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Resumen Introduccion y objetivos La enfermedad injerto contra huesped (EICH) cronica cutanea es una complicacion frecuente tras un trasplante de progenitores hematopoyeticos. La fototerapia es una modalidad terapeutica para pacientes con afectacion cutanea o para aquellos que precisan altas dosis de corticoesteroides (CE). El objetivo de este estudio es revisar los casos tratados en nuestro servicio y hacer una revision de la literatura. Material y metodos Recogida de datos de manera retrospectiva de todos los casos tratados desde marzo de 2011 a octubre de 2014 en el Servicio de Dermatologia del Hospital Universitario y Politecnico la Fe de Valencia. Resultados Recogimos un total de 16 pacientes, 10 tratados con PUVA y 6 con UVB-BE. Nueve pacientes obtuvieron una respuesta completa y 7 una respuesta parcial, aunque 2 recidivaron tras el tratamiento. Diez pacientes pudieron disminuir la dosis de CE durante el tratamiento y 3 pudieron disminuir el numero de otros inmunosupresores. No se presentaron efectos adversos graves. Conclusiones La fototerapia es una buena opcion terapeutica para pacientes con EICH cronica con gran afectacion cutanea, para aquellos que no responden al tratamiento topico o para pacientes corticodependientes. Su mayor beneficio es el de ser un tratamiento dirigido a la piel que permite ahorrar CE y que presenta un buen perfil de seguridad. La pauta de tratamiento se realiza de manera individualizada y, segun nuestra experiencia, con dosis iniciales y dosis maximas por sesion menores que para otras enfermedades.

Metastasis is respoMetastasis is responsible for most cancer-related deaths, and, among common tumor types, melanoma is one with great potential to metastasize. Here we study the contribution of epigenetic changes to the dissemination process by analyzing the changes that occur at the DNA methylation level between primary cancer cells and metastases. We found a hypomethylation event that reactivates a cryptic transcript of the Rab GTPase activating protein TBC1D16 (TBC1D16-47 kDa; referred to hereafter as TBC1D16-47KD) to be a characteristic feature of the metastatic cascade. This short isoform of TBC1D16 exacerbates melanoma growth and metastasis both in vitro and in vivo. By combining immunoprecipitation and mass spectrometry, we identified RAB5C as a new TBC1D16 target and showed that it regulates EGFR in melanoma cells. We also found that epigenetic reactivation of TBC1D16-47KD is associated with poor clinical outcome in melanoma, while conferring greater sensitivity to BRAF and MEK inhibitors.

We report on a child with a divided or kissing nevus of the penis with benign symmetric globular pattern on dermoscopic examination that evolved into a globular-reticular pattern after 1 year of follow-up. Divided nevus of the penis is exceedingly rare, with only four cases with dermoscopic findings reported to date. Dermoscopy seems to be useful when deciding on the most appropriate management of these cases.

Introduction Chronic graft-versus-host disease (cGVHD) is the most important cause of late non-relapse mortality after allogeneic hematopoietic stem cell transplantation. Sclerodermatous cGVHD is usually steroid refractory and remains a therapeutic challenge. Activating antibodies against the PDGFR have been reported in patients with sclerodermatous cGVHD. These antibodies induce PDGFR phosphorylation and lead to fibrosis. There is increasing evidence of successful treatment of sclerodermatous cGVHD with imatinib, a tyrosine kinase inhibitor. Objective To evaluate the response of cutaneous sclerodermatous cGVHD to imatinib. Materials and methods Retrospective study of 18 patients with sclerodermatous cGVHD refractory to immunosuppressants treated with imatinib in a single center. Evaluation of treatment response was performed by clinicians’ assessment and patients’ subjective response at one, 3, 6, 9, 12 and 18 months after initiation of imatinib. Response was assessed as complete, partial, significant, no change or progression. Tapper off steroids was complete, partial or not possible. Results In our series, 4 (22%) patients achieved complete response, 9 (50%) patients partial response, 2 (11%) patients significant response, 2 (11%) patients had no change and one (6%) patient progressive disease at last follow-up. Mean time from initiation of imatinib to any degree of response was 2,75 months (range 1-9 months). Conclusions This study provides further evidence of the role of imatinib for the treatment of steroid refractory sclerodermatous cGVHD.

Purpose: Surface electronic brachytherapy (EBT) is an alternative radiotherapy solution to external beam electron radiotherapy and high-dose-rate radionuclide-based brachytherapy. In fact, it is also an alternative solution to surgery for a subgroup of patients. The objective of this work is to confirm the clinical efficacy, toxicity and cosmesis of a new EBT system, namely Esteya ® in the treatment of nodular and superficial basal cell carcinoma (BCC). Material and methods: This is a prospective single-center, non-randomized pilot study to assess the efficacy and safety of EBT in nodular and superficial BCC using the Esteya ® system. The study was conducted from June 2014 to February 2015. The follow up time was 6 months for all cases. Results: Twenty patients with 23 lesions were included. A complete response was documented in all lesions (100%). A low level of toxicity was observed after the 4 th fraction in all cases. Erythema was the most frequent adverse event. Cosmesis was excellent, with more than 60% of cases without skin alteration and with subtle changes in the rest. Conclusions: Electronic brachytherapy with Esteya ® appears to be an effective, simple, safe, and comfortable treatment for nodular and superficial BCC associated with excellent cosmesis. It could be a good choice for elderly patients, patients with contraindications for surgery (due to comorbidities or anticoagulant drugs) or patients where surgery would result in a more disfiguring outcome. A longer follow-up and more studies are needed to confirm these preliminary results. J Contemp Brachytherapy 2015; 7, 3: 231-238 DOI: 10.5114/jcb.2015.52140

Background: The genetic basis of melanoma affects its clinicopathologic characteristics and increasingly influences its management. B-Raf proto-oncogene, serine/threonine kinase gene (BRAF)-mutated melanoma may present with specific dermoscopic features. Objectives: To identify the dermoscopic features associated with BRAF mutation in cutaneous melanoma and to evaluate a model capable of predicting BRAF mutations on the basis of dermoscopic and clinicopathologic features that are easily accessible in normal clinical practice. Methods: A prospective, cross-sectional, observational, and descriptive study was performed. A total of 93 cutaneous melanomas with dermoscopic images from 93 patients were included. BRAF mutational status was determined by genetic analysis using 2 methods: cobas 4800 BRAF V600 Mutation Test (Roche Molecular Systems, Pleasanton, CA) and Sanger sequencing. Clinicopathologic data were collected; dermoscopic images were analyzed by 2 independent blind observers. Results: Blue-white veil in dermoscopy was significantly associated with BRAF mutations (odds ratio, 4.3; 95% confidence interval, 1.6-11.5; P=.003). Patients with BRAF-mutated melanomas were significantly younger than those with wild-type melanomas (odds ratio, 0.96; 95% confidence interval, 0.93-0.99; P=.008). On the basis of these 2 variables, it was possible to predict BRAF mutational status in melanoma with 73% accuracy. Limitations: Histologic data were obtained from pathology reports. The accuracy of the predictive model has not been tested with a new data set. Conclusions: Blue-white veil in dermoscopy is associated with BRAF mutations in cutaneous melanoma.

Molecular diagnostics are increasingly performed routinely in the diagnosis and management of patients with melanoma due to the development of novel therapies that target specific genetic mutations. The development of next-generation sequencing (NGS) technologies has enabled to sequence multiple cancer-driving genes in a single assay, with improved sensitivity in mutation detection. The main objective of this study was the design and implementation of a melanoma-specific sequencing panel, and the identification of the spectrum of somatic mutations in a series of primary melanoma samples. A custom panel was designed to cover the coding regions of 35 melanoma-related genes. Panel average coverage was 2,575.5 reads per amplicon, with 92,8% of targeted bases covered ≥500×. Deep coverage enabled sensitive discovery of mutations in as low as 0.5% mutant allele frequency. Eighty-five percent (85/100) of the melanomas had at least one somatic mutation. The most prevalent mutated genes were BRAF (50%;50/199), NRAS (15%;15/100), PREX2 (14%;14/100), GRIN2A (13%;13/100), and ERBB4 (12%;12/100). Turn-around-time and costs for NGS-based analysis was reduced in comparison to conventional molecular approaches. The results of this study demonstrate the cost-effectiveness and feasibility of a custom-designed targeted NGS panel, and suggest the implementation of targeted NGS into daily routine practice.

Purpose: The purpose of this study is to compare high frequency ultrasonography (HFUS) and histpathologic assessment done by punch biopsy in order to determine depth of basal cell carcinoma (BCC), in both superficial and nodular BCCs prior to brachytherapy treatment. Material and methods: This study includes 20 patients with 10 superficial and 10 nodular BCCs. First, punch biopsy was done to confirm the diagnosis and to measure tumour depth (Breslow rate). Subsequently, HFUS was done to measure tumour depth to search for correlation of these two techniques. Results: Neither clear tendency nor significance of the punch biopsy vs. HFUS depth determination is observed. Depth value differences with both modalities resulted patient dependent and then consequence of its uncertainty. Conceptually, HFUS should determine the macroscopic lesion (gross tumour volume – GTV), while punch biopsy is able to detect the microscopic extension (clinical target volume – CTV). Uncertainties of HFUS are difficult to address, while punch biopsy is done just on a small lesion section, not necessarily the deepest one. Conclusions: According to the results, HFUS is less accurate at very shallow depths. Nodular cases present higher depth determination differences than superficial ones. In our clinical practice, we decided to prescribe at 3 mm depth when HFUS measurements give depth lesion values smaller than this value. J Contemp Brachytherapy 2014; 6, 4: 356–361 DOI: 10.5114/jcb.2014.47860

we report three cases of pure cutaneous Rosai-Dorfman disease (RDD) showing prominent nuclear pleomorphism. This unusual finding confers a worrisome appearance to these lesions, challenging their recognition and creating difficulty in the differential diagnosis with malignant neoplasms. This article is protected by copyright. All rights reserved.

In numerous clinical practice guidelines, emphasis is placed on the need for coordinated care of psoriatic arthritis (PsA) between rheumatologists and the objective was to develop experience-based points to consider facilitating the implementation of multidisciplinary units (Dermatology/Rheumatology) for the management of patients with PsA. A scientific committee of rheumatology and dermatology experts in the management of PsA, and with experience in joint care, discussed the critical aspects of multidisciplinary PsA Units. The discussion became the basis for a Delphi survey in two rounds submitted to a panel of 24 specialists in rheumatology and dermatology not involved in PsA units. The statements and practices that reached a consensus were summarized and further elaborated. After two Delphi rounds, agreement was reached for 49 of the 50 proposed statements. These included a justification of the units, objectives, and utilities, as well as operational aspects of the units, such as the minimal and ideal premises, referral criteria, and necessary resources. The statements were compiled in 11 points to consider. This consensus offers some points to consider, including premises and recommendations, for the development of specialized Units in the management of PsA based on expert opinion. We trust these guidelines may facilitate their implementation in the future. Pfizer.

Introduction: It is important to identify subgroups within the general population that have an elevated risk of developing cutaneous melanoma because preventive and early-detection measures are useful in this setting. The findings of most studies that have evaluated risk factors for cutaneous melanoma are of limited application in Spain because the populations studied have different pigmentary traits and are subject to different environmental factors. Objective: To identify the phenotypic characteristics and amount of exposure to sunlight that constitute risk factors for cutaneous melanoma in the population of the Autonomous Community of Valencia, Spain. Methods: We performed a multicenter observational case-control study. In total, the study included 242 patients with melanoma undergoing treatment in 5 hospitals and 173 controls enrolled from among the companions of the patients between January 2007 and June 2008. The information was collected by means of a standardized, validated questionnaire. The odds ratio (OR) was calculated for each variable and adjusted using a multiple logistic regression model. Results: The risk factors found to be statistically significant were skin phototypes I and II, blond or red hair, light eye color, abundant melanocytic nevi, and a personal history of actinic keratosis or nonmelanoma skin cancer. After the multivariate analysis, only blond or red hair (OR = 1.9), multiple melanocytic nevi (OR = 3.1), skin phototypes i and ii (OR = 2.1), and a personal history of actinic keratosis (OR = 3.5) or nonmelanoma skin cancer (OR = 8.1) maintained significance in the model as independent predictive variables for melanoma.

Spitz nevus is a benign melanocytic proliferation that shows relatively characteristic clinicopathologic features. Despite this, Spitz nevus is clinically confused with many other lesions, and histopathologically it is sometimes difficult to distinguish it from melanoma. However, Spitz nevus rarely causes differential diagnostic problems with granulomatous dermatitis. This article describes an 8-year-old girl who presented with a nodule on her right arm, a clinical appearance of a pyogenic granuloma. Histopathologically, there was a dermal lesion composed of aggregates of large epithelioid cells surrounded by a heavy inflammatory infiltrate, mimicking a sarcoid-like granulomatous dermatitis. Immunohistochemistry showed epithelioid cells with strong nuclear and cytoplasmic staining with S-100 protein, thus establishing the diagnosis of a melanocytic tumor. The heavy T-cell lymphocytic infiltrate that accompanies the large epithelioid cells caused its granulomatous appearance. Molecular assessment showed H27H mutation in the HRAS gene. We suggest the term 'pseudogranulomatous' for this variant of Spitz nevus because it indicates that the lesion is not authentically granulomatous and simply mimics a granulomatous dermatitis.

Background Photodynamic therapy (PDT) and imiquimod are the treatments of choice for actinic keratosis (AK). As they have different mechanisms of action, it seems reasonable to assume that applying both treatments sequentially would be efficacious. Objectives We sought to determine which of these therapeutic modalities provides a better clinical and histologic response in patients with AK and whether sequential use of both was more efficacious than each separately. Methods Patients were randomly assigned to one treatment group: group 1, PDT only; group 2, imiquimod only; or group 3, sequential use of PDT and imiquimod. The primary outcome measure was complete clinical response. Partial clinical response was defined as a reduction of more than 75% in the initial number of lesions. A complete clinicopathologic response was defined as lack of evidence of AK in the biopsy specimen. Results In all, 105 patients completed the study (group 1, 40 patients; group 2, 33 patients; group 3, 32 patients). Sequential application of PDT and imiquimod was more efficacious in all the outcome measures. More patients were satisfied with PDT than with the other two modalities ( P = .003). No significant differences were observed among the 3 modalities and tolerance to treatment. Limitations Only one cycle of imiquimod was administered. The follow-up period was brief. Conclusions Sequential application of PDT and imiquimod provides a significantly better clinical and histologic response in the treatment of AK than PDT or imiquimod monotherapy. It also produces less intense local reactions and better tolerance and satisfaction than imiquimod monotherapy.

Chrysalis, also named shiny white streaks, are white, linear structures only visible with polarized dermoscopy. They have been reported in several tumors included melanomas and Spitz nevi, and their histological substrate is believed to be dermal fibrosis. We have performed a correlation study between the dermoscopic and the histopathological features of 9 Spitz nevi. Chrysalis were present in 4 Spitz nevi (44%) and in all of them there was a high degree of fibroplasia. In one case, chrysalis, evident at the center of the lesion, progressively merged with negative pigment network at the periphery. We suggest that chrysalis and negative pigment network are manifestations of the same histopathological finding: increased collagen occurring at different levels of the dermis.

Different melanocytic nevi have been reported as being associated with dermal cysts. Signet ring cell melanocytic nevus is a rare variant of melanocytic nevus characterized by cells with signet ring morphology within a common melanocytic nevus. This article describes an exceptional case of melanocytic nevus composed exclusively of signet ring cells over a trichilemmal cyst. Histologically, above the cyst, there was a small, symmetrical and sharply demarcated lesion showing a compound proliferation of small, round, monomorphous cells with signet ring morphology. Immunohistochemically, signet ring cells were negative for cytokeratin AE1/3, leukocyte common antigen, HMB-45, and CD34. Occasionally, isolated signet ring cells were positive for S-100 and melan A. Melanocytic nevus composed of signet ring cells should raise the differential diagnosis with other cutaneous tumors exhibiting signet ring cells. Previous cases of this entity reported in the literature are also reviewed.

Background There is debate in the literature regarding the management of basal cell carcinoma following excision with positive surgical margins. While in some cases recurrence is not observed even after many years of follow-up, those in which recurrence does occur are at an increased risk of complications. Factors may exist that help to choose the best therapeutic approach for basal cell carcinomas on the head in which positive margins are observed following excision. Material and methods A total of 46 patients were selected who had been treated by Mohs micrographic surgery as a result of positive surgical margins being present following previous tumor excision. The factors associated with the absence of tumor nests and the occurrence of negative margins following a single Mohs stage were analyzed. Results No associations were observed with sex, tumor size, affected margin (lateral, deep, or both), time since diagnosis, number of previous treatments, histological type, or tumor site. There was a certain trend towards more frequent identification of tumor remnants when both surgical margins were affected and towards a requirement for a single Mohs stage in tumors less than 1.2 cm and in which less than 5 years had elapsed since diagnosis. Conclusions Conclusive data are unavailable with which to define cases in which re-excision is necessary or those in which conventional excision could be sufficient. The best option for the treatment of these tumors is Mohs micrographic surgery, although conventional excision could be reasonable in small tumors located at low-risk sites and in which long periods have not elapsed since diagnosis.

Resumen Introduccion El queratoacantoma es considerado hoy dia un carcinoma epidermoide in situ que aparece principalmente en pacientes mayores de 70 anos. Se trata de un tumor de buen pronostico que, en algunos casos, muestra resolucion espontanea. El tratamiento de este tipo de tumoracion es la exeresis simple. Sin embargo, la localizacion preferente en las regiones facial y acral, el tamano y su rapido crecimiento son factores que hacen que la cirugia sea en algunos casos agresiva y antiestetica. Objetivo El objetivo principal del estudio es evaluar la eficacia de la infiltracion intralesional de metotrexato en la reduccion del tamano prequirurgico de la lesion y del correspondiente defecto quirurgico resultante de la intervencion. Material y metodos Se realizo un estudio prospectivo aleatorizado en el que se incluyeron todos aquellos pacientes atendidos en nuestro Servicio diagnosticados de queratoacantoma de al menos 1,5 cm de tamano entre enero de 2009 y enero de 2010. Se establecieron dos grupos, uno en el que los pacientes recibieron una infiltracion de metotrexato previamente al acto quirurgico y otro en el que se realizo directamente la cirugia. Resultados De los 25 pacientes incluidos en el estudio, 10 casos recibieron neoadyuvancia con metotrexato intralesional (grupo A) y 15 casos fueron intervenidos mediante cirugia aislada (grupo B). Los pacientes del grupo A mostraron una reduccion en el tamano tumoral en el momento de la cirugia que oscilo entre un 50 y un 80%. Ninguno de los pacientes presento complicaciones relacionadas con la inoculacion del metotrexato ni con la intervencion quirurgica. En el grupo B solo uno de los casos mostro una discreta disminucion de sus dimensiones en el momento del acto quirurgico. El resto de las lesiones mostraron una estabilidad (4 casos; 26%) e incluso un aumento de las dimensiones del tumor (10 casos; 66%) en el momento de la intervencion. Cinco de los casos incluidos en este ultimo grupo requirieron ingreso hospitalario en relacion con la intervencion quirurgica. Conclusiones El metotrexato intralesional como terapia neoadyuvante es una medida bien tolerada, que permite evitar cirugias agresivas en pacientes de edades avanzadas que presentan un queratoacantoma de diametro superior a 1,5 cm localizado en la region facial y acral.

The growth rate (GR) of melanomas is not uniform. A fast-growing subtype has been identified and seems to have a role in the stabilization of the mortality rates because of melanoma. To examine features associated with fast-growing melanomas (FGMs) and to determine the relationship between the GR and well-recognized prognostic factors of melanoma, a series of 386 new invasive cutaneous melanomas seen during 2004-2009 were retrieved from our database. The GR was calculated according to earlier published studies. FGMs were defined as those whose GR was greater than 0.49 mm per month. Differences in clinical, epidemiological, and pathological features were evaluated. Correlations between the GR, tumor thickness, and mitotic rate were also analyzed. FGMs were significantly more prevalent among patients aged over 65 years and with a higher rate of past personal history of nonmelanoma skin cancer. This subtype was over-represented among melanomas located on both nonexposed and usually exposed skin and was less related to earlier sunburns. Patients with FGMs presented with more aggressive pathological features and had more advanced disease with sentinel node analysis affected in up to 35% of cases. There was a strong positive correlation between the GR and tumor thickness (r=0.762), and mitotic rate (r=0.542). This study was limited by being retrospective in nature. FGMs are a highly aggressive subtype of melanomas that seem to develop after at least two routes, one related to chronic sun exposure and another unrelated to the sun. Older patients have a higher predisposition to develop this kind of tumor. This variant warrants specific strategies to improve primary and secondary prevention.

Summary Background Photodynamic therapy (PDT) and imiquimod are two excellent treatments for actinic keratosis but are often not well tolerated by patients. Objectives To ascertain which treatment is better tolerated and which produces greater patient satisfaction. A secondary objective was to determine the factors related to the patient’s tolerance to each treatment. Methods Patients with at least five actinic keratosis lesions on the face and scalp were selected. The patients were randomized to receive treatment with PDT with methyl aminolaevulinate or treatment with imiquimod. Tolerance, satisfaction and predisposition to repeat the treatment were evaluated. Results Most patients exhibited good or acceptable tolerance to both PDT and imiquimod treatment. There was a higher percentage of patients treated with PDT (93%) who were very satisfied compared with imiquimod (62%) (P = 0·004). Most patients treated with either one of the two options would repeat the same treatment. No significant relationship was found between age, sex, working time exposed to the sun, phototype and hair colour and the tolerance to both treatments. Conclusions Both PDT and imiquimod are treatments that are generally well tolerated. While both treatments provide a high level of satisfaction, PDT appears to be slightly superior in this regard.

Resumen Antecedentes Los pacientes diagnosticados de un melanoma cutaneo tienen mas riesgo que el resto de la poblacion de padecer nuevos melanomas a lo largo de su vida. La mayoria de estos melanomas aparecen «de novo», pero existe un porcentaje de ellos que se desarrolla sobre nevos melanociticos previos. Objetivo Determinar los factores de riesgo asociados al desarrollo de un segundo melanoma cutaneo sobre nevo en pacientes diagnosticados de melanoma cutaneo. Metodos Se seleccionaron los datos de 981 pacientes diagnosticados de un primer melanoma cutaneo, 47 de los cuales habian sido diagnosticados de un segundo melanoma. Todos los pacientes fueron clasificados en funcion de si el melanoma presento o no asociacion histologica a un nevo. Resultados La edad inferior a 40 anos, la localizacion en el tronco y el subtipo histologico de extension superficial, fueron los factores de riesgo independientes asociados al desarrollo de un primer melanoma sobre nevo. El unico factor asociado al desarrollo de un segundo melanoma sobre nevo fue que el primer melanoma tambien se hubiera presentado asociado a un nevo (OR: 9,51, 95% de intervalo de confianza: 1,6–56,56; p=0,042). Conclusiones Los melanomas se desarrollan asociados a un nevo principalmente en pacientes jovenes, en el tronco y del subtipo tipo de extension superficial. A su vez, el desarrollo de un primer melanoma sobre nevo aumenta el riesgo hasta 9 veces de desarrollar un segundo melanoma sobre un nevo previo. Estos hallazgos, subrayan la importancia del seguimiento estrecho de todas las lesiones melanicas en los pacientes que han desarrollado un primer melanoma sobre nevo.

A number of molecular alterations have been described for melanoma. Melanomas with BRAF mutations tend to be located in areas of intermittent sun exposure, whereas melanomas with KIT mutations mostly appear in acral areas, the mucosas, and areas of chronic sun exposure. Sorafenib, a BRAF inhibitor, has a cytostatic effect on most melanomas with mutations affecting the mitogen-activated protein kinase (MAPK) pathway, and is also capable of triggering apoptosis in a small subgroup of these melanomas. By inhibiting KIT, imatinib has a cytostatic and cytotoxic effect on melanomas with KIT mutations, and probably has the same effect on another subgroup of melanomas with other as yet imperfectly understood KIT mutations. For therapy to be effective, agents should be selected according to the pathways associated with the genetic mutations present in the melanoma.

Intralymphatic histiocytosis is a condition with nonspecific clinical features but with characteristic histopathological and immunohistochemical findings. It presents as a poorly demarcated erythematous plaque or a lesion similar to livedo reticularis, usually located on the limbs. Histologically, dilated vessels containing mononuclear cells are observed in the reticular dermis. In the past, the majority of these cases were thought to be cases of reactive angioendotheliomatosis or intravascular lymphoma, but the development of more specific immunohistochemical markers showed that these were dilated lymph vessels containing histiocytes, and so were considered as a separate condition. We present the case of a man with a past history of left axillary lymphadenectomy for lymphatic tuberculosis, leukocytoclastic vasculitis, and cancer of the colon. The patient developed an erythematous plaque in the left pectoral region. Histology and immunohistochemical stains of the lesion revealed histiocytes within dilated lymph vessels in the reticular dermis, but no neoplastic cells. We present a new case of intralymphatic histiocytosis in a patient with autoimmune and neoplastic diseases.