Systemic retinoids for chemoprevention of non-melanoma skin cancer in high-risk patients.

Patients at high risk for the development of multiple non-melanoma skin cancers, especially those receiving immunosuppressive medications following solid organ transplantation, are candidates for chemoprophylaxis. In patients where photo-protection and topical medications are insufficient to prevent the growth of new cancers, there is considerable evidence that oral retinoids, including vitamin A, and synthetics such as isotretinoin, etretinate and acitretin are efficacious in this regard. This manuscript is a review of the literature regarding the use of these agents for chemoprophylaxis of non-melanoma skin cancer. Also included is anecdotal evidence that bexarotene, a rexinoid, may be as effective as acitretin in terms of chemoprevention, with a comparable side effects at doses recommended for chemoprophylaxis.

Unilateral lichen planus pigmentosus mimicking acral lentiginous melanoma.

The authors report a case of a Latin American woman who developed progressive pigmentation primarily involving two digits of her right hand. She was scheduled for amputation based on a presumptive histologic diagnosis of melanoma with regression. Dermatology consultation with repeat biopsies disclosed a lichenoid tissue reaction with marked pigment incontinence and no evidence of melanoma. This report should prompt physicians to include lichen planus pigmentosus in the differential diagnosis of acral lentiginous melanoma.

Familial pityriasis rubra pilaris: report of a family and therapeutic response to etanercept.

Pityriasis rubra pilaris (PRP) is an uncommon dermatosis of unknown etiology. The familial subtype is rare and usually presents as type V PRP. It is generally inherited in an autosomal dominant fashion with variable expression. Other forms of inheritance, such as autosomal recessive and X-linked, have also been reported. The use of etanercept in treating resistant forms of PRP is promising given reports of its success in a few cases. Herein, the authors report two cases of PRP arising in a mother and son and review the rare familial subtype of this disease. In addition, a successful therapeutic trial of etanercept was initiated in the mother based on case reports of its efficacy in other patients with PRP.

Primary cutaneous angioimmunoblastic T-cell lymphoma histologically mimicking an inflammatory dermatosis.

Angioimmunoblastic T-cell lymphoma (AITL) is a systemic lymphoproliferative disease characterized by a polymorphous neoplastic infiltrate involving lymph nodes as well as extranodal locations, including the skin. Cutaneous involvement is seen in approximately 50 percent of cases and is usually secondary to systemic disease. Patients with cutaneous involvement classically present with a transient morbilliform eruption of the trunk; however, papules, nodules, urticarial plaques and erythroderma have also been reported. In contrast, primary cutaneous AITL is exceedingly rare. The authors report a case of a 79-year-old woman with AITL who presented with primary cutaneous tumors and ulcerated nodules, with no evidence of systemic involvement, hypergammaglobinemia, or B symptoms. Histologically, a subtle lymphoid infiltrate was present, dominated by marked fibrosis and a diffuse infiltrate of neutrophils, eosinophils and plasma cells, mimicking an inflammatory or infectious etiology. This presentation presents a unique diagnostic challenge; careful investigation and strong clinical suspicion must be utilized in order to correctly identify AITL in this setting.

Histopathology of cutaneous squamous cell carcinoma and its variants.

Squamous cell carcinoma is the second most common type of skin cancer, causing approximately 2,500 deaths in the United States each year. The principle risk factor for its development is ultraviolet light exposure. Conventional clinical and pathologic attributes of this neoplasm include an ulcerating papule located in a sun-exposed site with histologic sections showing an infiltrating neoplasm comprised of keratinizing epithelioid cells. Several histologic variants of squamous cell carcinoma with distinctive clinical and pathologic attributes including Bowen's disease, keratoacanthoma, acantholytic, spindle cell, desmoplastic, and verrucous and pigmented types have been described and are the topic of discussion in this article.