Diagnostic Pearls of Vulvar Epidermolytic Acanthoma: Case Report.

Epidermolytic acanthomas (EA) are uncommon benign tumors clinically presenting as single to multiple papules. Histologically, EA display hyperkeratosis, hypergranulosis, acanthosis, and epidermal degeneration-also known as epidermolytic hyperkeratosis (EH). EA may be misdiagnosed as condyloma both clinically and histopathologically when located on the genitalia. Thus, this diagnosis carries a significant psychological burden and must remain in the differential when initially considering genital warts. We utilize the case of a 62-year old female referred to dermatology for a 5-year history of multiple pruritic and hypopigmented vulvar papules-misdiagnosed as genital warts-to highlight the impact of differentiating EA from genital warts. This patient was initially misdiagnosed with common genital warts at her gynecologist's office and treated unsuccessfully for years. A shave biopsy was performed and histology revealed EH, consistent with EA.

Two Cases of Lepromatous Leprosy from Exposure to Armadillos in Florida.

The first patient was a 41-year-old white man who was referred to the dermatology clinic with a 2-year history of numerous erythematous, hypoesthetic, poorly demarcated papules and plaques present on the trunk, buttocks, and bilateral upper and lower extremities (Figures 1 and 2). The lesions had initially begun as localized erythematous plaques on the right flank, and were diagnosed and treated as cellulitis and allergic contact dermatitis by primary care on separate occasions, with no resolution and continued gradual but persistent spread.

Obesity and the incidence of skin cancer in US Caucasians.

BACKGROUND: Limited information is available on the potential link between obesity and either melanoma or non-melanoma skin cancers. OBJECTIVE: To conduct a prospective study to examine the association between obesity and the risk of both melanoma and non-melanoma skin cancers. METHODS: Using pooled data from two large national cohorts in the US, the Nurses' Health Study (NHS) and the Health Professionals Follow-up Study (HPFS), we prospectively examined the incidence of melanoma, squamous cell carcinoma (SCC), and basal cell carcinoma (BCC) among participants grouped according to body mass index (BMI). RESULTS: Compared to participants with an updated BMI in the normal range, those with a BMI in the obese range had a 32 % lower risk of developing SCC, and those with a BMI in the morbidly obese category had a 37 % lower risk of developing SCC. The decrease in SCC risk was limited to women. Compared to participants with a BMI in the normal range, those with a BMI in the obese range had a 19 % lower risk of developing BCC, and those with a BMI in the morbidly obese category had a 29 % lower risk of developing BCC. The risk of developing melanoma did not statistically differ by BMI grouping. The results were similar using BMI measurements obtained 10 years prior to the diagnosis of skin cancer. CONCLUSION: Obesity appears to be inversely associated with the development of non-melanoma skin cancers. Obesity is most likely a surrogate marker for lack of chronic sun exposure, which is a risk factor for non-melanoma skin cancers.

Urticarial hypersensitivity reaction caused by temozolomide.

Temozolomide is an oral alkylating agent approved for the treatment of glioblastoma and anaplastic astrocytoma, and is currently under clinical investigation for the treatment of brain metastases from a variety of cancers. Temozolomide is well tolerated, and the reported dermatologic side effects of this medication are limited. Here, the authors report the first case of an urticarial hypersensitivity reaction induced by temozolomide. As this drug will likely be increasingly utilized in the near future, it is important to be aware of its potential to cause adverse cutaneous manifestations.

The role of phototherapy in cutaneous T-cell lymphoma.

Cutaneous T-cell lymphoma (CTCL) is a type of non-Hodgkin's lymphoma characterized by the malignant proliferation of T lymphocytes in the skin. Phototherapy has been proven an effective treatment modality for CTCL, in particular early stage disease (patch and plaque). Specifically, broadband ultraviolet B (BB-UVB), psoralen and ultraviolet A (PUVA), and more recently narrowband UVB (NB-UVB) are the skin-directed phototherapies typically utilized. Phototherapy poses the risk of sunburn, photoaging and photocarcinogenesis. Combination therapies with IFN-alpha, retinoids (acitretin and isotretinoin) and rexinoid (bexarotene) are adjunctive systemic therapies that facilitate enhanced therapeutic response and often allow for lower doses of phototherapy. Extracorporeal photopheresis (ECP) has also been shown to be effective in more advanced stage disease.

The role of maintenance phototherapy in cutaneous T-cell lymphoma.

Phototherapy is well-recognized as effective therapy in early stage cutaneous T-cell lymphoma (patch and plaque), often resulting in complete clearance of clinical disease and subsequent remission. Although not curable, long-term remission can often be attained utilizing maintenance phototherapy, consisting of a course of less frequent treatments over time. Herein, the authors review the literature regarding the role of maintenance phototherapy in cutaneous T-cell lymphoma (CTCL) and its success in prolonging clinical remission and disease-free survival in CTCL.