Pigment synthesizing melanoma (so-called animal type melanoma): a clinicopathological study of 14 cases of a poorly known distinctive variant of melanoma

AIMS

Pigment synthesizing melanoma (so-called animal type melanoma) (PSM) is a rare histopathological variant of melanoma so termed because of prominent melanin production and its similarity to a variant of melanoma seen in grey horses. The aim of this study was to report the clinicopathological characteristics of 14 cases of animal type melanoma.

METHODS AND RESULTS

Six patients were female and eight were male with ages ranging from 5 to 52 years (mean 31 years, median 39 years). The head and neck represented the most common site. The clinical diagnosis was of melanoma in seven cases, blue naevus in three cases, benign naevus in three cases and a pigmented basal cell carcinoma in one case. The histological diagnosis of PSM was predicated on the basis of an asymmetrical, predominantly intradermal tumour formed of deeply pigmented, round or short, spindle-shaped dendritic melanocytes with some degree of hyperchromatism and a single nucleolus. Cytological atypia was always present but was not pronounced. A prominent population of macrophages was invariably present. Four tumours were compound and 10 tumours were predominantly intradermal. The mitotic count was usually low, ranging from 1 to 5 per 10 high-power fields (mean 2). Perineural and lymphovascular invasion was not seen. The Breslow thickness ranged from 1.1 to 7.5 mm (mean 3.3 mm). Follow-up was available in 13 patients. The median follow-up period was 5 years. Six patients had no recurrence, three had local recurrence in the form of satellite nodules adjacent to the scar, four had spread to the regional lymph nodes and one patient had distant metastases to the liver. There were no deaths.

CONCLUSIONS

This study demonstrates that PSM is a distinctive, possible low-grade variant of melanoma usually lacking the histological features predictive of aggressive behaviour seen in ordinary melanoma. It should be managed in the same way as other melanomas with wide local excision.

Epithelioid haemangioma in association with a deep arteriovenous malformation

Epithelioid haemangiomas are benign, vascular tumours characterized by the proliferation of epithelioid endothelial cells with abundant eosinophilic hyaline cytoplasm. We report a case of epithelioid haemangioma in association with a deep arteriovenous malformation of the subclavian artery. The association of reactive vascular proliferations with arteriovenous malformations is uncommonly reported.

Complete pain relief following treatment of a glomangiomyoma with the pulsed dye laser

Hereditary multiple glomus tumours constitute an autosomal dominant skin disease which is known to demonstrate cutaneous mosaicism typified by type 1 and 2 segmental arrangements. We report a patient with type 2 segmental multiple glomangiomyomas who was disturbed by the pain of her lesions. A symptomatic lesion was successfully treated with the pulsed dye laser and to date there has been no recurrence of the pain. Possible explanations for the clinical response are discussed.

Red ink tattoo reactions: successful treatment with the Q-switched 532 nm Nd:YAG laser

BACKGROUND

In the South-west Thames region there were an unprecedented number of lichenoid tattoo reactions to red ink in patients who had visited a local tattoo parlour. The red ink was found to contain mercuric sulphide, a compound known to cause allergic reactions. Topical Dermovate (clobetasol propionate 0.05%, GlaxoWellcome) ointment alone had little impact.

OBJECTIVES

To investigate whether the Q-switched 532 nm Nd:YAG laser could produce permanent flattening of the reaction.

METHODS

This was an open nonrandomized clinical trial. Biopsies were taken from the lichenoid areas within the tattoos. Subjects were patch tested to 1% ammoniated mercury in petrolatum prior to treatment with the Q-switched 532 nm Nd:YAG laser. Laser treatments were delivered at 6-weekly intervals by a single operator. Patients also applied topical Dermovate between treatments. Therapy was discontinued when the lesions flattened. Clinical photographs were assessed at baseline and prior to each laser treatment.

RESULTS

Seven patients with Fitzpatrick skin types I-III were enrolled in the study (four females, three males, mean age 39 years). All patients completed the trial. Patch testing to mercury was universally negative at 48 and 96 h. Substantial flattening and depigmentation of the red ink within the tattoos was noted after six laser treatments. No adverse effects were recorded.

CONCLUSIONS

The Q-switched 532 nm Nd:YAG laser in combination with topical Dermovate ointment is a safe and effective method of treating red ink tattoo reactions.

Vitiligo in association with human immunodeficiency virus infection

Autoimmune disorders such as vitiligo have been previously reported in patients with human immunodeficiency virus (HIV) infection. We describe a case of vitiligo in association with HIV where a rising CD4 lymphocyte count due to highly active antiretroviral therapy (HAART) closely correlated with changes in the skin. This effect, to our knowledge, has not been previously observed.

Giant condyloma of Buschke-Loewenstein in association with erythroderma

The Buschke-Loewenstein tumour is regarded as a type of verrucous carcinoma occurring on anogenital mucosal surfaces. The tumour is locally invasive but displays a benign cytology and rarely metastasizes. It is associated with human papillomavirus types 6 and 11. We describe a case of Buschke-Loewenstein tumour occurring in a 61-year-old man which behaved in a locally aggressive manner and was associated with human papillomavirus type 16 and erythroderma which proved resistant to treatment. The patient refused surgery and therapy with interferon alpha was ineffective. Chemotherapy with systemic cisplatin and 5-fluorouracil produced a partial response before the patient succumbed from gram-negative septicaemia.

Diffuse hypertrichosis and faun-tail naevus as cutaneous markers of spinal dysraphism

We describe two cases of spinal dysraphism where detection of the cutaneous signs - namely a faun-tail naevus and diffuse hypertrichosis - led to early recognition of the occult neurological abnormalities and institution of corrective surgery. The dermatologist may be the first physician to observe these skin changes and an early neurosurgical referral can prevent subsequent neurological complications.

Childhood granulomatous periorificial dermatitis in an Asian girl--a variant of sarcoid?

Childhood granulomatous periorificial dermatitis (CGPD) is a benign, facial eruption which has previously been reported in prepubertal, Afro-Caribbean children. It is a condition of unknown aetiology, characterized by a monomorphic, papular eruption around the mouth, nose and eyes. Typically the eruption persists for several months but resolves without scarring. The condition can usually be distinguished from sarcoidosis on clinical and histological grounds. To our knowledge, this is the first case of CGPD occurring in an Asian child with sarcoidal histology and is unusual in its persistence for 4 years. We suggest that this case of CGPD may well be a variant of sarcoid.