Three cases of verrucous carcinoma.

Verrucous carcinoma of the skin and mucosa is an uncommon clinicopathological variant of low grade squamous cell carcinoma. Here, we present three different clinical types of verrucous carcinoma. The first patient presented with an anogenital verrucous carcinoma, also known as Buschke-Loewenstein tumour. The second patient had verrucous carcinoma of the heel with endophytic growth (i.e. epithelioma cuniculatum) and the third patient had gluteal verrucous carcinoma with a cauliflower-like appearance. Clinically, the lesion of the first patient best resembled giant condyloma accuminatum without any prominent verrucous component, whereas the second patient showed a big deep ulcer on the heel. None of the patients had metastasis. The diagnosis was confirmed with biopsy and total excision was performed in all cases. Although the cases have different clinical presentations in different locations, we think that they should be considered as a single entity; that is, verrucous carcinoma.

Bilateral inflammatory linear verrucous epidermal nevus associated with psoriasis.

Inflammatory linear verrucous epidermal nevus is a benign hyperplasia of the epidermis. Bilateral distribution of inflammatory linear verrucous epidermal nevus is an extremely rare presentation. Although inflammatory linear verrucous epidermal nevus is generally accepted as a distinct entity, it has similar clinical and histopathologic features to psoriasis, or they occasionally may overlap. We report the case of an 8-year-old boy with bilateral inflammatory linear verrucous epidermal nevus who also had psoriasis.

Histologic patterns of basal cell carcinoma based upon patient immunostatus.

BACKGROUND: The biologic behavior of basal cell carcinoma (BCC) seems to be dictated by the histologic subtype. Moreover, BCCs in immunosuppressed patients appear to show a more aggressive biologic behavior. OBJECTIVE: The purpose of this study was to retrospectively investigate different histologic subtypes of BCC to determine whether a particular subtype would predominate in immunosuppressed patients. METHODS: The histologic patterns of 112 primary BCCs from 77 immunosuppressed patients and 60 primary BCCs from 46 patients who are endogenously immunocompromised, due to diabetes mellitus and/or chronic renal failure, were examined. The results were compared with 488 primary BCCs of 318 immunocompetent patients. RESULTS: The nodular subtype was the predominant pattern among all patients. However, a statistical difference was found in the immunosuppressed patients in that there was a lower percentage of nodular pattern (P = .0038), and a higher percentage of infiltrative pattern (P = .0002). The higher frequency of the infiltrative pattern in the immunosuppressed group was particularly prominent among chronic alcoholics. CONCLUSION: In immunosuppressed patients, the higher frequency of the infiltrative subtype of BCC, particularly among chronic alcoholics, may have a predictive role in the management of these cases.

Basal cell carcinoma of the scalp resulting in spine metastasis in a black patient.

Basal cell carcinoma (BCC), the most common skin cancer in the United States, is locally invasive but has a low risk of metastasis. BCC is rare in black patients but, regardless of racial origin, most BCC occurs on sun-exposed areas. We describe a 67-year-old black man with a large BCC on the hairy scalp, a relatively sun-protected area, that metastasized to the spine. To our knowledge, this is the first description of a black patient with development of metastatic BCC on an otherwise normal scalp.

p53 Protein expression in squamous cell carcinomas from sun-exposed and non-sun-exposed sites.

BACKGROUND: In sun-exposed nonmelanoma skin cancers, observation of specific p53 gene mutations implicate the role of UV radiation-induced mutations in the pathogenesis of these tumors. Immunohistochemical p53 protein overexpression and p53 gene mutation have been frequently considered related events. OBJECTIVE: We investigated the differences in p53 immunostaining in squamous cell carcinomas (SCCs) with varying degrees of differentiation, from both chronically sun-exposed and sun-protected sites of the skin. METHODS: Twenty-six SCCs (15 UV-related and 11 UV-unrelated) and five specimens of Bowen's disease (in situ SCC) from sun-exposed skin were examined by means of BP53-12-1 monoclonal antibody immunohistochemistry. RESULTS: p53 Immunoreactivity was observed in 66.7% of sun-exposed, 54.5% of non-sun-exposed invasive SCCs (Fisher's exact test, p = 0.689), and 80% of Bowen's disease specimens. In 50% of all samples, p53 positivity was more prominent in the proliferating periphery of the tumor with gradual loss of positivity as the cells differentiated. CONCLUSION: The reliability of p53 immunohistochemistry needs further molecular genetic studies.

Lupus vulgaris in a patient with pulmonary tuberculosis.

A fifty-three-year-old woman with pulmonary tuberculosis in association with lupus vulgaris is reported. Her condition had been misdiagnosed for several years; the need for early diagnosis of tuberculosis is emphasized again.