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Chromoblastomycosis (CBM) is a granulomatous mycosis rarely described outside tropical countries. Degeneration into squamous cell carcinoma (SCC) is its most serious complication. We report the first case of nasal CBM degenerating into SCC. In 2006, a sixty-year-old male presented himself with an infiltrated plaque on the right thigh. The diagnosis of CBM was confirmed by the presence of fungal elements. In 2019, the patient had developed a mass coming from the right nasal cavity. It had rapidly involved the nasal dorsum. An ulcer-budding nasal tumor and an elevated erythematous and verrucous plaque on the thigh were noted. A biopsy revealed a granulomatous dermis with fungal elements. Other nasal biopsy fragments showed differentiated SCC. A fungal culture inoculated with tissue from both lesions showed dark colonies. The diagnosis of nasal CBM with SCC degeneration was reached. The patient presented asymptomatic endonasal CBM that had slowly evolved and recently degenerated.

A 47-year-old female was referred to our department because of skin-colored lesions located mainly on the dorsum of the hands and feet. The patient had no diseases and had not taken continuous medication. The lesions were present at birth and had increased in number since then. Four more members of the family, including the mother and the uncle (mother’s brother), had similar skin lesions. A dermatological examination revealed multiple flesh-colored, flat-topped papules, about 2–5 mm in size, which were reminiscent of flat warts on the dorsum of the hands and feet (Fig. 1). A nail examination revealed thickened nails with V-shaped nicks at their free margins on the fingers of both hands (Fig. 2). The patient declined skin biopsy. We retained the diagnosis of acrokeratosis verruciformis of Hopf (AVH). AVH is a rare inherited disorder of keratinization caused by an abnormal ATP2A2 gene [1,2]. Familial cases indicate an autosomal dominant pattern of inheritance, yet sporadic cases of the disease have also been reported [2]. It is characterized by multiple asymptomatic, flat-topped, skin-colored papules on the dorsum of the hands and feet. Other features may include pits on the palms and soles and nail dystrophy (pearly white nails or nails with longitudinal ridges and nicks in the free edge) [3]. AVH is diagnosed clinically, which becomes easier if there are family members with similar skin findings. Sometimes, a skin biopsy is performed to assist the diagnosis. The key features on histology are hyperkeratosis, hypergranulosis, acanthosis, papillomatosis, and circumscribed epidermal elevations known as church spires, which are a distinctive finding [1,2].

We report an original case of carcinoma en cuirasse associated with zosteriform metastasis. A 40-year-old woman presented to our department with painful erythematous lesions. She had a history of invasive ductal carcinoma of the left breast. Numerous erythematous, papules and whitish vesicles were present over the right side of the chest in a dermatomal distribution with indurated coalescent plaques. Biopsy revealed metastatic carcinoma of breast origin. Breast mammography showed suspicious right nodule. Controlateral breast carcinoma with CM was diagnosed. CM show a wide range of clinical manifestations. Carcinoma en cuirasse, is a very rare form of metastatic cutaneous breast cancer. It is characterized by diffuse sclerodermatous induration of the skin. Zosteriform metastasis is also rarely seen. It may be distributed along dermatomeres in a variety of clinical patterns, including nodular, papulovesicular, or vesiculobullous. In our case, the zosteriform metastasis occurred in the contralateral site. It announced the developing of contralateral breast cancer.

A 55-year-old male presented to our dermatology department with 3 months history of an asymptomatic and red raised plaque on the nose. There was no history of discoloration of skin prior to the development of this lesion. His only medical history was type 2 diabetes and high blood pressure. He had never undergone radiation therapy. On clinical examination, a well-defined glistening bluish-erythematous plaque 3 * 3 cm was present on the nose which was soft and non-tender (Fig. 1). Nasal mucosa was completely spared. No cervical lymphadenopathy was found. Head and neck examination was unremarkable. A CT scan of head and neck founded a soft tissue mass without infiltration of underlying structures. Figure 1: A well-defined glistening bluish-erythematous plaque 3*3 cm on the nose. DERMOSCOPY FINDINGS The dermoscopy revealed homogeneous pattern with combinations of colors (pinkish, bluish, and violaceous) and whitish veil areas without well-defined vessels or lacunae (Fig. 2). Figure 2: Homogeneous pattern with combinations of colors (pinkish, bluish, and violaceous) and whitish veil areas. HISTOLPATHOLOGY The histological examination of the first biopsy revealed a benign fibtoblastic reaction around normal vessels with fibrin deposits and without nuclear atypia. The second skin biopsy showed anastomosing vascular structures of variable diameter in the dermis, lined by plump endothelial cells with marked cellular, nuclear polymorphism and occasional mitosis, dissecting the collagen bundles (Fig. 3a). On immunohistochemistry, tumor cells expressed CD31, ERG, CD34 and VIII Factor. Ki67 was high in tumor cells (60%) (Fig. 3b). Figure 3: (a) HE x 400. Vascular proliferation with atypical endothelial cells (arrow). (b) IHC x 200, Elevated proliferation index Ki67.