Faculty Bibliography

Congenital syphilis is a rare and serious disease that, although preventable, continues to be a major healthcare problem. Its clinical spectrum ranges from an asymptomatic infection to fulminating sepsis or death. A diagnosis of congenital syphilis was made in an 8-week-old infant whose mother had adequate prenatal care. We present the clinical and histopathologic findings of this uncommon congenital disease.

Solar elastosis is a recognized manifestation of chronic sun exposure affecting mainly Caucasian skin. Recognizable clinical manifestations of solar elastosis include cutis rhomboidalis nuchae, Favre-Racouchot syndrome, actinic comedonal plaque, nodular forms such as elastomas, elastic nodule of the ear and elastotic bands, collagenous plaques of the hand, and colloid milia. We report two patients with an unusual presentation of vesicular lesions clinically and histopathologically situated in zones of severe solar elastosis that has been previously referred to as bullous solar elastosis.

BACKGROUND: Five percent imiquimod cream, a topically applied immune response modifier with potent antiviral and antitumor activity, has been reported to be effective in the management of lentigo maligna and cutaneous metastases from melanoma. OBJECTIVE: We report a case in which 5% imiquimod cream was effective in the management of a persistent melanoma in situ. METHODS: Five percent imiquimod cream was applied to the affected area twice to three times a week, as tolerated. RESULTS: After 4 months of treatment, repeated biopsies of the previously affected areas showed complete regression of the melanoma. CONCLUSION: Treatment of melanoma in situ of sun-damaged areas with 5% imiquimod cream certainly appears warranted in selected cases where surgical procedures have failed or are not feasible owing to factors such as size and/or localization of the lesion, advanced age, or deteriorated medical status of the patient. Rigorous posttreatment follow-up is mandatory, because long-term recurrence rates after treatment of melanoma in situ with imiquimod are yet unknown.

BACKGROUND: Angiolymphoid hyperplasia with eosinophilia is a benign vascular proliferation that usually affects the head and neck region. METHOD: An 89-year-old man who had a squamous cell carcinoma on the posterior aspect of one ear developed lesions of angiolymphoid hyperplasia with eosinophilia on the anterior aspect of the same ear. RESULTS: After surgical treatment of the malignant neoplasm, the lesions of angiolymphoid hyperplasia with eosinophilia disappeared spontaneously. CONCLUSIONS: Damage to the vasculature of the ear by the malignant neoplasm or the release of angiogenic factors by the same neoplasm is a plausible explanation for the development and eventual resolution of the vascular proliferation.

We report a case of a persistent blue nevus that significantly extended beyond the scar of the original excision mimicking those clinical changes usually seen in melanoma. The histopathologic evaluation revealed a common blue nevus. The lesion was re-excised, and 10 months later a bluish macule appeared next to the surgical scar. This case of a persistent blue nevus with an unusual clinical presentation and a benign clinical course highlights the fact that the clinical markers commonly used to identify melanoma in pigmented lesions will not always accurately diagnose melanoma.

BACKGROUND: Solar lentigines are benign keratinocytic proliferations resulting from prolonged and cumulative sun exposure. The newer photoselective lasers have become the mainstay of treatment. However, cryosurgery and trichloroacetic acid (TCA) solution are cost-effective alternatives in the treatment of solar lentigines. METHODS: Twenty-five patients with multiple solar lentigines over the dorsa of their hands were included. Each hand was treated randomly with either 30% TCA solution or liquid nitrogen spray. The efficacy of treatment was evaluated at 8 weeks. RESULTS: Cryosurgery was more likely to produce significant lightening of the lentigines than 30% TCA solution (P < 0.05) but was more painful and took longer to heal. CONCLUSION: Cryosurgery was found to be superior to TCA 30% solution in the treatment of solar lentigines. This study demonstrates that old-fashioned treatments for solar lentigines are still excellent and cost-effective therapeutic choices.

We report the case of a 69-year-old man who had a persistent lesion develop on his nose during a 1-year period of time that was diagnosed as rhinophyma. Despite laser treatment the lesion continued to grow. Histopathology and immunohistochemical studies were consistent with cutaneous angiosarcoma. Rhinophyma-like features should be considered as an unusual clinical manifestation of cutaneous angiosarcoma.

BACKGROUND: The rate of human immunodeficiency virus (HIV) infection in women of reproductive age has increased dramatically in the last decade. The effects of pregnancy on the prevalence of cutaneous diseases in this group is unclear. OBJECTIVES: To compare the prevalence of cutaneous diseases in healthy pregnant women, HIV-positive pregnant women, and HIV-positive nonpregnant women. METHODS: Fifty HIV-positive pregnant women and 52 HIV-positive nonpregnant women were compared with a control group of 50 HIV-negative pregnant women for the prevalence of cutaneous diseases. RESULTS: The prevalence of cutaneous diseases was higher (65%) in the HIV-positive nonpregnant group than in the HIV-positive pregnant group (42%) or the control group (28%). Infectious diseases were more frequent in the HIV-positive nonpregnant group. CONCLUSIONS: Pregnancy does not seem to increase the prevalence of cutaneous diseases that occur during the course of HIV disease.