Dermoscopy Clues in Pigmented Bowen's Disease

Pigmented tumors have similar clinical features that overlap and hamper diagnosis. Dermoscopy increases the diagnostic accuracy of doubtful melanocytic lesions and has been used as a noninvasive tool in the detection of pigmented lesions (PLs) like melanoma, basal cell carcinoma, and pigmented Bowen's disease (pBD). Our objective was to show the dermoscopic features of 2 cases of pBD and compare with the findings reported in the literature. Two dermoscopic images of biopsy proven pBD were retrospectively analyzed for dermoscopic patterns. Both cases showed brown regular globules, structureless brown and blue pigmentation, glomerular vessels, hypopigmented regression-like areas, and keratosis. These findings were similar to the cases reported previously. The dermoscopic diagnosis of pBD is based on the absence of criteria for a melanocytic lesion in the presence of glomerular vessels, regular brown globules and keratosis. Although pBD is rare, it should be included in the differential diagnosis of PLs, especially melanoma

Lichen planus-like keratosis: Another differential diagnosis for kaposi sarcoma

Epidemic Kaposi sarcoma is a common finding among HIV/AIDS patients that are not under antiretroviral treatment, and sometimes it is the first sign of the disease. However, it can be seen even in patients with undetectable viral load and high CD 4 cell count. Under these circumstances, the clinical presentation can be atypical in location or number. For this reason, the number of differential diagnosis is increased and biopsy of the suspicious lesions is essential for an accurate diagnosis and further apropiate treatment

Expression of E-cadherin, syndecan 1, Ki-67, and maintenance minichromosome 3 in tissue lesions of actinic prurigo obtained by incisional biopsy

Actinic prurigo (AP) is an idiopathic photodermatosis; the initial manifestations usually occur during the first decades of life but can appear at any age. Cases are usually diagnosed late once the lesions have exacerbated; due to the extensive involvement of the vermilion border and the etiology, it has been confused with and related to a potentially malignant process. Syndecan-1 and E-cadherin were positive in the epidermis, with moderate-to-intense staining in 100% of samples. Ki67 and MCM3 were expressed in the lower third of the epidermis and showed greater immunolabeling in samples that contained lymphoid follicles (Ki 67: epidermis [17.7% ± 6.79%] and dermis [7.73% ± 6.69%]; MCM3: epidermis [22.92% ± 10.12%] and dermis [6.13% ± 6.27%]). In conclusión AP is a disease in which there is no evidence that the lesions are potentially cancerous. AP cheilitis should not be confused with actinic cheilitis because they are separate entities

Lichenoid drug reaction after ipilimumab/nivolumab combination therapy: A case report

Nivolumab (PD-1 inhibitor) and ipilumumab (CTLA-4 inhibitor) are recently approved checkpoint inhibitors for treatment of non-small cell lung cancer. Immune-related adverse events related to the usage of checkpoint inhibitors are growing with their popularity. We present the case of a patient in combination treatment of nivolumab and ipilimumab who developed a lichenoid drug reaction, notable because it worsened to a bullous lichenoid drug reaction. Treatment with prednisone and withdrawal of checkpoint inhibitors aided in clinical resolution. Initial presentation of a lichenoid reaction that progressed to a bullous, desquamated presentation indicates the possibility of the prodromal rash progressing to a Stevens-Johnson Syndrome-like dermatosis. When dermatologists are consulted for rashes developed during checkpoint-inhibitor therapy, they should be aware that early treatment may prevent progression to bullae formation and desquamation and develop their treatment plans with this in mind

Clavicular skin-colored nodule

An accessory tragus (AT) is a congenital flesh-colored nodule occasionally covered with vellus hair. It can arise anywhere along the line from the preauricular area to the corner of the mouth. It can also be found on the glabella or suprasternal region. The tragus is derived from the first branchial arch, which also develops into the mandible and mouth. The rest of the external ear develops from the second branchial arch. AT may occur as an isolated defect or in chromosomal first branchial arch syndromes with ear anomalies, cleft lip and palate, and mandibular hypoplasia

Quantification of Hair Follicles in the Scalp in Mexican Mestizo Population

Introduction: There are no reports of the density of hair follicles in the scalp of Mexican mestizo population, necessitating the determination of normal references values for this population compared with other ethnic groups. Objective: To determine the average hair follicle count on the scalp in Mexican mestizo population. Materials and Methods: A total of 50 scalp samples (25 men and 25 women) from Mexican mestizo individuals aged between 19 and 60 years, with no clinical evidence of hair disease, obtained by biopsy punch at General Hospital “Dr. Manuel Gea González” were collected over 2 years. The total follicular density, vellus and terminal hair follicles, and the percentage in anagen and catagen-telogen phase were measured. χ2 was used as the basic statistical test. Results: The mean number of total hair follicles in our Mexican mestizo population was 23.2 ± 4.2, which is lower compared with Thais, Iranians, and Caucasians. However, the ratio of terminal and vellus hair follicles was higher than in Thais, Caucasians, and African-Americans. The percentage of terminal hairs in anagen phase was lower than in the other populations, and higher in telogen, without exceeding 15%, established as the normal reference value. There was an association between sex and terminal hairs in telogen phase (p < 0.05). The average follicular density per mm2 was slightly higher compared with AfricanAmericans and Asians. Women had more terminal hairs than men. Conclusions: The density of total follicles is lower in the Mexican mestizo population compared with Iranians, Thais, and Caucasians. However, the greater number of terminal hairs compared to vellus hairs gives the appearance of greater overall volume. The results of this study can be used as a reference for diseases of the scalp in the Mexican population

Myopericytoma in an unusual location

Myopericytoma is a soft-tissue tumor of perivascular cells (pericytes). It is slow-growing, usually asymptomatic, and generally benign, although a malignant variant has been described. The etiology is unknown, but it has been associated with local trauma. The most common location is on the distal extremities. Histologically, it is characterized by a well-circumscribed, non-encapsulated proliferation of spindle shaped cells similar to myofibroblasts with oval nuclei and eosinophilic cytoplasm, arranged in perivascular concentric rings. There are few mitoses and no necrosis is reported. The immunohistochemical analysis is positive for smooth muscle actin and negative or weakly positive for desmin. A low Ki-67 proliferation index is typical. Treatment is surgical excision with free margins. Recurrences after adequate excision are uncommon. We describe a 48-year-old woman with a myopericytoma in an unusual location (next to the inner corner of her left eye) who was treated with surgical excision; there has been no recurrence after 5 years of follow up

Myopericytoma in an unusual location

Myopericytoma is a soft-tissue tumor of perivascular cells (pericytes). It is slow-growing, usually asymptomatic, and generally benign, although a malignant variant has been described. The etiology is unknown, but it has been associated with local trauma. The most common location is on the distal extremities. Histologically, it is characterized by a well-circumscribed, non-encapsulated proliferation of spindle shaped cells similar to myofibroblasts with oval nuclei and eosinophilic cytoplasm, arranged in perivascular concentric rings. There are few mitoses and no necrosis is reported. The immunohistochemical analysis is positive for smooth muscle actin and negative or weakly positive for desmin. A low Ki-67 proliferation index is typical. Treatment is surgical excision with free margins. Recurrences after adequate excision are uncommon. We describe a 48-year-old woman with a myopericytoma in an unusual location (next to the inner corner of her left eye) who was treated with surgical excision; there has been no recurrence after 5 years of follow up