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The behavior of the basement membrane in diseases of the skin and oral mucosa has been discussed. These diseases are lichen planus, erythema multiforme, lupus crythematosus, pemphigus vulgaris, benign mucous membrane pemphigoid, and epidermolysis bullosa simplex. The basement membrane has been evaluated by light microscopy using the PAS and silver stain techniques. While the number of lesions in four of the diseases is small, this study illustrates the value of silver stains for studying the basement membrane in patients with skin and mucous membrane diseases.

THE combination of multiple basal-cell carcinomas, cysts of the jaw, and skeletal deformities forms an uncommon disorder often referred to as the basal-cell nevus syndrome . The condition can be recognized in early childhood and is thought to be inherited as a highly penetrant, autosomal dominant gene with multiple and variable effects. 1 Cases have been described with scoliosis, prominent frontal bosses, short metacarpal bones, nasal deformity, agenesis of the corpus callosum, calcification of the falx cerebri, medulloblastoma, mental changes, hypertelorism, gonadal dysplasia, milia, and dyskeratosis of the palms and soles. 2-10 It has recently been suggested that this syndrome may be a variant of pseudohypoparathyroidism because of (1) certain gross similarities, including body habitus, short metacarpal bones, ectopic calcification, and mental abnormalities, and (2) the failure to respond to infusions of parathyroid hormone with a phosphorus diuresis. 8,9 We have studied a boy with multiple basal-cell carcinomas and bone defects.

Lichen planus is a pruritic disease often prolonged and frustrating for the physician and patient. Emotions play an important role in its cause and control, and some drugs may be etiologic agents. Treatment depends on the course and stage of the disease.

To the Editor.— Recent letters have argued the merits of lumping vs splitting in porokeratosis (Porokeratosis, LETTERS TO THE EDITOR. Arch Derm 105:296, 1972). Here presented is some evidence for lumping. This 36-year-old woman developed a linear porokeratosis at age 5 following the measles (Fig 1). After puberty, she developed the small lesions of disseminated superficial actinic porokeratosis (DSAP) on the arms and legs, with exacerbation in the summer (Fig 2). Biopsies of both areas showed the coronoid lamella. Three of her sisters were also examined and had biopsies. They had DSAP on the extremities, with onset soon after puberty. Four brothers and a younger sister were not affected. The parents had no DSAP.

To the Editor: I write with reference to the paper by Stanley Schoenfeld and Philip C. Hoszberger entitled "Palatal Leukokeratosis Secondary to Candela pa Den" [Arch Derm90:89 (July) 1964]. In keeping with the exotic flavor of local dialects, I use the term from Southern India, "Adda Poga," meaning "reverse smoking." I wish to point out to the authors that this habit of smoking with the lit end inside the mouth has been reported in the literature: Reddy, D. G.; Reddy, D. B.; and Rao, P. R.: Experimental Production of Cancer With Tobacco, Tar, and Heat, Cancer 13:263, 1960. Reddy, D. G., and Rao, V. K.: Cancer of Palate in Costal Andhra Due to Smoking Cigars With Lit End Inside the Mouth, Indian J Med Science 11:791, 1957) Holzberger and Schoenfeld state, "It seems remarkable that such abuse, though producing a baroque version of a precancerous lesion

This case of actinomycosis involving the hand and arm is noteworthy because of the unique location. Not only was the skin affected but also the subcutaneous tissue, muscle, periosteum, and axillary node of the right arm. No discernible history could be elicited of any injury, occupational contact, or endogenous foci. Most cases of actinomycosis of the skin, reported in the literature, reveal a history of farm work or of trauma due to human bites or of fist blows to the mouth. The cases resulting from oral contact include three involving the hand; in each instance the patient had hit another person on the mouth (Cope, 1 McWilliams, 2 and Burrows 3 ). Others in which oral contact was suspected were 14 cases of primary actinomycosis of the breast, reported by Davies, 4 and one, described by Robinson, 5 in which the infection was traced to a human bite. Farm