Acneiform Presentations of Folliculotropic Mycosis Fungoides.

Background: Folliculotropic mycosis fungoides (FMF) is a variant of cutaneous T-cell lymphoma that has clinical overlap with a variety of inflammatory follicular unit disorders. However, we describe distinctive presentations of FMF with acneiform features that can be diagnostically challenging, leading to diagnostic delay.

Objective: To highlight the importance of histopathologic and immunohistochemical evaluation for diagnostic confirmation of presumed inflammatory follicular unit-based disorders that are unusual in presentation or unresponsive to standard therapies.

Cutaneous peripheral T-cell lymphoma, not otherwise specified: A single-center prognostic analysis.

Background: Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) is a rare and aggressive disease either originating in or secondarily involving the skin.

Objective: We sought to assess clinical, histopathologic, and prognostic features of patients with cutaneous PTCL-NOS.

Methods: This was a retrospective chart review of patients with cutaneous PTCL-NOS between 1993 and 2013.

Indolent course of cutaneous gamma-delta T-cell lymphoma.

Cutaneous gamma-delta T-cell lymphoma (γδTCL) is a rare malignancy that typically displays an aggressive clinical course. We present an unusual case of a 57-year-old woman with a 3-year history of lower extremity nodules. Histopathologic, immunophenotypic and molecular genetic studies revealed a clonal, predominantly pannicular gamma-delta T-cell infiltrate, leading to a diagnosis of cutaneous γδTCL.

Retrospective analysis of tissue plasminogen activator as an adjuvant treatment for calciphylaxis.

Objective: To report our experience with low-dose tissue plasminogen activator in the treatment of calciphylaxis, a rare, usually fatal thrombotic condition that results in ischemia, necrosis, and infarction of adipose and cutaneous tissue.

Design: Retrospective chart review.

Setting: Tertiary care academic medical center.

Prognostic factors in Merkel cell carcinoma: analysis of 240 cases.

Background: Knowledge regarding behavior of and prognostic factors for Merkel cell carcinoma (MCC) is limited.

Objective: We sought to further understand the characteristics, behavior, prognostic factors, and optimal treatment of MCC.

Methods: A multicenter, retrospective, consecutive study of patients with known primary MCC was completed.

Unknown primary Merkel cell carcinoma: 23 new cases and a review.

Background: Knowledge is limited regarding unknown primary Merkel cell carcinoma (UPMCC).

Objective: We sought to document the characteristics and behavior of UPMCC, and determine the most appropriate treatment.

Methods: A multicenter, retrospective, consecutive study reviewing patients given a diagnosis of UPMCC between 1981 and 2008 was completed.

Net-like pattern of calcification on plain soft-tissue radiographs in patients with calciphylaxis.

Background: Calciphylaxis is a rare, life-threatening syndrome marked by vascular calcification and cutaneous necrosis. The role of radiographic imaging in assisting in diagnosis has not been established.

Objective: To investigate the potential role of plain radiographic imaging in the diagnosis of calciphylaxis.

The dermatology hospitalist: creating value by rapid clinical pathologic correlation in a patient-centered care model.

Background: The active and continuous presence of dermatologists in hospitals has undergone continued involution over the past two decades. Our patient-centered, value-based dermatology hospitalist model describes an efficient system for the integration of the dermatologist in the hospital treatment team.

Methods: We describe five difficult inpatient cases to illustrate the value of dermatology intervention and clinical pathologic correlation in facilitating timely diagnosis and treatment.

The role of CD10 in distinguishing atypical fibroxanthoma from sarcomatoid (spindle cell) squamous cell carcinoma.

Background: The role of CD10 needs clarification in a broader immunohistochemical battery for distinguishing atypical fibroxanthoma (AFX) from spindle cell squamous cell carcinoma (sSCC).

Methods: We retrospectively reviewed 23 cutaneous spindle cell tumors previously classified as AFX (n = 11) or as sSCC (n = 12). Each tumor was stained with CD10, S-100, p63 and two or more cytokeratin stains.

Malignant melanoma in solid transplant recipients: collection of database cases and comparison with surveillance, epidemiology, and end results data for outcome analysis.

Objective: To determine malignant melanoma cause-specific and overall survival among patients with melanoma diagnosed after organ transplantation compared with a national sample with malignant melanoma.

Design: Retrospective review.

Setting: Mayo Clinic sites.

Specificity of IRF4 translocations for primary cutaneous anaplastic large cell lymphoma: a multicenter study of 204 skin biopsies.

Current pathologic criteria cannot reliably distinguish cutaneous anaplastic large cell lymphoma from other CD30-positive T-cell lymphoproliferative disorders (lymphomatoid papulosis, systemic anaplastic large cell lymphoma with skin involvement, and transformed mycosis fungoides). We previously reported IRF4 (interferon regulatory factor-4) translocations in cutaneous anaplastic large cell lymphomas. Here, we investigated the clinical utility of detecting IRF4 translocations in skin biopsies.

Folliculotropic mycosis fungoides: single-center study and systematic review.

Objectives: To clarify clinicopathologic features and reconcile discrepancies in previous studies of folliculotropic mycosis fungoides (FMF).

Design: A single-center retrospective clinicopathologic study and a systematic review of FMF.

Setting: Tertiary referral center in the midwestern United States.

Effects of chronic lymphocytic leukemia on the development and progression of malignant melanoma.

Background: An association exists between chronic lymphocytic leukemia and malignant melanoma.

Objectives: To study the clinical behavior of malignant melanoma in patients with chronic lymphocytic leukemia.

Methods: A retrospective chart review was conducted of patients with chronic lymphocytic leukemia and malignant melanoma.

Paucity of intraepidermal FoxP3-positive T cells in cutaneous T-cell lymphoma in contrast with spongiotic and lichenoid dermatitis.

Background: FoxP3 is the most specific available marker for regulatory T cells (Tregs). Tumor-associated FoxP3-positive Tregs have been identified in various neoplasms, including cutaneous T-cell lymphoma (CTCL). FoxP3 expression in CTCL varies across groups; few studies have compared CTCL with inflammatory conditions.

Fatal cytotoxic cutaneous lymphoma presenting as ulcerative psoriasis.

Background: Psoriasis is a common, nonulcerative skin disorder.

Observations: We describe 3 men recently referred to our institution for evaluation and treatment of severe, ulcerative psoriasis that ultimately was determined to be aggressive, cytotoxic, cutaneous lymphoma. Each had a history of relatively indolent, nonulcerative patches and plaques (duration, 2-45 years) that changed to ulcerated lesions; these rapidly progressed and eventuated in death.

Metastatic malignant melanoma.

Metastatic malignant melanoma is an incurable malignancy with extremely poor prognosis. Patients bearing this diagnosis face a median survival time of approximately 9 months with a probability of surviving 5 years after initial presentation at less than 5%. This is contrasted by the curative nature of surgical resection of early melanoma detected in the skin.

Outcomes of melanoma in recipients of solid organ transplant.

Background: There is concern that the immunologic tumor malignant melanoma (MM) may have worse outcomes in immunosuppressed hosts than in the general population.

Objective: We sought to describe outcomes of MM in immunosuppressed solid organ transplant recipients and compare them with the general population.

Methods: We conducted a retrospective review of medical charts and pathology slides of cases of MM and solid organ transplantation between 1978 and 2007, with comparison of outcomes.

Pathogenesis of calciphylaxis: Hans Selye to nuclear factor kappa-B.

The clinical syndrome of calciphylaxis is characterized by arteriolar medial calcification, thrombotic cutaneous ischemia, necrotic skin ulceration, and a high mortality rate. This review integrates calciphylaxis risk factors with the molecular processes governing osseous and extraosseous mineralization. As the pathogenesis of calciphylaxis is better understood, targeted therapies aimed at disease prevention and reversal will follow.

The role of the hospital dermatologist in the diagnosis and treatment of calciphylaxis and nephrogenic systemic fibrosis.

Calciphylaxis and nephrogenic systemic fibrosis are rapidly progressive diseases associated with renal impairment with high rates of mortality and morbidity. In this review, we highlight the role of the dermatologist in the multispecialty team approach to the diagnosis, treatment, and management of these patients. We present sample cases from our hospital practice to emphasize the importance of diagnosis, clinicopathologic correlation, rapid intervention, and treatment of these challenging skin disorders.

Dermal and pannicular manifestations of internal malignancy.

The concept that noncutaneous malignancies may induce paraneoplastic inflammatory reactions and neoplastic or non-neoplastic proliferations in the skin is well known. Previous work on this subject primarily provides lists and descriptions of dermatologic entities that are exclusively or occasionally associated with specific or varied internal cancers or precancerous states. This review seeks to provide a different perspective to this subject by emphasizing components of the skin (the dermis and subcutis) as focal points of paraneoplastic phenomena, with the intent of broadening thinking and differential diagnoses when the findings described are encountered in dermatology clinics and dermatopathology laboratories.