Recalcitrant Verrucae in Patients With DOCK8 Deficiency.

An 18-year-old Caucasian man presented with extensive recalcitrant verrucae on his trunk and extremities that were unresponsive to cryotherapy, salicylic acid, topical imiquimod, CO2 laser, candida antigen, and intralesional bleomycin. He had a diagnosis of hyperimmunoglobulin E syndrome until 2011, when he was determined to have DOCK8 immunodeficiency after genetic testing at the National Institutes of Health. In addition to verrucae, he had a personal history of eczematous dermatitis, osteomyelitis, molluscum infections, cutaneous abscesses, recurrent pneumonia, and severe food allergy.

A rare case of melanoma with Touton-like giant cells: a potential diagnostic pitfall.

Although approximately 876,000 individuals in the United States currently have a diagnosis of melanoma, the Touton-like giant cell variant has been described only twice in the literature to date. In our case, a 70-year-old man with a history of sclerosing carcinoma on the scalp presented for evaluation of a new nodularity at the site of his previous surgery. On examination, a new complex pigmented lesion on the posterolateral scalp, adjacent to the recurrent sclerosing carcinoma, was noted. Biopsy of the pigmented lesion revealed an invasive melanoma with a Breslow depth of at least 2.78 mm. Microscopic sections showed a predominantly dermal-based tumor composed of sheets and nests of enlarged epithelioid cells. These cells contained oval-to-reniform nuclei with prominent nucleoli and an abundant amount of eosinophilic to vacuolated cytoplasm. Interestingly, numerous multinucleated melanocytes, some with a "Touton" appearance, were scattered throughout the lesion. The lesional cells demonstrated positivity to Mart-1 and HMB-45. Fortunately, the patient's sentinel lymph node biopsy was negative for micrometastases, and a subsequent Position Emission Tomography (PET) scan was unremarkable. Documentation of individual cases of this rare histologic variant of melanoma is necessary given the ability of this lesion to mimic benign histiocytic proliferations at scanning magnification.

Bilateral suborbital rash: a dermatologic manifestation of neuropsychiatric disease in a pediatric patient.

A 10-year-old girl presented with a new onset bilateral suborbital rash. Dermatologic examination revealed violaceous, non-tender, well-demarcated patches with an atypical distribution and pigmentation. After further investigation, a diagnosis of Munchausen syndrome was made and the patient was referred to her primary care provider for further management.

Atypical fibrous histiocytoma arising in the perianal area: a case report and review of the literature.

Atypical fibrous histiocytoma (AFH) is an uncommon variant of cutaneous fibrous histiocytoma that can display histologic features associated with malignancy. Fewer than 150 cases have been reported in the literature. The majority of these lesions present on the trunk and extremities of middle-aged women. Genital lesions are rare, with one documented case of vulvar AFH and another case of scrotal AFH in the literature. We report an additional case of a 68-year-old woman who was diagnosed with an AFH in an unusual location, the perianal area. Histologically, the lesion was characterized by a nodular fairly well-circumscribed proliferation of large epithelioid macrophages with scattered lymphocytes and mast cells in the background. The atypical macrophages contained enlarged markedly pleomorphic nuclei with prominent nucleoli. Scattered multinucleated "monster cells" and atypical mitoses were observed throughout the lesion. Immunologically, the lesional cells were focally positive when stained with antibodies against CD163 and Factor XIIIa. They were negative for CD34, CD31, desmin, smooth muscle actin, CAM 5.2, keratin 5/6, S100, CD3, CD20, and CD30. The constellation of histologic and immunologic features was most consistent with an AFH. To our knowledge, this case is the first perianal presentation of AFH to date.