Amelanotic lentigo maligna melanoma: a diagnostic conundrum-- presentation of four new cases.

BACKGROUND: The clinical appearance of amelanotic lentigo maligna melanoma (ALMM) is quite confusing and usually is not diagnosed prior to histopathologic examination. METHODS: We have studied four new patients with ALMM whose correct diagnosis was not obtained from any one clinical finding. We arrived at the final diagnosis in an unexpected way, having had biopsied the lesions for diagnoses other than malignant melanoma. RESULTS: ALMM presents as a nonspecific skin lesion with no single indicative characteristic. A search of the literature confirmed our difficulty in making the diagnosis. CONCLUSIONS: To diagnose ALMM, one has to be cognizant of this condition and has to consider a constellation of findings that are unusual with melanocytic lesions. Questionable lesions must be biopsied for definitive histopathologic diagnosis.

Cost reduction of skin biopsy and surgical instrumentation.

Saving the physicians time is very desirable in rendering first-rate dermatological service at lower cost. The aim is to reduce surgical instrumentation during skin biopsy procedures and follow-up visits. A combined instrument is used to obtain skin biopsies from 100 patients, and gelatin sponge plugs are used in hemostasis and to assist healing of the biopsy wound site. Skin biopsy samples are obtained simply and with ease, and, as the tissue sample is handled minimally, it appears to be more intact and less distorted in comparison to the usual procedure. Skin biopsy samples can be obtained with the combined instrument in a more cost-effective manner with savings of the physician's time and less instrumentation.

Pilary complex carcinoma: an adnexal carcinoma of the skin with differentiation towards the components of the pilary complex.

We report twelve cases with a distinctive form of adnexal carcinoma occurring most commonly over the head and neck of relatively old individuals. The growth was single in all cases, deep dermal in location, and consisted of massive proliferation of small basaloid cells with only occasional connection with the surface epidermis. The basaloid tumor masses showed only a few areas of palisading of their outer cell nuclei and occasional retraction space formation. The neoplasm revealed scattered areas of trichilemmal and epidermoid keratinization, foci of sebaceous, and areas of sweat ductal differentiation indicating participation of various components of the pilary complex.

[Autopsy results and malpractice expert assessment]. / Sektionsergebnis und Kunstfehler-Gutachten.

39 deaths, in which medical malpractice was suspected and forensic autopsy therefore was carried through, were examinated. Among 22 cases with manifest malpractice not sufficient diagnosis, not adequate anamnesis and mistakes related with surgical treatment are dominant. If any deciding factors refer to medical malpractice, a specialists opinion of the respective discipline should be taken together with medicolegal opinion. In such cases it proved to be useful, when medicolegal expert has a coordinating function.

Histochemical differentiation of localized morphea-scleroderma and lichen sclerosus et atrophicus.

Dermatologic literature has debated the occurrence of concomitant morphea-scleroderma (M-S) and lichen sclerosus et atrophicus (LSA) for sometime. Presentation of a case which has the appearance of both M-S and LSA creates a diagnostic dilemma frequently unresolved even by histopathology. Routine hematoxylin and eosin stained sections may add to the confusion and the difficulty of the differentiation, but examination for the presence or absence of elastic fibers in the upper corium of the lesions affords a definitive separation of these two conditions.

Development of proliferating trichilemmal cyst in organoid nevus. Presentation of two cases.

One of the two types of complications that may occur with organoid nevus (nevus sebaceus) is the category of brain malformations and seizure disorders. The second type is the late occurrence of various epithelial growths that are usually observed to develop in long-standing organoid nevi. Among these later-occurring lesions, we are describing the occurrence of proliferating trichilemmal cysts in association with organoid nevi.

Adnexal displacement and regression in association with histiocytoma (dermatofibroma).

The literature about the changes occurring in histiocytomas mentions only the possibility of induction of primitive pilosebaceous structures and basal cell epithelioma-like lesions by the histiofibrocytic growth. We suggest here that the histopathologic findings are indicative of regressive changes of the pre-existing cutaneous adnexa resulting in the formation of basal cell epithelioma-like structures.

Syringoacanthoma. Acanthotic lesion of the acrosyringium.

An acanthotic and papillomatous cutaneous lesion with a seborrheic verruca (keratosis)-like clinical appearance that, under light microscope examination, shows intermingling of sweat ductal and epidermal cells is described. Other lesions related to the distal end of the eccrine sweat duct have been recorded before, but these lesions, named syringoacanthoma herein, have not been described previously, to my knowledge. Twenty-one cases of syringoacanthoma , 12 benign and nine malignant, are reviewed and their relationship with similar lesions is discussed.

Hidroacanthoma simplex--a review of 15 cases.

Hidroacanthoma simplex was first described in 1956, but because of its rarity there is still confusion regarding the nomenclature of this and similar entities. The histological features of fifteen cases are presented and the literature is reviewed.

Eccrine adenocarcinoma. A clinicopathologic study of 35 cases.

A clinicopathologic study was made of 35 patients with primary eccrine adenocarcinoma diagnosed in the past 20 years from among 450,000 consecutive skin biopsy specimens. Histologically the following four distinct variants were identified: eccrine porocarcinoma (18 cases), syringoid eccrine carcinoma (12 cases), mucinous eccrine carcinoma (three cases), and clear cell eccrine carcinoma (two cases). Overall, eccrine adenocarcinomas are destructive lesions with a tendency to local recurrence. The syringoid histologic variant appears to be well differentiated and may have a benign clinical course; the lesion remained localized to the skin in our 12 cases. Regional lymphatic and distant metastasis, however, occurred in two patients with eccrine porocarcinoma.

Basal cell epithelioma (carcinoma) in children and teenagers.

Among over 390,000 routine dermatopathologic specimens there were 85 cases diagnosed as basal cell epithelioma (carcinoma) (BCE) in persons 19 years old or younger. This number was refined to 40 cases de novo BCE in children and teenagers. Basal cell epithelioma unrelated to other conditions is rare in the young and it should be differentiated from similar fibroepithelial growths.