Basal cell carcinoma of the nail unit treated with Mohs micrographic surgery: superficial multicentric BCC with jagged borders--a histopathological hallmark for nail unit BCC

We present a case of basal cell carcinoma (BCC) of the nail unit with a special emphasis on superficial multicentric histopathologic type with jagged borders that was treated with Mohs micrographic surgery. Nail unit BCCs may not be as rare as previously believed and jagged borders in the superficial neoplastic buds may be a hallmark for superficial BCCs of the nail unit

Indolent Acremonium strictum infection in an immunocompetent patient

WOS: 000171586500008PubMed ID: 11679001A 35-year-old housewife presented with an 11-year history of a painless lesion on the right cheek, which had enlarged over the last 2 years. She had no history of travel or trauma. Various topical and systemic antimicrobial and antifungal agents, such as fluconazole, ketoconazole, sulbactam/ampicillin, and mupirocin, had been prescribed, with a probable diagnosis of pyoderma. and blastomycosis, without significant benefit. Her medical history was otherwise unremarkable. Dermatologic examination revealed a well-circumscribed, erythematous, infiltrative, 8 X 10 cm plaque covering the right cheek and a 2 X 3.5 cm vegetative, ulcerated lesion on the chin (Fig. 1). There were no sinus tracts or grains. The following laboratory test results were within the normal limits: complete blood count, blood biochemistry, urinalysis, immunoglobulins and complement levels, T lymphocyte, CD4 and CD8 cell counts, and response to mitogens. X-Rays of the chest and maxillar and mandibular bones were normal. Routine bacterial cultures were negative. Skin biopsies and fungal and mycobacterial cultures were taken with a preliminary diagnosis of deep fungal or mycobacterial infection. Dermatopathologic examination revealed irregular epidermal hyperplasia with follicular plugging. A dense nodular lymphohistiocytic infiltrate was observed within the reticular dermis, with many multinucleated giant cells and plasma cells. In higher magnification, even in hematoxylin and eosin sections, large septate hyphae and spores were noticeable. Periodic acid-Schiff stain revealed abundant fungal structures within the giant cells and extracellularly throughout the inflammatory infiltrate (Fig. 2). Lymphocytes were rather sparse in comparison to the large amount of microorganisms within the tissue. Fungal cultures were performed on Sabouraud's dextrose agar and, within 1 week of incubation, white fungal colonies were observed. On multiple passages at 26 degreesC, white tufted colonies with a salmon-colored base had formed (Fig. 3). Native preparations from the cultured colonies revealed septate hyphae, and 90 degrees angled branches, together with phialides decorated with ellipsoidal conidia with rounded edges (Fig. 4). These findings were consistent with Acremonium strictum, a saprophytic fungus. Further laboratory examinations revealed no systemic involvement. Following the diagnosis of Acremonium infection, amphotericin B therapy and surgical excision of the tumoral lesion were planned, but the patient refused further treatment and failed to respond to our follow-up attempts

Dermatomal lichenoid graft-versus-host disease within herpes zoster scars

Kocyigit, Pelin/0000-0002-4793-7736; Erdem, Cengizhan/0000-0002-9312-5683; Arat, Mutlu/0000-0003-2039-8557WOS: 000183972100016PubMed: 12839612Case 1 A 23-year-old woman was diagnosed with chronic myelogenous leukemia in 1997. In 1999, she underwent allogeneic bone marrow transplantation (BMT) from a human leukocyte antigen (HLA)-matched sibling donor after induction chemotherapy with cyclophosphamide and busulfan. At day 46 after BMT, she was discharged with a medication regimen which included cyclosporine, fluconazole, acyclovir, and trimethoprim/sulfamethoxazole. Five months later she developed clusters of vesicles and pain over the right inframammary and right infrascapular areas corresponding to the T5 - T6 dermatomes. Herpes zoster infection was diagnosed clinically and acyclovir therapy ( 3 x 10 mg/kg/day) was started. All lesions healed within 2 weeks leaving atrophic cicatrices and postinflammatory hyperpigmentation. Eight months after BMT, she presented with erythematous and hyperpigmented macules on the malar areas. Follicular hyperkeratosis on the chest and interscapular area, reticulated white plaques on the buccal mucosa, and significant xerosis were also observed on dermatologic examination. Dermatopathologic examination of a biopsy specimen obtained from the lesions on the face was evaluated to be consistent with "atrophic folliculocentric lichen planus." Two weeks later she was admitted again for new lesions on the trunk. Flat, violaceous, slightly scaly papules were located exactly on the dermatomes of the previous herpes zoster infection ( Fig. 1). A biopsy specimen of these lesions showed a dense, subepidermal, band-like, lymphocytic inflammatory infiltrate, vacuolar degeneration of the basal cell layer, and scattered dyskeratotic cells in the epidermis, confirming the diagnosis of lichenoid graft-versus-host disease (GVHD) (Fig. 2a and 2b). Case 2 A 47-year-old woman was diagnosed with chronic myelogenous leukemia in 1998. She underwent allogeneic BMT from an HLA-matched sibling donor after a preoperative chemotherapy regimen with cyclophosphamide and busulfan in 1999. At day 20, she developed erythema and a burning sensation on her palms and soles and erythema, hyperpigmentation, and desquamation on her face and neck. The lesions increased gradually within 3 weeks. Dermatologic examination on day 40 revealed widespread violaceous, lichenoid papules and plaques on the face, neck, trunk, upper extremities, and genital region. There were also reticulated, white plaques on the buccal mucosa. A biopsy obtained from the lesions on the neck showed findings consistent with both acute and lichenoid GVHD. The skin lesions resolved within 1 month after prednisolone therapy leaving postinflammatory hyperpigmentation. Seven months later, she developed herpes zoster infection involving the right neck, shoulder, chest, and scapular area corresponding to the C3 - C4 dermatomes. She was treated with famcyclovir for 10 days and the lesions healed completely. Three months after this infection, new, violaceous, lichenoid papular lesions were noted which remained confined to the dermatomes affected by the herpes zoster infection ( Fig. 3). Dermatopathologic examination revealed dyskeratotic cells, focal vacuolization in the basal cell layer, and a superficial band-like lymphocytic infiltrate in the papillary dermis, consistent with lichenoid chronic GVHD