Solitary cylindroma with malignant transformation.

A 59-year-old woman presented with a history of rapidly progressive recurrent tumor of 6.5 cm diameter of the scalp. Histopathological examination revealed a case of malignant cylindroma. There has been no recurrence or metastases and the patient is disease free at the end of 15 months postoperatively. Malignant transformation occurs less often in solitary form of cylindroma, but once transformed, tumors behave aggressively with extensive local infiltrative growth or metastases. The case is reported to document a rare case of malignant cylindroma arising in a patient with solitary cylindroma on the parieto-temporal region.

Physiological skin manifestations in twins: association with maternal and neonatal factors.

There is paucity of literature on the incidence and clinical associations of transient benign dermatological conditions in twin neonates. This prospective study evaluated 253 live-born twin babies (≥23 wks) at a tertiary care hospital in Delhi, India. All study subjects were observed for the first 7 days of life, and regular dermatological examination was performed. The primary focus was on palatine Epstein pearls (PEP), milia, erythema toxicum neonatorum (ETN), and physiological skin desquamation (PDS). Zygosity was determined with the help of sex combination of the pairs, chorionicity of the placentae, and seven blood group phenotypes. Chi-square test, Cohen's kappa test, and logistic regression analysis were done. PEP, milia, ETN, and PDS were seen in 88.1%, 83.4%, 2.4%, and 4.3% twin babies, respectively. Preputial Epstein pearls were not seen. Birth order, maternal anemia, route of delivery, meconium staining of amniotic fluid, gestational maturity, birth weight, and presence of intrauterine growth restriction were found to be associated with one or more of the studied skin conditions (p < 0.05), but maternal age, pregnancy-induced hypertension, and sex of the baby did not affect incidence of any (p > 0.05). The intrapair concordance was highly significant (p < 0.001) in mono- and dizygotic twins. PEP and milia were equally common in the evaluated twins as compared to reports in singletons, while ETN and PDS were less common in this twin cohort. Environmental and genetic factors may regulate physiological skin manifestations in newborns.

Granulomatous rosacea: unusual presentation as solitary plaque.

A 45-year-old male presented with a 6 month history of an enlarging smooth, erythematous plaque over the central part of his face. Mild erythema of both eyes was present. Sarcoidosis, Hansen disease, lupus vulgaris, cutaneous leishmaniasis, pseudolymphoma, foreign body granuloma, granuloma faciale, discoid lupus erythematosus, and granulomatous rosacea were considered in the differential diagnosis. CBC, urinalysis, renal function tests, liver function tests, serum electrolytes, and blood sugar were all normal. Chest X-ray and ECG revealed no abnormality. Serology for syphilis and HIV, and mantoux test were negative. Slit-skin smear, tissue smear and culture for AFB and fungi were negative. Skin biopsy revealed multiple non-caseating epitheloid granulomas around the pilosebaceous unit suggestive of granulomatous rosacea. Granulomatous rosacea, a rare entity comprising only about 10 percent of cases of rosacea can mimic many granulomatous conditions both clinically and histologically making the diagnosis an enigma. It usually presents as yellowish brown-red discrete papules on the face; non-caseating epithelioid granulomas are seen on histology examination. We herein report the case because it presented in atypical fashion, as a solitary indurated plaque on the nose, likely representing Morbihan's disease or solid persistent facial edema of rosacea (rosacea lymphedema).