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Carcinosarcomas are rare malignant tumors derived of both epithelial and mesenchymal elements. Herein, we report an elderly man originally diagnosed with a squamous cell carcinoma of the hand. Upon excision, the tumor was found to be a more aggressive carcinosarcoma. Immunohistochemical stains revealed that the sarcoma component of the lesion was vimentin positive, whereas the primary carcinoma tumor cells were positive for p63 and CK903. Both components were negative for CD34 and D2-40. This tumor was found to have angiolymphatic invasion and eventually metastasized to the axillary lymph nodes and lungs.

Background: Onychopapilloma is a benign neoplasm of the nail bed and the distal matrix. Although not uncommon in our experience, only up to 32 cases of this tumor have been reported in the literature., Objective: We sought to review the clinical, dermoscopic, and pathologic features of onychopapilloma., Methods: We retrospectively analyzed the clinical features of 47 patients with pathologically confirmed onychopapilloma diagnosed within the last 5 years, and reviewed the published literature., Results: The most common clinical presentation was longitudinal erythronychia (n = 25); followed by longitudinal leukonychia (n = 7); longitudinal melanonychia (n = 4); long splinter hemorrhages without erythronychia, leukonychia, or melanonychia (n = 8); and short splinter hemorrhages without erythronychia, leukonychia, or melanonychia (n = 3), with subungual mass (n = 47) and distal fissuring (n = 11). Pathology was consistent with acanthosis of the nail bed and distal matrix, with matrix metaplasia underlying distal subungual hyperkeratosis., Limitations: This was a retrospective analysis., Conclusion: To our knowledge, our series of onychopapilloma is the largest so far. Among various clinical presentations, longitudinal erythronychia is the most common. Dermoscopy of the free edge of the nail plate showing a small subungual keratotic mass where the band reaches the nail plate margin provides a clue for the diagnosis., (Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Matrical carcinoma (pilomatrix carcinoma) is a rare follicular low-grade malignancy with matrical differentiation. A pigmented variant with admixed dendritic melanocytes is exceedingly rare with only 7 cases reported in the literature. The diagnosis of malignancy can be difficult to establish. The authors report a case of a 79-year-old woman with a matrical carcinoma who presented with an ulcerated nodule on the posterior right leg, measuring 2.2 cm in greatest dimension. The excisional biopsy showed irregularly shaped dermal and subcutaneous nodules ranging in size from 0.1 to 0.5 cm. The nodules were composed of aggregates of large atypical basaloid cells, with multiple, sometimes atypical, mitoses, admixed with ghost cells, and central necrosis en masse. In addition, the neoplasm was characterized by focal marked melanocytic proliferation and multiple whorls of pink eosinophilic material reminiscent of keratin pearls (squamoid whorls). The basaloid cells were positive for beta-catenin both in the nuclei and the cytoplasm and negative for BerEp4. S100, Melan-A, and HMB45 highlighted the melanocytic dendritic cells. Pan-cytokeratin was negative in the ghost cells and focally positive in the squamoid whorls. Squamoid whorls seem to be a significant feature of matrical carcinoma.

Lymphomatoid papulosis (LyP) is a chronic recurrent lymphoproliferative disorder characterized clinically by self-regressing cutaneous lesions. Histologically, it is recognized by clusters of CD30 atypical lymphocytes in the background of mixed inflammatory infiltrate. It has been classified as type A, B, C, and D. Recently, a further variant of LyP was described as "angioinvasive LyP" in a series of 16 patients. We report a case of a 73-year-old female presenting with papules and nodules on the extremities evolving into eschar-like necrotic plaques. Histological examination revealed medium- to large-sized atypical lymphoid CD30 cells densely infiltrating the dermis with distinct angioinvasion and angiodestruction. No systemic involvement was identified. The clinicopathologic features conformed to the newly described angioinvasive LyP.

Neoplastic changes arising at the sites of chronic, nonhealing wounds are not uncommon; however, they often go undiagnosed. We report a case of rapidly progressing plantar melanoma presenting as a chronic, nonhealing ulcer. A 46-year-old patient presented at a specialized Wound Healing Center with an enlarging painful ulcer on the right heel of 3 months duration. The wound was biopsied and specimens were sent for examination at the Wound Pathology service at the Department of Dermatology and Cutaneous Surgery, University of Miami. Histology demonstrated features consistent with acral malignant melanoma. Immunohistochemistry using melanocytic markers MART-1, S-100, HMB-45 revealed positive staining indicating the presence of malignant cells, and D2-40 staining showed lymphatic invasion of the tumor in the wound biopsy specimen. The case presented here underscores the importance of wound biopsying in the diagnosis of malignancies associated with nonhealing wounds.

A 2-year-old white girl with divided (or kissing) epidermal nevus of the third and fourth fingers of the left hand is described. The possible pathogenesis of this unique lesion is also discussed., (© 2012 Wiley Periodicals, Inc.)

Spitz nevus (SN) and Spitzoid malignant melanoma (SMM) represent benign and malignant counterparts at both ends of the spectrum of Spitzoid lesions. Atypical Spitzoid neoplasm (ASN) is a poorly defined and characterized category of melanocytic tumors with histologic features of both benign Spitz nevi and malignant melanomas. The group of ASN represents a mixture of Spitz nevi with atypical features and Spitzoid melanomas. However, at the current moment in time, histopathologists are not capable of differentiating between the 2 in some cases and are forced to place them in this ambiguous category, where the behavior of these lesions cannot be predicted with certainty. Because this group encompasses both benign and malignant lesions, and perhaps also a separate category of melanocytic tumors that behave better than conventional melanomas, some of these neoplasms can metastasize and kill patients, whereas others have no metastatic potential, and yet others might only metastasize to regional lymph nodes. Although diagnostic accuracy has improved over the years, many of these lesions remain controversial, and there is still poor interobserver agreement in classifying problematic Spitzoid lesions among experienced dermatopathologists. The objective of this review article is to summarize the most relevant information about SN and ASNs. At this time histologic examination remains the golden standard for diagnosing these melanocytic neoplasms. We therefore concentrate on the histopathologic, clinical, and dermoscopic aspects of these lesions. We also review the most recent advances in immunohistochemical and molecular diagnostics as well as discuss the controversies and dilemma regarding whether to consider sentinel lymph node biopsy for diagnostically ambiguous melanocytic neoplasms., (Copyright © 2010 Elsevier Inc. All rights reserved.)

We describe what we believe to be the seventh report of a combined tumor with histologic features of both malignant melanoma and a squamous cell carcinoma, a squamomelanocytic tumor. An 82-year-old woman presented with a nondescript, skin-colored, firm papule on her nose. Histology showed 2 different neoplastic cell proliferations: atypical squamoid cells and irregularly shaped nests of atypical pigmented epithelioid cells (melanocytes) arranged in small to large nests at the dermal-epidermal junction and within the epidermis. Both components were closely admixed and restricted to the epidermis. Immunohistochemistry showed diffuse cytoplasmic reactivity for pancytokeratin in all areas supporting the histopathologic features of a squamous cell carcinoma. S-100 and melanoma antigen recognized by T cells 1 did not stain these areas and showed strong selective positivity for the atypical melanocytic component. A true malignant proliferation of 2 distinct cell phenotypes due to close paracrine interactions is our favored interpretation because of the intimate admixture, distinct immunohistochemical pattern, and unique histologic features. Perhaps, chronic sun damage (facial location and advanced age) and reduced immunity (history of other malignancies, particularly recent history of a basal cell carcinoma) played a complementary role for the development of the squamomelanocytic tumor.