Generalized lichen nitidus: case report and literature review.

Lichen nitidus is a rare condition of unknown cause, characterized by minute, flesh-colored, shiny papules occurring on the genitalia, abdomen, chest, and extremities. This disorder is most often localized, but a few cases of generalized lichen nitidus have been reported. We describe a young patient with a 1.5-year history of unremitting generalized lichen nitidus.

Eruptive milia.

Milia are small subepidermal keratin cysts. They may arise either spontaneously or in the course of bullous diseases or trauma. We describe an unusual case of multiple eruptive milia on the posterior neck and back and review the classification of milia.

Darier's disease associated with multiple café-au-lait macules.

Darier's disease, or keratosis follicularis, is an autosomal dominant inherited skin disease characterized by keratotic papules predominantly on the upper trunk and scalp, palmar pits, and nail dystrophy. It has been reported in association with basal cell carcinoma and other skin cancers, neuropsychiatric disorders, salivary gland obstruction, renal and testicular agenesis, bone cysts, and psoriasis. We describe the first report of a patient with multiple café-au-lait macules, but no personal or family history of neurofibromatosis, who developed Darier's disease.

Malignant melanoma in a tattoo: case report and review of the literature.

Several benign and malignant lesions have occurred in tattoos, including verrucae, granulomas, allergic reactions, basal cell carcinomas, and squamous cell carcinomas. In addition, seven documented cases of malignant melanoma occurring in tattoos have been reported in the English literature. We describe another patient with malignant melanoma in a tattoo.

Cutaneous manifestations of disseminated cryptococcosis.

Disseminated cryptococcosis is a life-threatening infection with cutaneous dissemination in 10% to 20% of cases. We describe seven patients with disseminated cryptococcosis with variable cutaneous manifestations. AIDS was a predisposing factor in six patients. Cutaneous presentations included a draining sinus tract, verrucous nodules, molluscum-like lesions and erythematous, indurated plaques. Histologically, all lesions revealed numerous encapsulated cryptococcal organisms in a gelatinous pattern, highlighted with periodic acid-Schiff, mucicarmine, and methenamine silver stains. The patients responded variably to treatment with amphotericin B, flucytosine, and fluconazole.

Unilateral pterygium inversum unguis.

Pterygium inversum unguis is a nail abnormality in which the distal aspect of the nail bed/hyponychium is adherent to the ventral surface of the nail plate, resulting in obliteration of the distal groove. We present a 50-year-old man who developed this abnormality on his right fingers and toes after a stroke that resulted in paresis of his right side. Unusual features of this case include the association with a neurologic disorder, assymetric distribution, involvement of toes as well as fingers, and occurrence in the male gender.

Scabies and lice.

Scabies and pediculosis, two commonly encountered infestations both having an incidence that is on the rise, are discussed in detail in this article with special emphasis given to their symptomatology, pathogenesis, and treatment.

Pedunculated pigmented basal-cell carcinoma on the buttock of a black man.

A pedunculated pigmented basal-cell carcinoma on the buttock of a black male is presented. Unusual features of this case include an atypical pendunculated appearance, suggesting nevus or neurofibroma, atypical location on a covered area of the body, and occurrence in a low-incidence racial group.

Generalized morphea with peripheral eosinophilia, fasciitis and myositis.

The distinctions between eosinophilic fascitis (Shulman's syndrome) and scleroderma may sometimes be unclear. We describe a patient with generalized morphea who also had peripheral blood eosinophilia, fibrosis and inflammation of fascia, and hyper-globulinemia, features usually attributed to Shulman's syndrome. The latter diagnosis should be restricted to those patients whose history, clinical and laboratory findings, and response to therapy closely resemble Shulman's original description. Scleroderma and eosinophilic fasciitis may represent slightly differing aspects of the same disease spectrum, with a similar immunologic pathogenesis.

Lymphangiosarcoma arising from lymphangioma circumscriptum.

A lymphangiosarcoma arose at the site of a preexisting lymphangioma circumscriptum on the skin of the anterior part of the abdominal wall. To our knowledge, this is only the second such case to be reported, and in both patients, the preexisting lymphangioma circumscriptum had been exposed to substantial x-ray therapy. Since it is possible that x-irradiation may play a role in the development of this unusual malignant neoplasm, it seems advisable that lymphangioma circumscriptum not be exposed to substantial amounts of such radiation, if feasible.

Sebaceous carcinoma of the skin with visceral metastases.

Sebaceous carcinoma is an uncommon cutaneous malignant neoplasm that rarely metastasizes. We report a case in which a moderately well-differentiated sebaceous carcinoma arising on the anterior aspect of the chest produced widespread visceral metastases. This unexpected clinical behavior underscores the fact that sebaceous carcinoma of the skin can sometimes be very biologically aggressive.

Apocrine cystadenoma of the skin of the chest.

A black patient with an enlarging apocrine cystadenoma on the chest is presented herein. This location is very infrequent for this benign lesion. This is the second report of an apocrine cystadenoma in a black person.

Malignant neoplasms of the paranasal sinuses involving the skin.

Malignant neoplasms of the mucosa and minor salivary glands of the paranasal sinuses may involve the skin by direct extension. When a tumor appears on the overlying skin, these sinuses should be considered as a possible site of origin. Adenoid cystic carcinoma of the paranasal sinuses arise from minor salivary glands. They can infiltrate overlying skin and easily be confused with a primary cutaneous adenoid cystic carcinoma. Malignant melanomas of the paranasal sinuses are clinically very aggressive. They are often amelanotic, and this may lead to an incorrect histopathologic diagnosis. Hence, physical and radiological examination of the nose, mouth, and paranasal sinuses should be performed whenever a tumor appears in the overlying skin that does not have a clear cutaneous origin or whenever the primary site of a metastatic malignant melanoma is unknown.

Giant cell tumor of the tendon sheath involving skin.

Giant cell tumor of the tendon sheath is the second most common tumor of the fingers and hands but is only rarely mentioned in the dermatologic literature. Although its pathogenesis has been debated, it is probably a type of fibrous histiocytoma. This tumor is almost always benign but may locally invade the overlying dermis and be confused with a malignant neoplasms. It often extends to the synovium of the adjacent joint space and necessitates total excision to prevent local recurrence. Therefore, excision should be undertaken by a physican who is surgically qualified for such procedure. We report a case that illustrates the clinical and pathologic aspects of this lesion.

Multiple cutaneous metastases of a scapular chondrosarcoma.

The onset of metastatic chondrosarcoma in a young woman was heralded by the appearance of multiple firm, tender, cutaneous nodules two years after the primary tumor in the left scapula had been resected. Chondrosarcoma rarely metastasizes to the skin, but when it does, it may have an identical histological appearance to a cartilaginous tumor of the skin, an entity that is generally considered clinically benign. Although it is very unlikely that an occult chondrosarcoma will be first manifested clinically by a solitary cutaneous metastasis, the abrupt appearance of multiple cutaneous cartilaginous lesions would seem to warrant an investigation for primary chondrosarcoma.