Consumption of the epidermis–what is its place in the spectrum of aberrant melanocyte-keratinocyte interactions?

Cramer SF.

Morphologic image on infundibular origin of verrucous cyst.

Fernandez-Flores A.

Interstitial granulomatous dermatitis secondary to acute promyelocytic leukemia.

Swing DC Jr, Sheehan DJ, Sangüeza OP, Woodruff RW.

A case of eccrine spiradenoma arising in nevus sebaceous in an adolescent girl.

Turhan-Haktanir N, Demir Y, Tokyol C.

A linear orofacial macule.

Walsh SN, Jorizzo JL, Haverstock C, Sangüeza OP.

Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. sarahnwalsh@aol.com

Nodular and diffuse fibrous proliferation of the penis and tunica vaginalis.

Fibrous benign proliferations of the testis and paratesticular tissues are an uncommon and heterogeneous group of lesions that can mimic true neoplasms. Among them, those considered to be reactive proliferations have been included in the category of fibrous pseudotumors and are often associated with trauma, hydrocele, or infection. We report 2 cases of nodular and diffuse fibrous proliferation. This condition is part of the spectrum of reactive benign fibrous lesions and has previously been described in the testicular tunics and paratesticular region only. One of our 2 cases had the peculiarity of being located in the penile shaft, whereas the other involved the tunica vaginalis. To the best of our knowledge, this is the first report of a diffuse and nodular fibrous tumor involving the penis.

Musulen E, Carvia-Ponsaille RE, Fernandez-Figueras MT, Barranco-Garcia Jde D, Ariza A.

Department of Pathology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. emusulen@hotmail.com

Papular elastorrhexis, a distinctive entity?

Papular elastorrhexis is a rare entity of elastic tissue characterized by multiple white papules usually located on the trunk. We report a case of papular elastorrhexis in a 22-year-old man with sparse lesions and discuss the main controversial facts in this entity: its consideration as an independent disease or as an incomplete form of Buschke-Ollendorff syndrome and the confusion with and its possible inclusion as a variant of elastic tissue naevi.

Del Pozo J, Martínez W, Sacristán F, Fernández-Jorge B, Fonseca E.

Department of Dermatology, Hospital Juan Canalejo, La Coruña, Spain. del_pozo@canalejo.org

Melanoma with second myxoid stromal changes after personally applied prolonged phototherapy.

Most malignant melanomas are easily diagnosed; however, melanoma is also one of the lesions most frequently reported to mimic other tumors. One of the most difficult patterns to recognize is characterized by prominent myxoid matrix. A case is presented of primary cutaneous melanoma with abundant myxoid matrix in a patient who underwent prolonged phototherapy. Three years before, after getting sunburns, the patient noticed changes of a congenital nevus located in the area of sunburns. It became darker, started to blanch, and grew, with occasional bleeding. Without consulting a physician, the patient applied phototherapy onto the area for 30 months. He used a Bioptron lamp with polarized, polychromatic, incoherent light, at a wavelength from 480 to 3400 nm, without ultraviolet radiation. Clinically, the lesion was unevenly pigmented, ulcerated, covered with hemorrhagic crust, and measuring 3.5 cm in greatest dimension, with a satellite nodule. Multiple metastatic subcutaneous nodules were also found on the scalp and trunk. Histologically, the primary tumor and metastases were composed of nests and pseudotubular formations of polygonal, spindle, and stellate cells embedded in abundant myxoid stroma that comprised more than 80% of the tumor mass. Focally, in the epidermis and papillary dermis, nests of atypical melanocytes and numerous melanophages were observed. Chemotherapy and immunotherapy were administered as suggested by an oncologist. The patient died from distant metastases 6 months after the diagnosis. Although some authors believe that myxoid changes do not seem to alter the behavior of melanoma, it remains an important differential diagnosis issue.

Ulamec M, Soldo-Belić A, Vucić M, Buljan M, Kruslin B, Tomas D.

Department of Pathology, Ljudevit Jurak, Sestre Milosrdnice University Hospital, Zagreb, Croatia.

Identical twins with primary cutaneous melanoma presenting at the same time and location.

Thus far there have been very few cases that document such a rarity as the same cancer occurring in monozygotic twins, at the same time, in the same location. We report this extraordinary phenomenon in our patients, 71-year-old identical female twins, presenting with melanoma at the same time (within 10 days of each other) and location (the right calf).

Rao BK, Noor O, Thosani MK.

University of Medicine & Dentistry of New Jersey Robert Wood Johnson Medical School, Somerset, NJ 08873, USA. RaoSkin@aol.com

Complete regression of primary malignant melanoma.

Over the years, histopathologic studies to determine the nature and significance of regression in malignant melanoma have yielded different results. At least in part, this most likely reflects differences in the definition of what constitutes regression. Although partial regression is relatively common, complete regression is rare. It has been said that complete regression of a primary lesion is associated with metastatic disease, but the evidence for this is largely anecdotal-the literature contains only case reports and small series. We found 2 cases of complete regression in our dermatopathology database. Metastatic disease was identified in both cases; in 1 case, the suspicion of melanoma was raised on the initial biopsy and subsequent workup revealed lymph node metastasis. These cases illustrate the histologic features of a completely regressed primary melanoma and add credence to the theory that completely regressed melanoma is associated with a poor outcome.

Emanuel PO, Mannion M, Phelps RG.

Division of Dermatopathology, Mount Sinai Medical Center, New York, NY 10029, USA. patrick.emanuel@mssm.edu