Pigmented Papules Research Articles

P084 An unusual case of Intradermal “Kissing” Naevus presenting as penile warts

Background/introduction We describe a case of a 38 yr old white heterosexual male with Crohns disease presenting with warty lesions of the penis which were found on histological diagnosis to be benign intradermal naevi. The differential diagnosis included papular warts, skin tags, and in this case Crohns and pyoderma gangrenosum. Aim(s)/objectives Initially presented with two smooth papular warty type lesions on the prepuce and glans adjacent to the coronal sulcus,which had been present for several months causing discomfort during sexual activity and unsightly appearance. Currently taking oral prednisolone and mesalazine for longstanding Crohns disease,with no other cutaneous manifestations, and had regular female partner. Results Initially treated with Liquid Nitrogen application but with minimal resolution and in light of his medical history to exclude “metastatic” Crohns and associated pyoderma gangrenosum a punch biopsy was carried out. Histological appearances were that of a benign intradermal naevus with characteristic nests of naevus cells within the dermis only, there was no atypia present. He was subsequently referred to the urologist for surgical excision of the lesions. Discussion/Conclusion Benign intradermal naevi or “kissing naevi” of Penis such as this are extremely rare there being only a handful previously reported. Due to the dermal location of naevus cells they usually present as skin coloured or slightly pigmented papules and may be confused with warts, skin tags or dermatofibroma. Treatment with surgical excision or laser therapy results in satisfactory functional and aesthetic outcomes.

Pigmented Papules and Patches of the Folds: A Case Series of Lcihen Planus Pigmentosus Inversus with Review of the Literature

We report nine cases of Lichen Planus Pigmentosus (LPP) inversus in Caucasian patients. They were 5 women and 4 men aged from 29 to 77 years with violaceous hyper pigmented ovalar or annular macules and patches mostly located at axillary folds but also groin, submammary folds, popliteal and genital regions. Histological examinations showed a band-like lymphocytic infiltrate in the upper dermis and melanophages in the papillary dermis. LPP inversus is a rare variant of LPP appearing in non-sun exposed areas. In contrast to LPP which occurs almost exclusively in dark skinned individuals, a comprehensive review of the literature revealed that about half of the cases reported of LPP inversus affects fair skinned individuals including Caucasian patients.

Cutaneous plasmacytosis: a clinicopathologic study of 12 cases in Taiwan revealing heterogeneous underlying causes.

Cutaneous plasmacytosis is clinically characterized by multiple pigmented papules and plaques that occur mainly on the trunk and many plasma cells in the lesional skin. Most of the cases reported have occurred in Japan. Whether cutaneous plasmacytosis is a unique reactive disease or a neoplastic condition has not been established. We collected 12 cases fulfilling the criteria for a diagnosis of cutaneous plasmacytosis at our institution from 2001 to 2013. We analyzed clinicopathologic features and performed immunohistochemical and immunoglobulin gene rearrangement studies. All 12 patients presented with characteristic cutaneous lesions mainly on the trunk and proximal extremities. Many plasma cells were observed in the lesional skin, and the basal layer was hyperpigmented. Four patients had numerous plasma cells in lymph nodes, and one patient also had increased plasma cells in bone marrow. One patient fulfilled the criteria for immunoglobulin G4 (IgG4)-related lymphadenopathy. Elevated serum IgG and IgG4 concentrations were found in seven patients. Monoclonal immunoglobulin gene rearrangements were detected in four patients. The median duration of follow-up was four years. One patient was lost from follow-up. Partial remission of the cutaneous lesions was observed in five patients, and progressive disease was noted in five patients. One patient died of respiratory failure. Our study suggests that the so-called "cutaneous plasmacytosis" has heterogeneous underlying causes with or without systemic involvement and may be associated with clonal immunoglobulin gene rearrangements and IgG4-related lymphadenopathy. No effective treatment is available for this condition.

Nevus genital atípico

A 22-year-old patient who consulted for presenting a pigmented papule on the left major lip. The pathology shows an atypical genital cell nevus with the presence in the dermoepidermal junction of a proliferation of atypical and theca melanocytes with loss of cell cohesion. Diagnostic criteria, histopathological parameters and differential diagnosis are discussed.

Peripheral odontogenic keratocyst associated with nevoid basal cell carcinoma syndrome: a case report

Peripheral odontogenic keratocyst (POKC) is a rare gingival cyst showing histologic features identical to those of keratocystic odontogenic tumor. A rare case of POKC associated with nevoid basal cell carcinoma syndrome (NBCCS) is presented. A 24-year-old woman with NBCCS presented with a pigmented papule, 3 mm in size, involving the lingual gingiva of the right canine area of the mandible. Based on a clinical diagnosis of benign pigmentation, an excisional biopsy was performed, and a histopathologic diagnosis of POKC was rendered. The lining cells were positive for the proteins GLI2, BCL2, keratin 8, keratin 17, and mTOR. TP53 and Ber-EP4 were also weakly positive. Gene mutational analysis on a buccal swab sample revealed 2 missense mutations in the PTCH1 gene. This case is a distinctive example of a genuine soft tissue counterpart of keratocystic odontogenic tumor, in which an aberrant PTCH1-GLI pathway played a considerable role in the pathogenesis.

Locally Invasive Dermal Squamomelanocytic Tumor With Matrical Differentiation

Dermal-based combined squamous and melanocytic neoplasms are emerging clinicopathologic entities that tend to appear on sun-exposed areas of elderly patients. The biologic behavior of such cutaneous neoplasms remains uncertain because of their rarity. Histopathologic differential includes the following diagnostic entities: (1) dermal squamomelanocytic tumor, (2) melanocytic matricoma, and (3) rare histologic variant of pilomatrical carcinoma, the so-called pilomatrical carcinoma with intralesional melanocytes. Herein, we present a novel case of locally invasive dermal squamomelanocytic tumor. A 72-year-old man presented with a pigmented papule on nasal ala that was clinically concerning for basal cell carcinoma. Histopathologic evaluation demonstrated atypical melanocytic cells architecturally and intimately intermixed with single units and clusters of atypical squamous cells. Most notable feature of this case is focal matrical differentiation and locally invasive tumor growth, characterized by multifocal perineural invasion.

Progressive Petechial and Pigmented Macules and Papules on the Lower Extremities

Progressive Petechial and Pigmented Macules and Papules on the Lower Extremities

Progressive Petechial and Pigmented Macules and Papules on the Lower Extremities

Progressive Petechial and Pigmented Macules and Papules on the Lower Extremities

Familial Eruptive Syringomas: Case Report and Review of the Literature

Syringomas are benign neoplasms of eccrine origin. A clinical variant is eruptive syringomas, which presents as firm, smooth, yellow to pigmented papules that appear as successive crops on the neck, axillae, chest, abdomen, and/or periumbilical region. To our knowledge, there are only 10 published reports of familial eruptive syringomas. Herein we describe the eleventh report of familial eruptive syringomas, review the literature on this unusual presentation, and suggest a novel classification of familial syringomas based on our literature review. We report two cases of eruptive syringoma within a family. Eruptive syringomas were widely distributed on the trunk of a healthy 16-year-old female and her 19-year-old brother. Both the 19-year-old man and his mother also had infraorbital syringomas. Familial eruptive syringomas are a rare clinical entity that is likely autosomal dominantly inherited. Future reports of this unusual condition may provide further insight into the etiology of familial syringomas, and genetic analysis of cases may enable the causative gene mutation to be determined.

Lichen Planopilaris is a Common Scarring Alopecia among Iraqi Population

Background: Scarring alopecia like discoid lupus erythematosus, lichenplanopilaris and scarring folliculitis are common skin problems where differentiations between them are often difficult in many cases. Objective: To report, study and evaluate cases of lichen planopilaris and characterize the different clinical points in favor of this disease. Patients and Methods: This case series descriptive study was done at Department of Dermatology-Baghdad Teaching Hospital from January 2010 to November 2012. Sixty seven patients were included where histological and dermatological examinations were carried out to all patients regarding all relevant points related to the disease. Punch biopsies were performed from ten patients for histopathological study. Results: The mean age of onset of the disease was 36.7 ± 5 years with a mean duration of the disease being 4.4 ± 3 years. The male to female ratio was 1.4:1. The characteristic lesions were pigmented scarring moth eaten alopecia surrounded by pigmented hyperkeratotic follicular papules involving mainly the fronto-vertical and parietal scalp. Conclusions: Lichen planopilaris is a common cause of scalp scarring alopecia in adult and it has many characteristic clinical features which can facilitate differentiation from other pathologic scalp conditions like discoid lupus erythematosus.

Multiple dermatofibromas: Dermoscopic patterns

Dermatofibromas are benign skin lesions that consist of pigmented papules or nodules. They produce the dimple sign when laterally squeezed and are usually found on the legs. These clinical features lead to the diagnosis in most cases. However, the differential diagnosis with other lesions, such as atypical nevi and melanoma can be difficult, and the dermoscopy may help the diagnosis. There are several dermoscopic patterns associated with dermatofibromas, the most common being a central white scar like patch with delicate pigment network at the periphery. This article describes the case of a patient who had eleven clinically similar dermatofibromas, with four distinct patterns when submitted to dermoscopic examination.

Potential Role of Human Growth Hormone in Melanoma Growth Promotion

BACKGROUND Human growth hormone (HGH) and insulin-like growth factor-1 (IGF-1) have been shown to play a role in the malignant transformation and progression of a variety of cancers. HGH is also known to upregulate molecular signaling pathways implicated in the pathogenesis of melanoma. Although HGH has previously been implicated in promoting the clinical growth of both benign and malignant melanocytic neoplasms, to our knowledge there are no conclusive studies demonstrating an increased risk of melanoma following HGH therapy. Nevertheless, there are reports of melanoma developing subsequent to HGH coadministered with either other hormones or following irradiation. OBSERVATION A 49-year-old white man presented with a new pigmented papule that was diagnosed as melanoma. The patient reported using HGH for 3 months prior to the diagnosis. His 51-year-old wife, who also was white, had also been using exogenous HGH for 3 months and had been diagnosed as having a melanoma 2 weeks prior. CONCLUSIONS Given the unlikelihood of 2 unrelated people developing melanoma within a short time span, it is reasonable to assume that a common environmental component (HGH or other shared exposure) contributed to the development of both melanomas. Because of the increased use of exogenous HGH as an antiaging agent, it is important to be aware of the growth-promoting effects of this hormone. Until better data are available that determines the true risk of exogenous HGH, its use as an antiaging agent merits increased surveillance.

Familial Confluent and Reticulated Papillomatosis: Two Brothers

Confluent and reticulated papillomatosis (CRP) is a rare disease presenting with keratotic pigmented papules located mostly on the chest, neck and trunk with unknown etiology. Genetic, keratinization abnormalities, abnormal host reaction to fungal or bacterial infections and endocrine diseases are suspected in the etiopathogenesis. The role of heredity in the pathogenesis of CRP arised with the familial case reports. There are sporadic case reports whereas familial reports are rare in the literature. Here, we present 22 and 20 year-old two brothers with familial confluent and reticulated papillomatosis. Our cases who live apart in different countries with different environments and climates, supply strong evidence for the genetic basis of the disease. This two brothers with CRP are presented due to rare familial occurence. (Turk J Dermatol 2012; 6: 108-10)

Late-onset, Eruptive Syringoma in an Elderly Man: Correlation with Carbamazepine

Syringomas are benign neoplasms of the eccrine sweat gland ducts that commonly appear around the eyelids in women. Clinically, they manifest as small, skin-coloured or slightly pigmented papules. Syringoma is classified into four clinical types: localized; familial; Down’s syn-drome associated; and generalized, which encompasses multiple and eruptive syringomas (1). Furthermore, clear cell syringoma, which is characterized by histological proliferation of clear cells, has been reported to be asso-ciated with diabetes mellitus (2). Eruptive syringoma is a rare variant and usually appears before or during puberty (3). The lesions occur in large numbers and in successive crops on the neck, chest, abdomen, maxillae and genitalia. We describe here a case of late-onset eruptive syringoma in a 69-year-old man and discuss its possible association with an anti-epileptic drug. CASE REpoRTA 69-year-old man was referred to our department for the evaluation of skin lesions, which he had first noti-ced at the age of approximately 60 years. The lesions had first appeared on his abdomen, and3 years ago the

Spitz Nevus in a Hispanic Population: A Clinicopathological Study of 130 Cases

Spitz nevus is an uncommon melanocytic nevus distinctive by its epithelioid and spindled melanocytes. Many studies have attempted to characterize Spitz nevus, but none of them in a Hispanic population. Our aim is to characterize the clinical and histopathological presentation of the Spitz nevus in a Hispanic population. A retrospective study was carried out from our files that included those cases histopathologically diagnosed as Spitz nevus. A blinded examination was performed to evaluate the histopathological characteristics of 130 lesions. The demographics of the patients, the anatomic location, and the accuracy of the clinical diagnosis were analyzed. Eighty-one females and 49 males (ratio of 1.7:1) were included in the study. The mean age was 18.8 years. Overall, the most common location was the lower extremities (41%), followed by the upper extremities (27%), trunk (16%), and head and neck (16%). The nevi followed a similar anatomic distribution in females and males. The lesions were clinically diagnosed with accuracy in 20% of the cases and characterized as a pigmented papule in 42% of the cases. Upon histopathological evaluation, most nevi exhibited symmetry (84%), were well circumscribed (91%), and exhibited epidermal hyperplasia (69%). The junctional type was seen in 42% of the cases, the compound type in 38%, and the dermal type in 20%. Sixty-eight percent of nevi were mostly composed of epithelioid melanocytes, the spindled-shaped melanocytes predominated in 17% of cases, and 12% were composed of both epithelioid and spindled-shaped melanocytes. Multinucleated melanocytes were seen in 7% of nevi, mostly in the epithelioid Spitz nevus (67%). Abundant melanin was observed in 51 cases, from which the most common variant was the classic Spitz nevi. The typical dull eosinophilic globules (Kamino bodies) were observed in a minority of the cases (11%), mostly in the classic Spitz nevus. The most common variant was the classic Spitz nevus (65%), followed by the dermal Spitz nevus (15%). In conclusion, Spitz nevus in a Hispanic population most commonly presents as a pigmented papule on the lower extremities irrespective of sex and age. It is characterized by a melanocytic proliferation most commonly composed of nested epithelioid melanocytes in a junctional or compound arrangement, with the presence of abundant melanin.

Lymph node melanosis in a patient with metastatic melanoma of unknown primary.

Tumoral or nodular melanosis in the skin is considered a variation of completely regressed melanoma, presenting clinically as a suspicious pigmented papule or nodule. Microscopically, the lesion consists of a nodular accumulation of heavily pigmented melanophages in the dermis, staining positive for immunohistochemical markers of histiocytic lineage (CD68) and negative for those of melanocytic lineage (S100, HMB-45, Melan-A). This process is rarely described in lymph nodes. We present a report of a patient with melanosis involving multiple lymph nodes of an axillary dissection, done for metastatic melanoma with an unknown primary, and discuss possible prognostic and treatment factors.

Lymph Node Melanosis in a Patient With Metastatic Melanoma of Unknown Primary

Tumoral or nodular melanosis in the skin is considered a variation of completely regressed melanoma, presenting clinically as a suspicious pigmented papule or nodule. Microscopically, the lesion consists of a nodular accumulation of heavily pigmented melanophages in the dermis, staining positive for immunohistochemical markers of histiocytic lineage (CD68) and negative for those of melanocytic lineage (S100, HMB-45, Melan-A). This process is rarely described in lymph nodes. We present a report of a patient with melanosis involving multiple lymph nodes of an axillary dissection, done for metastatic melanoma with an unknown primary, and discuss possible prognostic and treatment factors.

Multiple Pigmented Follicular Cysts of the Vulva Successfully Treated with CO2 Laser

BACKGROUND A pigmented follicular cyst is an uncommon epithelial cyst, typically occurring as a single asymptomatic pigmented papule or nodule on the head and neck of adult men. To the authors' knowledge, no previous cases of vulvar pigmented follicular cyst have been reported. Although benign, pigmented follicular cyst can affect quality of life when multiple and symptomatic. OBJECTIVE The objective was to describe the clinicopathologic features of vulvar pigmented follicular cyst and to evaluate the efficacy of CO2 laser therapy in this region. METHODS A 62-year-old woman with multiple pigmented follicular cysts affecting the labia majora bilaterally is described. Owing to frequent inflammation and tenderness, continuous-wave CO2 laser was used to treat the skin lesions under local anesthesia. RESULTS All cystic nodules were successfully ablated with CO2 laser. The patient tolerated the procedure well and had a satisfactory cosmetic outcome. CONCLUSION CO2 laser is a tolerable and effective therapeutic modality for multiple and symptomatic pigmented follicular cysts of the vulva.

Primary Localized Cutaneous Amyloidosis in Association with Papillary Thyroid Carcinoma

Background: Lichen amyloidosis, a type of primary localized cutaneous amyloidosis, is characterized by pruritic brown or grayish pigmented papules. Objective: We report a case of lichen amyloidosis in which the skin lesion consisted of asymptomatic salmon-pink-colored papules on the back of the neck to the upper back. This was different from typical clinical pictures of lichen amyloidosis. Our patient proved to have thyroid papillary carcinoma. Conclusion: Our case may suggest that lichen amyloidosis could be a cutaneous manifestation of thyroid cancers.

Melanoma induction in a hairless mouse with short-term application of dimethylbenz[a]anthracene.

Melanomas have been induced in hamsters and guinea pigs with short-term, low dose applications of dimethylbenz [a]anthracene (DMBA) alone. In mice, however, melanoma induction has required either croton oil or ultraviolet radiation promotion in addition to DMBA. In this study, we report the development of a malignant melanoma, with metastases, in a hairless mouse after six applications of 0.25% DMBA alone. At sacrifice, a large primary tumour with characteristics of intralesional transformation was present, along with numerous pigmented macules and papules. Metastases were present in lymph nodes and lungs. There was a marked similarity between this melanoma and its precursor lesions and those seen in an earlier, Weiser-Maple guinea pig model, which, in turn, resembled human melanoma.