 3.1 cm, respectively. The mean distance of dehiscence in the midline from the horizontal reference plane of the female cadavers was 3.7+/-1.8 cm, with a range of 1.3 to 6.0 cm. The left frontalis belly formed an angle with the midline of 15.9+/-16.6 degrees, while the right belly formed an angle of 22.3+/-20.1 degrees, with an overall average angle of 38.2 degrees. The interbelly distances at 3, 4, 5 and 6 cm were 0.4 cm, 0.9 cm, 1.7 cm and 2.6 cm, respectively. One third of females had no midline frontalis dehiscence at 6 cm above the orbital rims. CONCLUSIONS: The anatomic characterization of the midline frontalis muscle dehiscence permits more intelligent placement of chemotherapeutic agents when treating forehead rhytids.

Incidental microscopic foci of nevic aggregates in skin.

Microscopic foci of nevic aggregates have been described in normal lymph nodes, where they may pose diagnostic challenges to pathologists. In the course of our practice, we have observed a similar phenomenon in cutaneous tissue. For this reason, we performed a retrospective study of cutaneous excisions over a 1-year period to better characterize this observation. We reviewed 2482 pathology reports of cutaneous excisions, of which 0.8% were associated with such microscopic foci of incidental nevic aggregates. Incidental nevic aggregates were typically dermal in nature and found commonly in excisions from the head and neck region. They were clinically unapparent, with a maximum mean horizontal and vertical diameter of 0.86 mm (0.3-1.5 mm) by 0.46 mm (0.1-1.3 mm). The nevic aggregates were separate and located in normal skin, away from any associated tumors or scar tissue. Although their etiology remains unknown, we hypothesize a derivation from dermal melanocytes, in keeping with the Hochsteigerung theory of nevogenesis. The purpose of this study is to draw attention to the existence of incidental cutaneous nevic aggregates, thereby alerting pathologists and dermatopathologists to their potential as a diagnostic pitfall, especially in the setting of concurrent primary cutaneous malignant melanoma or melanoma in situ.