Annular elastolytic giant cell granuloma in a woman with metabolic syndrome.

Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous skin condition. It belongs to a group of skin and elastic fiber disorders. When it affects sun-exposed skin, it is also called actinic granuloma. The etiology and pathogenesis are still debated. However, sun-induced actinic damage to elastic fibers is acknowledged as the primary triggering factor, though the pathogenesis of instances in sun-covered areas is unknown. The most commonly linked systemic illness is diabetes mellitus. Different case reports show an association of this disease with hematological conditions, infections, sarcoidosis, and protoporphyria. Multisystemic involvement was also reported in a case. The disease is clinically recognized by erythematous non-scaly annular patches and plaques with raised borders and hypopigmented or skin-colored centers, sometimes atrophic. It is usually asymptomatic or mildly itchy. The presence of an inflammatory infiltration with non-palisading granulomas, multinucleate large cells, elastin degradation, and elastophagocytosis, as well as the absence of necrobiosis and mucin, are histopathological characteristics. We report a 5-year history of annular elastolytic giant cell granuloma in a 66-year-old woman with a history of type two diabetes mellitus, hypertension, and fatty liver disease (steatosis). She presented with asymptomatic polymorphic erythematous skin lesions mainly in sun-exposed areas.

Ultrasonographic features of superficial and nodular basal cell carcinoma.

AIM: To describe the ultrasonographic findings of surface and nodular basal cell skin cancer (BCC) using high frequency ultrasonography. MATERIALS AND METHODS: We examined 60 primary BCCs in different locations with the High Frequency Ultrasound (HFU) system DUB Skin Scanner using 75 MHz and 30 MHz probes. Epidermis, dermis, and depth of tumors spread in the region of interest (ROI) were measured. Visually unchanged, contralateral skin areas were examined as the control. Results: The surface BCC most often had elongated contours, clear margins and hypoechoic structure, while the nodular BCC had round or oval outlines and diffusely hypo-heterogeneous structure with clear margins. Sclerodermiform BCCs were visualized as hypoechoic areas of irregular shape penetrating in the dermis, with wavy fuzzy margins. The average thickness of the surface BCC in the US examination was 556.28±136.95 µ, the nodular BCC thickness was 2439.71±865.92 µ and the sclerodermiform thickness was 1500±325.33 µ. A statistically significant increase in the average thickness of tumors of the nodularand scleroderma forms was observed in comparison with the surface clinical variant (p<0.05). Hyperechoic inclusions were observed in 11% of the surface BCC's and in the 100% of the nodular BCC's. Their average number was 2±0.57 and 4±4.8, with the average area of 0.03±0.02 mm2 and 0.04±0.03 mm2 (p>0.05), respectively. In the surface BCC, they were mainly located along the periphery of the hypoechoic zones. In nodular BCC, the inclusions had a peripheral and combined (center and peripheral) distribution. CONCLUSIONS: Ultrasound allows differentiating BCC as diffuse-heterogeneous, hypoechoic, formations in the dermis with distinct contours. Depending on the clinical picture, they differ in form, depth of bedding, as well as in the quantitative ratio and distribution of the point hyperechoic structures in them.