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Malakoplakia is an uncommon granulomatous infectious disease that is found primarily in the genito-urinary tract, but may rarely involve the skin. Histologic findings are marked by the presence of foamy macrophages containing basophilic concentric spherules, the Michaelis-Gutman bodies. Micro-organisms are not readily identifiable. Immunostaining with polyclonal anti-mycobacterium bovis (BCG) has been described as a method of identifying bacterial and fungal organisms in situations where organisms may be sparse. We report 2 cases of cutaneous malakoplakia with demonstration of organisms by immunostaining with anti-BCG antibodies. (J Am Acad Dermatol 2000;43:351-4.)

Malignant blue nevus is uncommon compared to its benign counterpart and is regarded as a rare form of malignant melanoma. We report the clinical and histological findings in eight cases. Histologically, all eight specimens showed no epidermal involvement and had contained within or were adjacent to portions of blue nevus or cellular blue nevus. Proliferation of bundles of bipolar spindle shaped cells with marked cellular atypia, mitotic figures, foci of necrosis, and inflammatory cell infiltrate were noted. Two of the cases were studied by DNA flow cytometry and the populations of tumor cells were found to be diploid. Two cases have died secondary to metastasis. Although malignant blue nevi may not behave as aggressively as nodular malignant melanoma, they have definite potential to do so and therefore should be removed by wide surgical excision.

Background: Epithelioid cell histiocytomas histologically resemble the intradermal form of Spitz nevus. Objective: We have studied eight patients with epithelioid cell histiocytoma. Methods: In addition to the routine stains, histologic sections were prepared by immunohistochemical techniques for S-100 protein, HMB-45, vimentin, α1-antitrypsin, and common leukocyte antigen. Results: Epithelioid cell histiocytoma is characterized by proliferation of angulated epithelioid cells with abundant eosinophilic cytoplasm. Immunostaining for S-100 protein and HMB-45 were negative. The majority of cells had positive reactions to staining for vimentin and α1-antitrypsin. Approximately 20% to 25% of cells also gave positive reactions to common leukocyte antigen. Conclusion: Immunostainings are useful in the differential diagnosis of epithelioid cell histiocytoma from the intradermal form of Spitz nevus.

To the Editor: In the September 1990 issue ofthe JOURNAL a brief communication was published by Drs. O. Stanton and P. E. LeBoit suggesting that fixation in an alcohol-based preservative solution (Omnifix) produced sclerodermoid artifactual changes in the skin biopsy specimen ofone case (1990;23:513). The authors gave no mention or references to the previous publications concerning this form of artifactual findings. We have previously described scleroderma-like artifactual tissue changes occurring when the pedicle of punch biopsy specimens was squeezed by forceps during the biopsy procedure. l , 2 We have not observed this type of artifact when tissue is surgically excised by a knife. In addition, we have used alcohol fixation (70% ethyl alcohol) in our laboratory for more than two decades with the purpose of preventing freezing artifact when the biopsy specimens are placed into a mailbox during the northern cold winter season. We do not observe scleroderma-like artifactual changes in our routinely alcohol-fixed tissue sections. Drs. Stanton and LeBoit should investigateother factors besides alcohol fixation for the cause of changes observed in their case.

Skin specimens from five mummies were examined histologically. The specimens ranged in age from 2,000 to 3,200 years. Material from two mummies had carbonized and showed only amorphous debris. The histology of the three remaining skin fragments retained surprising histologic architectural detail. One specimen obtained from the sole of the foot was compatible with a callus.

We report two cases of eccrine syringofibroadenoma. Both patients had a large, solitary hyperkeratotic nodular lesion over the extremities. Histologic sections showed spongelike masses of small cuboidal acrosyringeal cells. Fibrovascular connective tissue stroma resembling premalignant fibroepithelial tumor of Pinkus filled the spaces between the masses.

We are reporting a case of keratosis lichenoides chronica. This is a chronic dermatosis characterized by seborrheic dermatitis—like facial eruption and purplish papulonodular lesions of the extremities. These lesions sometimes show linear configuration. Histologic changes include features of a chronic and lichenified dermatitis and lichen planus.

A father and his son were seen because of multiple wartlike lesions on their fingers and palms. On histologic examination, these lesions showed changes compatible with vascular fibromas, myxoid fibromas, and, in a few instances, verruca vulgaris. We are not aware of reports of similar cases in the dermatologic literature.

One of the two types of complications that may occur with organoid nevus (nevus sebaceus) is the category of brain malformations and seizure disorders. The second type is the late occurrence of various epithelial growths that are usually observed to develop in long-standing organoid nevi. Among these later-occurring lesions, we are describing the occurrence of proliferating trichilemmal cysts in association with organoid nevi.

The mouse monoclonal antibody AFH1 was produced using formalin-fixed, sham paraffin-embedded human melanoma cell culture line A375 as immunogen. Reactivity of this antibody was assessed by immunohistochemical techniques against formalin- or acid alcohol-fixed paraffin-embedded tissue as well as formalin- or acid alcohol-fixed unembedded lesions. Ninety-seven nevomelanocytic lesions, neurofibromas, epithelial lesions, and a plasmacellular infiltrate were evaluated. AFH 1 was immunoreactive on 54 of 55 nevocytic lesions (98.2%), 15 of 16 primary melanomas (93.7%), a lentigo maligna, and nests in 21 of 21 dysplastic nevi (100%). Of 100 consecutive basal melanocytes of intraepidermal melanoma cells counted in each lesion, mean AFH1 immunoreactivity for nonnested basal melanocytes in nevocellular nevi was 3.8%; for dysplastic nevi, 13.8%; and for intraepidermal melanoma cells, 78.0%. When nonnested basal melanocytes were subdivided into cytologically normal and abnormal cell groups, AFH1 immunoreactivity was 9.4% and 72.6%, respectively. AFH1 recognition of the lentiginous portion of dysplastic nevi corresponds statistically to the appearance of abnormal melanocyte cytology, nest formation, or both. Using 50% immunoreactive nonnested melanocytes as the criterion, AFH1 seems to distinguish primary melanoma from dysplastic nevi with a sensitivity of 93.8% and a specificity of 95.8%.

The most common precancerous skin lesions are actinic keratoses, Bowen's disease, and keratoacanthoma. Actinic keratoses appear over the exposed areas of the body as the result of actinic radiation. Bowen's disease is most probably secondary to the effects of internal carcinogens. Keratoacanthomas are self-limited lesions that occasionally may transform into invasive squamous cell carcinoma.

Histologic studies have shown the evolution of lentigo senilis and have established the relationship between lentigo senilis, solitary lichen planus-like keratosis, and the reticulated form of seborrheic verruca. Histologic differentiation can be made between lentigo senilis and the early light-brown stage of lentigo maligna.

The development of basal cell carcinoma (BCC) in seborrheic keratosis (SK) is rare. Review of over 10,000 biopsies from SK revealed fourteen such cases. The material showed BCC in direct connection with the epidermis of the SK in eleven cases. In three cases the BCC was situated in the reticular dermis. A lesion with the clinical features of SK should be examined histologically when it appears inflamed, when it bleeds, or when it is crusted, eroded, or ulcerated.

The normal and pathologic morphology and chemistry of elastic fibers in human skin have been subject of renewed investigation during the past decade (1, 2, 3). New staining reactions and the availability of certain enzymes (4) that will attack elastic fibers comprise additional tools of investigation.

We are reporting seven cases of Mibelli's porokeratosis of the face. Facial involvement of porokeratosis is rare, and in this location the lesions are not clinically recognized.

The development of elastic fibers within the fibrous stroma of basal cell epithelioma has previously been reported (1). Because these cases only included material from sun-exposed regions, the influence of actinic exposure on elastic fibers could not be eliminated. It was therefore thought necessary to review a series of basal cell epitheliomas from areas not exposed to actinic irradiation and observe the elastic fibers. periphery of solid epithelial nestsf (Figure 1A). In the two other cases, the thin elastic fibers were found lying in a brush-like arrangement at the periphery of the epithelial nests within the stroma (Figure IB). DISCUSSION The study of elastic fibers in cases of superficial basal cell epithelioma from sun-protected areas was TABLE Elastic fibers in superficial basal cell epithelioma-sun protected areas Case Number Age and Sex Duration of Tumor Anatomical Location Pattern of Elastic Fibers within the Tumor 1 70 F-W 1 year Upper Chest Sheaths of elastic fibers surrounding tumor nests 2 64 F-W 20 years Upper Thigh Sheath like 3 42 F-W 1 month Upper Back Sheath like 4 50 F-W 4 years Breast Sheath like 5 40 F-W 6 months Lower Back Sheath like 6 40 F-W 4 years Posterior Leg Sheath like 7 70 M-W 10 years Midback Sheath like 8 35 M-W 1 year Upper Thigh Brush like pattern of elastic fibers 9 60 F-W Unknown Posterior Hip Brush like MATERIALS AND OBSERVATIONS One hundred cases of superficial basal cell epitheliomas on unexposed areas were reviewed. Sections were stained with acid orcein and Giemsa. The series included 43 men and 57 women with the average age of 55 years. Newly-formed elastic fibers were found in nine cases. The clinical data on these nine cases are given in the Table. The newly-formed elastic fibers in the fibrous stroma of basal cell epithelioma are much thinner than those of the surrounding normal corium. They are found in two different patterns. In seven cases, the thin orceinophilic fibers formed sheaths at the done mainly to supplement the previous work. In the present study no evidence of solar elastosis was present in the skin at the periphery of the tumor. Formation of elastic sheaths surrounding the epithelial nests in basal cell epithelioma resembles those seen at the periphery of normal hair follicles. This resemblance may be explained if one considers basal cell epithelioma as a monstrous attempt in adnexogenesis in post-embryonal incompetent skin (2, 3). Solar exposure seems to play no definite role in the formation of elastic fibers. Newly-formed elastic fibers were seen in nine of the hundred cases of superficial basal cell epithelioma on non-solar-exposed areas. The pattern f A similar pattern was seen in the previous study of basal cell epithelioma from sun-exposed areas.