Congenital spitz nevus.

BACKGROUND: Congenital Spitz nevus has been reported previously in the literature, but the histopathologic features have not been examined in detail. OBJECTIVE: To histologically examine and report on congenital Spitz nevus. METHOD: We examined 10 clinically submitted congenital melanocytic nevi that were histopathologically identified as congenital Spitz nevi and compared them to the characteristics seen in acquired Spitz nevus and superficial congenital melanocytic nevus. RESULTS: Of the 10 congenital Spitz nevi, 9 were compound and 1 was dermal. Two showed features of combined Spitz nevus (Spitz and blue). Six cases showed all 16 listed characteristics of acquired Spitz nevus, with two cases having 15 and two cases having 14 characteristics. Of the superficial congenital melanocytic nevus characteristics, all except three cases had all 12 attributes. The one dermal lesion had all the characteristics of the acquired Spitz nevus and all but one of the characteristics of the superficial congenital melanocytic nevus in regards to intradermal findings. CONCLUSIONS: Congenital Spitz nevi are true congenital lesions, with histopathologic features of both acquired Spitz nevus and superficial congenital melanocytic nevus.

Cutaneous squamous cell carcinomas consistently show histologic evidence of in situ changes: a clinicopathologic correlation.

Squamous cell carcinoma on sun-damaged skin is a malignant neoplasm that evolves from its inception as squamous cell carcinoma in situ, which is commonly referred to as an actinic keratosis. In this study, we reviewed 1011 squamous cell carcinomas on sun-damaged skin and found that nearly 100% of these lesions contained histopathologic changes consistent with squamous cell carcinoma in situ at the periphery or within the confines of the squamous cell carcinoma. These malignant changes began in single layer areas of the lower epidermis and evolved into the epidermis and dermis.

Superficial congenital compound melanocytic nevus. Another pitfall in the diagnosis of malignant melanoma.

METHODS: We reviewed the histology of 42 superficial congenital compound melanocytic nevi and found features that simulate malignant melanoma. In some, there were asymmetry and poor circumscription, an increased number of single melanocytes, which predominated over nests of melanocytes in some high power fields, single melanocytes were not equidistant from one another, scatter of single melanocytes was above the dermoepidermal junction, and there was confluence of nests of melanocytes, which are features in common with a malignant melanoma. RESULTS: Fifty-six percent of the cases had three to four criteria present, and 92% of the cases had three to six criteria present. The mean age of the patients at the time of biopsy was 20 years, and the mean size of the nevus at time of biopsy was 1.7 cm. CONCLUSIONS: Appreciation that simulation of a melanoma in situ by the epidermal component of a superficial congenital compound melanocytic nevus in older children and adults is an expected finding and may be similar to congenital nevi biopsied shortly after birth has not been emphasized. Awareness of these simulants may prevent misinterpretation of a benign superficial congenital compound melanocytic nevus as a malignant melanoma.

The evolution of pyoderma gangrenosum. A clinicopathologic correlation.

Pyoderma gangrenosum is a well-known clinical cutaneous condition, that has had a variety of conflicting microscopic descriptions. In an attempt to further our understanding of this condition, we obtained nine skin biopsy specimens of evolving, fully developed, regressing, and resolved lesions from six patients with pyoderma gangrenosum. We found that histopathologically, pyoderma gangrenosum evolves from folliculitis and abscess formation; it may also show leukocytoclastic vasculitis. The lesions then evolve to suppurative granulomatous dermatitis and finally regress with prominent fibroplasia. We illustrate the clinical and microscopic features herein and compare them to previous descriptions.

Pulsed dye laser treatment of recalcitrant verrucae: a preliminary report.

Patients with recalcitrant warts on the fingers and hands, periungual, and other parts of the body including verrucae plana and plantar surfaces were treated using the pulsed dye laser at 585 nm, 450 usec, and a spotsize of 5 mm diameter. Of the 39 patients treated, 28 (72%) were cleared of their warts after an average of 1.68 treatments at fluences of 6.25-7.5 J/cm2. Seven (18%) patients had a reduction of between 80-95% of their warts after 1.3 treatments, and verrucae reduced by 50% in four of the 39 patients after one treatment. The average follow-up period of the 28 cases cleared of their warts has been 5 months. Of this group, those with periungual warts have been followed for up to 6.4 months, compared to 4.8 months for those with warts on other parts of their body, 4.0 months for those with finger and hand warts, and 2.0 months for plantar warts. Only one of the 28 patients has had a recurrence after 3 months of clearance.

Warts: benign or malignant?

The number of identifiable types of human papillomavirus (HPV), based on deoxyribonucleic acid (DNA) sequence, has steadily increased in recent years. Although at one time verruca vulgaris was considered a benign reactive proliferation, current evidence submits that this is not the case; some types of HPV are malignant.

The cutaneous pathology of atopic dermatitis.

Sixteen skin biopsy specimens from early eruptive, evolving papules and well-developed plaques were obtained from eight patients with established atopic dermatitis. We found that the chronological and histopathological sequence begins with a perivascular interstitial spongiotic dermatitis, evolves into a psoriasiform microvesicular spongiotic dermatitis, which is sometimes focally lichenoid, and eventually concludes as a psoriasiform dermatitis. Thus, atopic dermatitis has characteristic and diagnostic histopathologic findings. These are portrayed and contrasted to what has been previously reported.

Keratotic melanocytic nevus.

Thirty-five percent of 363 melanocytic nevi were found to have a keratotic epithelial architectural pattern that was mostly infundibular and not previously emphasized. Keratotic melanocytic nevi were commonly from the trunk of women, and most were associated with an intradermal melanocytic nevus. The clinical and histopathologic features as well as a review of the literature of these keratotic melanocytic nevi are presented.

Port wine stain: a new therapeutic approach to an old birth defect.

A new treatment is available for port wine stains (PWS), which are congenital malformations. Both children and adults now can be treated by selective photothermolysis with a flashlamp, pumped, tunable, dye laser. Careful attention to the laser characteristics of pulse-width and dose allows significant lightening of PWS with minimal change in skin texture.

Steroid acne.

Steroid acne has become more common since the advent of organ transplant surgery and oncologic treatment regimens. Although its precise pathogenesis is still uncertain, the accelerated chronologic sequence of infundibular spongiosis, hyperkeratosis, microcomedo formation, and rupture is crucial to the development of the papules and papulopustules.

Flat fixation technique for shave biopsy specimens: stick & shake.

Curling of thin-shaved biopsy specimens is not uncommon in formalin-fixed tissue. The distorted tissue may cause improper orientation, with subsequent tangential sections by the histotechnician and misinterpretation by the pathologist. We describe a simple "stick & shake" fixation technique, performed by the surgeon at the time of shaving, which flattens the biopsy specimen, and thus reduces the possibility for curling. This technique is especially useful in the interpretation of difficult neoplasms, where visualization of the periphery (shoulders) is crucial for accurate diagnosis, e.g., dysplastic melanocytic nevi.

Painful papule of the ear: a follicular disorder.

The etiology of painful papule of the external ear, chondrodermatitis nodularis chronica helicis, has been an enigma for over half a century. I reviewed 84 skin biopsy specimens from 82 patients with this histopathologic diagnosis and found evidence that the infundibular portion of the hair follicle is probably the primary cutaneous structure involved in this condition. This lesion appears to evolve from an acute, suppurative, granulomatous dermatitis into a later-fibrosing dermatitis having the clinical and histologic features of perforating folliculitis and prurigo nodularis.

Bowenoid papulosis and squamous cell carcinoma of the genitalia: suspected sexual transmission.

The human papillomavirus causes a variety of genital lesions: condyloma acuminatum, bowenoid papulosis (carcinoma in situ), and squamous cell carcinoma. Only condylomata have been documented to be sexually transmitted. We report clinical and histopathologic evidence of suspected female to male transmission of bowenoid papulosis to the penis from a woman with condylomata acuminata, squamous cell carcinoma in situ, and focally invasive squamous cell carcinoma of the vulva. These findings indicate a need for thorough clinical and histopathologic evaluation of any anogenital lesions resembling condylomata and occurring in sexual partners. Conservative yet thorough destruction of bowenoid papulosis and squamous cell carcinoma in situ appears to be the treatment of choice.