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Abstract: Background: The benign and malignant patterns of acral melanocytic naevi (AMN) and acral melanomas (AM) have been defined in a series of retrospective studies. A three‐step algorithm was developed to determine when to biopsy acral melanocytic lesions. This algorithm has only been applied to a Japanese population. Objectives: Our study aimed to review the current management strategy of acral melanocytic lesions and to investigate the utility of the three‐step algorithm in a predominately Caucasian cohort. Methods: A retrospective search of the pathology and image databases at Mayo Clinic was performed between the years 2006 and 2016. Only cases located on a volar surface with dermoscopic images were included. Two dermatologists reviewed all dermoscopic images and assigned a global dermoscopic pattern. Clinical and follow‐up data were gathered by chart review. All lesions with known diameter and pathological diagnosis were used for the three‐step algorithm. Results: Regular fibrillar and ridge patterns were more likely to be biopsied (P = 0.01). The majority of AMN (58.1%) and AM (60%) biopsied were due to physician‐deemed concerning dermoscopic patterns. 39.2% of these cases were parallel furrow, lattice‐like or regular fibrillar. When patients were asked to follow‐up within a 3‐ to 6‐month period, only 16.7% of the patients returned within that interval. The three‐step algorithm would have correctly identified four of five AM for biopsy, missing a 6 mm, multicomponent, invasive melanoma. Conclusion: We found one major educational gap in the recognition of low‐risk lesions with high rates of biopsy of the fibrillary pattern. Recognizing low‐risk dermoscopic patterns could reduce the rate of biopsy of AMN by 23.3%. We identified two major practice gaps, poor patient compliance with follow‐up and the potential insensitivity of the three‐step algorithm to small multicomponent acral melanocytic lesions. [ABSTRACT FROM AUTHOR]

Copper ions play an important role in several physiological processes, including angiogenesis, growth factor induction and extracellular matrix remodeling, that modulate wound healing and tissue repair. In this work, copper-loaded alginate fibers were generated and used as surgical sutures for repair of incisional wounds in live mice. Approximately 95% of initially loaded copper ions were released from the sutures within the first 24 h following an initial burst release. This localized delivery of copper at the incision site resulted in significantly higher recovery in tissue biomechanical strengths compared to conventional nylon and calcium alginate sutures at early times following surgery. Irradiation of copper alginate sutures with near-infrared light resulted in a robust photothermal response and led to efficacies similar to those seen with nonirradiated sutures. Histopathology and immunohistological analyses indicated significantly reduced epithelial gap and higher number of CD31 + cells, which is indicative of increased angiogenesis around the incision site. Delivery of copper ions did not result in toxicity under the conditions employed. Our findings demonstrate that delivery of ionic copper from sutures resulted in efficacious approximation and healing of incisional wounds, and copper-eluting fibers may have translational potential for accelerating repair in surgical and trauma wounds.

Competing Interests: Competing interests: The authors have no conflicts of interest to disclose.

Multiple cutaneous manifestations of amyloidosis have been described, and include periorbital purpura, plaques, nodules, and papules. Blue skin tint is not a previously described feature of cutaneous amyloidosis. We report the clinical case of a patient with known multiple myeloma and amyloidosis of the gastrointestinal tract who presented with progressive "blueness" of the skin. Dermatopathological examination and mass spectrometry of a skin biopsy specimen revealed the presence of subcutaneous amyloid light chain (AL) deposition. We believe this to be the first reported case of blue skin resulting from systemic amyloidosis.

Cutaneous squamous cell carcinoma (SCC) occurs commonly and can metastasize. Identification of specific molecular aberrations and mechanisms underlying the development and progression of cutaneous SCC may lead to better prognostic and therapeutic approaches and more effective chemoprevention strategies. To identify genetic changes associated with early stages of cutaneous SCC development, we analyzed a series of 40 archived skin tissues ranging from normal skin to invasive SCC. Using high-resolution array-based comparative genomic hybridization, we identified deletions of a region on chromosome 10q harboring the INPP5A gene in 24% of examined SCC tumors. Subsequent validation by immunohistochemistry on an independent sample set of 71 SCC tissues showed reduced INPP5A protein levels in 72% of primary SCC tumors. Decrease in INPP5A protein levels seems to be an early event in SCC development, as it also is observed in 9 of 26 (35%) examined actinic keratoses, the earliest stage in SCC development. Importantly, further reduction of INPP5A levels is seen in a subset of SCC patients as the tumor progresses from primary to metastatic stage. The observed frequency and pattern of loss indicate that INPP5A, a negative regulator of inositol signaling, may play a role in development and progression of cutaneous SCC tumors., (©2010 AACR.)

Background: Coccidioides immitis is a soil-dwelling fungus found in arid regions of the Western Hemisphere. Interstitial granulomatous dermatitis is a histopathologic pattern that may be a reactive manifestation of diverse systemic diseases., Objective: Our purpose was to describe clinical and histopathologic findings in 5 patients who presented with interstitial granulomatous dermatitis associated with pulmonary coccidioidomycosis., Methods: Medical records and skin biopsy slides from 5 patients were retrospectively reviewed., Results: In each patient, edematous papules, nodules, and plaques developed abruptly during the onset of an acute febrile illness. Coccidioidomycosis was confirmed by serology. Skin biopsy specimens revealed interstitial granulomatous dermatitis with neutrophils, leukocytoclasis, and eosinophils. Fungal stains (5/5 cases) and fungal cultures (2/2 cases) revealed no organisms within the skin biopsy specimens., Conclusion: Interstitial granulomatous dermatitis may be a presenting feature of pulmonary coccidioidomycosis and may possibly represent a reactive manifestation of the infection.

Background: Mohs excision of melanoma remains controversial, in part because of concerns regarding evaluation of frozen section margins. Several immunohistochemical stains are available for melanoma that can be used on frozen sections., Objective: To review our experience with Mohs micrographic excision of melanoma using immunostains., Methods: Sixty-eight patients were treated, including 46 with melanoma in situ and 22 with invasive melanoma, 62 of which were on the head or neck. HMB-45, MEL-5, Melan-A (A-103), and S-100 stains were employed., Results: Sixty-seven of 68 tumors were excised to clear margins, requiring an average of 2.0 layers. Immunostains greatly enhanced detection of melanoma on frozen sections. The average margin required for clearance of in situ melanoma was 8.3 mm and of invasive melanoma was 11.1 mm. Only 23 of 46 (50%) in situ melanomas were clear with < or =6 mm margins; 15 mm margins were required to clear 96% of the tumors. Eleven of 22 (50%) invasive melanomas were clear with < or =6 mm margins; 26 mm margins were required to clear 95% of the tumors. Melan-A (A-103) was the most consistently crisp and easily interpreted immunostain., Conclusions: Mohs excision of melanoma using immunostains can be useful, especially for tumors on the head and neck. For routine excision, margins wider than those currently recommended may be required to ensure tumor clearance. We recommend that (1) biopsies be stained preoperatively for Melan-A and/or HMB-45, (2) a debulking layer be obtained for permanent sections prior to Mohs layers, and positive and negative control specimens from the tumor and distant skin should be employed for comparison of staining patterns. Large-scale prospective studies of in situ and invasive melanoma on the head and neck are necessary.

Collagenous fibroma (desmoplastic fibroblastoma) is a recently described tumor that may arise in the subcutaneous tissue or skeletal muscle. We report a case of collagenous fibroma, occurring on the forehead of a 67-year-old man. An awareness of this entity is necessary to avoid confusion with other soft tissue neoplasms, especially extraabdominal fibromatosis.

Background: Adult T-cell leukemia/lymphoma (ATL) is associated with infection with human T-cell lymphotropic virus type I (HTLV-I)., Objective: The objective was to describe the clinical, histopathologic, and immunologic features in three patients with ATL involving the skin., Methods: Clinical histories and skin biopsy specimens were reviewed. Immunophenotypic studies were performed on peripheral blood lymphocytes (three patients) and on skin biopsy specimens (one patient)., Results: Serologic testing in each patient was positive for HTLV-I. Specific cutaneous lesions of ATL were diverse. Histologic features included markedly epidermotropic lymphoid infiltrates and dermal aggregates of lymphocytes and macrophages resembling granulomas. One patient died 3 months after diagnosis; the other two are alive with residual lymphoma., Conclusion: A spectrum of clinical, histologic, and immunophenotypic features are seen in ATL involving skin. Those cases with a chronic course may resemble mycosis fungoides clinically and histologically. Serologic testing for HTLV-I is recommended in all patients with cutaneous lymphoma from endemic areas and in those with other risk factors for HTLV-I infection.

The morphologic, immunophenotypic, and clinical characteristics of 20 cases of primary cutaneous large cell lymphoma were analyzed. Immunoperoxidase stains in paraffin sections indicated B-cell phenotype in 14 cases and T-cell phenotype in six cases. By the Kiel classification, the B-cell lymphomas were classified into the following categories: follicular centroblastic (three patients), centroblastic/centrocytic with a predominance of large centrocytes (two patients), centroblastic (seven patients), and immunoblastic (two patients). The T-cell lymphomas (six cases) were all categorized as pleomorphic medium and large cell type. Three of these had an angiocentric growth pattern. The lymphocyte activation marker CD30 was expressed in three of the 20 cases. Among these 20 patients, the clinical course was remarkably variable. The only clinical or pathologic feature with prognostic significance was multicentricity of the skin lesions. All five patients with multifocal or disseminated skin lesions died within 13 months of their initial presentation; the median survival was 7 months. Most of the patients with localized skin lesions had an indolent clinical course with a median survival of 107 months. These results suggest that multicentricity of the skin lesions and necrosis are closely linked and are important prognostic features in cutaneous large cell lymphoma.

Acrodermatitis chronica atrophicans is a chronic cutaneous disease caused by the Lyme disease spirochete Borrelia burgdorferi. Acrodermatitis chronica atrophicans is endemic in some regions of Europe but is only rarely seen in the United States. This report describes the clinical and histopathologic findings in six cases of acrodermatitis chronica atrophicans seen at the Mayo Clinic between 1912 and 1961. Histologic differences between early and late phases of the disease were observed, and multisystemic symptoms consistent with chronic Lyme disease were documented in a subset of the patients. All five patients from whom biographical data were available were European immigrants. Our data suggest that some of the first patients with Lyme disease in the United States came to the Mayo Clinic earlier in this century.