We present the case of a 54-year-old woman with a clinically suspected malignant melanoma. Histology, however, revealed the unexpected diagnosis of large cell acanthoma. This is a benign epidermal neoplasm that is poorly...We present the case of a 54-year-old woman with a clinically suspected malignant melanoma. Histology, however, revealed the unexpected diagnosis of large cell acanthoma. This is a benign epidermal neoplasm that is poorly understood and underreported in the literature. The clinical and dermoscopic appearance in our patient differs from previously reported cases. We draw attention to this heterogeneous lesion and encourage further investigation into its classification and distinguishing features, which may ultimately inform optimal management for patients.
Brazão C, Borges-Costa J, Antunes-Duarte S
… +9 more, Mancha D, Sun L, Marques T, Gargaté MJ, Vilares A, Reis T, de Vasconcelos P, Soares-de-Almeida L, Filipe P
Cutaneous diseases in returning travelers encompass a wide spectrum of etiologies and often pose diagnostic challenges. We present the cases of a 50-year-old man and a 57-year-old woman who presented with a 3-month histo...Cutaneous diseases in returning travelers encompass a wide spectrum of etiologies and often pose diagnostic challenges. We present the cases of a 50-year-old man and a 57-year-old woman who presented with a 3-month history of erythematous, ulcerated plaques with well-defined elevated borders and a necrotic center on the lower limbs that began 3 weeks after returning from vacation in Costa Rica. Cutaneous biopsy revealed epidermal ulceration and extensive caseating granulomas throughout the full thickness of the dermis. Giemsa staining revealed no amastigotes. Microbiological examinations identified Leishmania braziliensis and excluded mycobacteria and fungi. The diagnosis of cutaneous leishmaniasis was established. Owing to clinical severity and antimonial unavailability, the man was treated with liposomal amphotericin B. The woman underwent surgical excision of the single lesion, along with oral fluconazole. Complete resolution was documented in both patients. These cases, which posed diagnostic and therapeutic challenges, highlight that cutaneous leishmaniasis, in all its versatile and often perplexing presentations, is a parasitic infection that should always be considered in dermatologic patients returning from vacation in endemic countries.
Aquagenic wrinkling of the palms (AWP) is a rare dermatologic condition characterized by rapid wrinkling, edema, and papules on the palms after brief water exposure. It is commonly associated with cystic fibrosis (CF) or...Aquagenic wrinkling of the palms (AWP) is a rare dermatologic condition characterized by rapid wrinkling, edema, and papules on the palms after brief water exposure. It is commonly associated with cystic fibrosis (CF) or CF carrier status but can also occur in individuals without these conditions. We report a healthy 12-year-old girl who presented with AWP without a family history of CF or related symptoms. After 4 minutes of water immersion, she exhibited typical wrinkling and translucent papules on the palms, which resolved completely within 15 minutes. A sweat test for CF was negative. The patient was managed with moisturizers and advised to minimize prolonged water exposure. This case highlights AWP as a potential early marker for CF or carrier status, even in the absence of other symptoms. Recognition of AWP may guide genetic screening and early intervention, underscoring the role of dermatologists in identifying this condition and facilitating timely diagnosis and management of CF.
Central centrifugal cicatricial alopecia (CCCA) is a form of scarring alopecia typically characterized by progressive hair loss that begins at the crown or vertex of the scalp and expands circumferentially over time. Alt...Central centrifugal cicatricial alopecia (CCCA) is a form of scarring alopecia typically characterized by progressive hair loss that begins at the crown or vertex of the scalp and expands circumferentially over time. Although most commonly described and diagnosed in women of African descent, CCCA can also occur in men. We describe the case of a 38-year-old man of African descent with a patchy presentation of CCCA. Unlike the classic distribution reported in the literature, this patient exhibited multifocal patchy areas of scarring hair loss. This case highlights the importance of considering CCCA in younger men presenting with atypical alopecia patterns to ensure accurate diagnosis and appropriate management.
A 34-year-old man from Guinea-Bissau presented with a rapidly growing tumor on his right foot over 6 months, arising from a long-standing pigmented papule present for more than 20 years. Clinical examination revealed an...A 34-year-old man from Guinea-Bissau presented with a rapidly growing tumor on his right foot over 6 months, arising from a long-standing pigmented papule present for more than 20 years. Clinical examination revealed an exophytic black tumor with ipsilateral inguinal lymphadenopathy. Histopathological analysis showed an epithelioid and fusiform melanocytic proliferation in the dermis with abundant melanin. Immunohistochemical staining demonstrated diffuse positivity for Sox-10, Melan-A, HMB45, and PRAME. A diagnosis of blue nevus-like melanoma (BNM) was confirmed. BRAF V600 mutation testing on a cutaneous metastasis was negative. Staging imaging revealed widespread metastases involving lymph nodes, brain, lungs, liver, stomach, duodenum, colon, adrenal glands, pancreas, gallbladder, and bones. Despite 4 cycles of ipilimumab/nivolumab immunotherapy, the disease progressed, and the patient died 4 months after diagnosis. BNM is a rare melanoma variant, often arising from a pre-existing blue nevus, with aggressive potential and frequent lymph node metastasis. The molecular heterogeneity of BNM and the limited therapeutic options underscore the need for further research into targeted therapies and prognostic biomarkers for this rare melanoma subtype.
We report the case of a 9-year-old boy with typical clinical and histopathologic features of childhood granulomatous periorificial dermatitis. Despite multiple previous treatment attempts, the condition persisted. The pa...We report the case of a 9-year-old boy with typical clinical and histopathologic features of childhood granulomatous periorificial dermatitis. Despite multiple previous treatment attempts, the condition persisted. The patient had a concurrent history of asthma and was receiving daily inhaled fluticasone therapy. Management was challenging, as the patient exhibited resistance to conventional treatments, possibly owing to the use of inhaled corticosteroids, where discontinuation is usually the first step. Therapy with topical and a single dose of oral ivermectin was employed successfully, likely owing to its anti-inflammatory and anti-parasitic effects on spp. To our knowledge, this is the first case of ivermectin use in this condition. Both topical and systemic ivermectin appear to be safe and efficacious therapeutic options.
The bilobed flap is a local transposition flap originally described for the reconstruction of surgical defects of the nose. Its success and versatility are well recognized in this anatomical region; however, its use in e...The bilobed flap is a local transposition flap originally described for the reconstruction of surgical defects of the nose. Its success and versatility are well recognized in this anatomical region; however, its use in extranasal reconstructions is less common. We present 5 clinical cases of extranasal applications of the bilobed flap that highlight its versatility across a wide range of anatomical sites. The locations include the hand (n = 1), foot (n = 1), ear and periauricular region (n = 1), chin (n = 1), and temporal region (n = 1). The surgical defects ranged from medium to large in size, with maximum diameters between 20 and 55 mm. All procedures were performed in a single session under local anesthesia, with no associated complications. All patients achieved good functional and aesthetic outcomes.
Lupus erythematosus panniculitis (LEP) is an uncommon variant of lupus erythematosus, characterized by subcutaneous indurated nodules or plaques that often heal with lipoatrophy or scarring. We report a 77-year-old woman...Lupus erythematosus panniculitis (LEP) is an uncommon variant of lupus erythematosus, characterized by subcutaneous indurated nodules or plaques that often heal with lipoatrophy or scarring. We report a 77-year-old woman who presented with a 4-month history of painful subcutaneous nodules and erythematous plaques. She had a history of discoid lupus erythematosus in her 30s, which was successfully managed with topical treatments and had since resolved. Deep incisional biopsy of a plaque on her back confirmed the diagnosis of LEP. The patient improved with treatment including methotrexate, folic acid, and prednisone. This case highlights a unique clinical presentation of LEP, both in terms of patient age and lesion distribution, and underscores the critical role of histopathology in excluding subcutaneous panniculitis-like T-cell lymphoma.
Verrucous keratotic melanoma (VKM) is a rare variant, accounting for approximately 3% of melanomas. Its deceptive clinical presentation, often mimicking benign lesions such as warts or seborrheic keratoses, contributes t...Verrucous keratotic melanoma (VKM) is a rare variant, accounting for approximately 3% of melanomas. Its deceptive clinical presentation, often mimicking benign lesions such as warts or seborrheic keratoses, contributes to frequent misdiagnoses and delayed management. We report the case of an 84-year-old woman with a history of nodular melanoma of the left foot, presenting with recurrent keratotic verrucous lesions at the site of prior surgical excision. Histopathological analysis confirmed VKM with a Breslow thickness of 2 mm and Clark level III. No metastases were detected on positron emission tomography. This case underscores the plasticity of melanoma, which can recur in atypical forms, and highlights the importance of considering VKM in the differential diagnosis of hyperkeratotic lesions. Early recognition and surgical excision are critical to optimizing patient outcomes and reducing the risk of systemic dissemination. Increased awareness of VKM characteristics may improve diagnostic accuracy and management.
Tetracyclines are used for a variety of dermatologic conditions, and a known side effect of this therapy is hyperpigmentation in multiple tissues throughout the body. We present the case of a 66-year-old man who underwen...Tetracyclines are used for a variety of dermatologic conditions, and a known side effect of this therapy is hyperpigmentation in multiple tissues throughout the body. We present the case of a 66-year-old man who underwent aortic valve replacement and was found to have discoloration of the aortic valve leaflets associated with his chronic use of minocycline for rosacea. Minocycline-induced pigmentation of cardiac valves is a documented, although uncommon, phenomenon. There is no evidence linking valve pigmentation to functional valve defects. This case highlights an infrequent manifestation of minocycline-induced pigmentation.
Arnaiz-Camacho A, Puig-Galy J, Martín-Nalda S
… +7 more, Bisbe-López L, Pueyo-Ferrer A, Bertolani Y, García-Hidalgo S, Pablos-Jiménez T, Pairó-Salvador A, Zapata MÁ
A 43-year-old woman presented with multiple exophytic lesions on both eyelids of the left eye. The patient underwent excisional biopsy of the lesions, and later 2 more interventions were necessary for the excision of the...A 43-year-old woman presented with multiple exophytic lesions on both eyelids of the left eye. The patient underwent excisional biopsy of the lesions, and later 2 more interventions were necessary for the excision of the affected margins. She was followed by dermatology and medical oncology specialists, as she presented several skin tumors in other locations. Two years after the intervention, she developed a lower corneal abscess in the left eye, with cultures positive for Candida spp. Approximately 12 months later, the infection had completely resolved, leaving a leukoma with both superficial and deep vascularization in the lower cornea. Lagophthalmos was observed along with a predominantly lateral cicatricial ectropion of the lower eyelid, accompanied by increased corneal vascularization, lipoid degeneration, and greater central opacity. The patient underwent cauterization of the superficial vessels and intrastromal bevacizumab injection into the deep vessels and has now been offered penetrating keratoplasty. Epidermodysplasia verruciformis is a rare skin condition characterized by the development of squamous cell carcinomas and flat warts. When these lesions involve the eyelid, close communication between dermatologists, corneologists, and oculoplastic surgeons is essential for optimal management of these patients.
Erythrodermic psoriasis is a severe and potentially life-threatening dermatologic condition that can be triggered or unmasked by medications. We report the case of a 73-year-old patient who developed new-onset erythroder...Erythrodermic psoriasis is a severe and potentially life-threatening dermatologic condition that can be triggered or unmasked by medications. We report the case of a 73-year-old patient who developed new-onset erythrodermic psoriasis following treatment with antiepileptic drugs (AEDs), specifically carbamazepine and levetiracetam, for autoimmune encephalitis. Despite discontinuation of the AEDs, the patient's condition persisted and improved only after systemic biological therapy. Clinical presentation, together with histopathologic findings, supported a diagnosis of new-onset psoriasis rather than a drug-induced psoriasiform reaction. This case highlights the importance of recognizing AEDs as potential triggers for psoriasis in patients with no prior history. Given the severe complications associated with erythroderma, timely diagnosis and initiation of appropriate therapy are essential. Clinicians should maintain a high index of suspicion for medication-induced dermatologic conditions in patients presenting with new or progressive skin eruptions.
GATA2 deficiency is a rare genetic disorder with heterogeneous clinical manifestations affecting the immune, hematologic, and vascular systems. We report the case of a 31-year-old woman with primary lymphedema progressin...GATA2 deficiency is a rare genetic disorder with heterogeneous clinical manifestations affecting the immune, hematologic, and vascular systems. We report the case of a 31-year-old woman with primary lymphedema progressing since childhood, associated with diffuse treatment-resistant warts and severe monocytopenia. Genetic testing revealed a mutation in the gene (c.1078T>C), resulting in complete loss of protein function. The patient also exhibited leukopenia and anemia, and bone marrow evaluation confirmed progression to acute myeloid leukemia. The immune deficiencies caused by this mutation explain the increased susceptibility to recurrent infections, particularly persistent human papillomavirus infections responsible for the extensive warts in this patient. The frequent progression to myelodysplastic syndromes and leukemia underscores the severity of this condition and the importance of early diagnosis. Management requires close monitoring, with hematopoietic stem cell transplantation representing the only curative option to improve prognosis and prevent progression to life-threatening complications. This case highlights the need for prompt identification of GATA2 mutations in patients with suggestive clinical features to optimize surveillance and treatment.
Palisaded encapsulated neuroma (PEN) is a nerve sheath tumor most commonly found on the face. These benign tumors are less commonly reported in skin of color and may be confused with other forms of nerve sheath tumors. D...Palisaded encapsulated neuroma (PEN) is a nerve sheath tumor most commonly found on the face. These benign tumors are less commonly reported in skin of color and may be confused with other forms of nerve sheath tumors. Detection of the distinctive histopathologic features of PEN and recognition of its various subtypes are key to an accurate diagnosis. We report a 68-year-old Black man with a pink to skin-colored papule on the right second fingertip of 6- to 12-month duration. We describe the clinical and pathologic diagnosis of PEN and discuss the differential diagnosis. This case highlights the importance of maintaining a broad differential when managing and treating neoplasms of the nail unit, including rare or uncommon diagnoses.