Faculty Bibliography

The authors describe an isolated, yellowish papular lesion of the upper eyelid in a 63-year-old man. Following excision, histopathologic analysis showed the features of a benign hypopigmented cellular blue nevus, the first and only case involving the eyelid skin.

BACKGROUND: Little is known regarding the clinical practice of immunohistochemistry in the diagnosis of melanoma. We aimed to assess the incidence of immunostain usage by referring pathologists and dermatopathologists in melanoma cases sent for consultative review. As a secondary objective, associations between immunostain use and specific melanoma characteristics were also evaluated. METHODS: This is a retrospective review of consultation reports of referred melanomas at a tertiary academic center in New York, New York from 2001-2015. Univariate regression analysis was performed on melanomas with accompanying immunostains and on characteristics such as Breslow's depth, location, prognostic factors, and morphologic subtypes. Associations between immunostain usage and these characteristics were analyzed using Fisher's exact test. RESULTS: Immunostain use significantly increased over the study period (p<0.001) and was more likely to be associated with melanomas that were thicker (OR=2.5; 1.7-3.6); located on the head and neck (OR=1.6; 1.4-1.9) or acral sites (OR=1.5; 1.1-2.0); had ulceration (OR=2.1; 1.6-2.8), dermal mitoses (OR=1.3; 1.1-1.5), or perineural invasion (OR=3.6; 2.0-6.5); or were of desmoplastic (OR=7.4; 4.5-12), amelanotic (OR=7.1; 3.6-14), or nevoid subtypes (OR=4.0; 1.7-8.9). CONCLUSIONS: Immunostain use in the diagnosis of melanoma has increased significantly in the past 15 years for reasons that remain unclear.

Sarcoidosis is a multiorgan inflammatory diseasewith variable clinical presentations and the commonhistopathologic finding of noncaseating granulomas.The etiology of the disease is not known, butevidence suggests both environmental and geneticcontributions to the pathogenesis. Depending onthe severity of cutaneous disease and extent ofextracutaneous involvement, therapies range fromtopical and intralesional glucocorticoids to systemicimmunomodulatory and immunosuppressiveagents. We present the case of a patient withcutaneous sarcoidosis with prominent necrosis onhistopathologic examination in the setting of severepulmonary sarcoidosis.

Frontal fibrosing alopecia is a scarring alopecia thatis characterized by recession of the frontotemporalhairline with the frequent loss of eyebrows. Itpredominantly affects postmenopausal womenand only rarely affects men. We report the caseof a 46-year-old man with a ten-year history of anerythematous patch with perifollicular erythemaat the superior aspect of the forehead andfrontotemporal hairline. A skin biopsy specimenshowed a perivascular, lymphocytic infiltrate withperiinfundibular fibrosis. These findings establisheda diagnosis of frontal fibrosing alopecia. Thepathogenesis of this condition is poorly understoodbut may be hormonally-mediated.

Cutis verticis gyrata that involves only the face isa rare presentation of this even rarer cutaneousanomaly. We present a 61-year-old man, whodeveloped primary essential progressive cutis verticisgyrata of the face.