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Terminology regarding classification of benign lesions with prominent eccrine differentiation can be confusing as these lesions can have overlapping clinical and histologic characteristics. In this report, we examine a case and review of the literature to suggest that these entities may be better classified as a spectrum of benign lesions with overlapping features rather than distinct entities. We describe a case of an acantholytic dyskeratotic epidermal nevus with eccrine differentiation on the back of a 2-year-old patient. We then discuss the classic clinical and histologic presentations of eccrine nevi and epidermal nevi with eccrine differentiation as they relate to each other and to our case.

Background. A comparison of diseased areas of skin with adjacent normal skin is often useful in making a diagnosis. Fusiform incisional biopsies have been suggested as a means to this end. Objective. To describe a more effective alternative method for obtaining incisional biopsies. Methods. Text and photographs are used to demonstrate the technique and effectiveness of what we call the “TramTrak” biopsy. Results. This technique provides superior tissue samples with acceptable cosmetic results. Conclusion. The TramTrak biopsy has proven to be a versatile tool and a significant improvement over fusiform incisional biopsies.

OBJECTIVE:To review the efficacy of macrolides and tetracyclines in several chronic inflammatory conditions.DATA SOURCES:Searches of MEDLINE (1966–March 2004) and an extensive bibliography search were undertaken. Key terms included acne, blepharitis, cardiovascular disease, cystic fibrosis, periodontitis, rosacea, and rheumatoid arthritis.STUDY SELECTION AND DATA EXTRACTION:Data were obtained primarily from randomized placebo-controlled trials upon which key recommendations are based.DATA SYNTHESIS:Antibiotics are often prescribed for months or even years for treatment of chronic inflammatory conditions such as acne, blepharitis, cardiovascular disease, cystic fibrosis, periodontitis, rosacea, and rheumatoid arthritis. Randomized controlled trials have shown that azithromycin is useful in the management of cystic fibrosis and the tetracyclines are beneficial in the management of rheumatoid arthritis, acne, blepharitis, and periodontitis. Several large, randomized controlled trials have failed to show any benefit of macrolides in the secondary prevention of cardiovascular disease. No randomized placebo-controlled clinical trials have been performed to assess the efficacy of macrolides or tetracyclines in patients with rosacea.CONCLUSIONS:The use of tetracyclines and macrolides for rosacea is based primarily on anecdotal reports or open-label trials. Limited clinical trials support the use of tetracyclines or macrolides in acne, blepharitis, periodontitis, rheumatoid arthritis, and cystic fibrosis. Trials to date do not support the use of antibiotics for secondary prevention of cardiovascular disease.

A phase 1 smallpox vaccine trial involving 350 adult volunteers was conducted. Of these subjects, 250 were naive to vaccinia virus vaccine (i.e., "vaccinia naive"). Volunteers received a new cell-cultured smallpox vaccine or a live vaccinia virus vaccine. Nine self-limiting rashes (3.6%) were observed in the vaccinia-naive group. None of the vaccinia-experienced patients had a rash. Rashes appeared 6-19 days after vaccination and had 5 different clinical presentations. Five volunteers had urticarial rashes that resolved within 4-15 days, 1 had an exanthem that lasted 20 days, and 1 each presented with folliculitis, contact dermatitis, and erythematous papules found only on the hands and fingers. Volunteers reported pruritus, tingling, and occasional headaches. Relief was obtained with antihistamine and acetaminophen therapy. No volunteer experienced fever or significant discomfort.

Dermatologists were shown digitized images of skin lesions compressed by Joint Photographic Expert Group (JPEG) and fractal image format (FIF) algorithms and asked to make a diagnostic assessment and rate the image quality in displaying the features necessary for that assessment. Dermatologists performance in the diagnostic assessment was not affected by the level of compression (up to 40×) using either algorithm, but ratings of image quality for all compressed images were significantly lower than for uncompressed images and for the original photographic slides. There were no significant differences in dermatologists' performance or ratings between the two compression algorithms.

REPORT OF A CASE In November 1988, a 52-year-old white man noted the onset of an indurated area on the bridge of his nose. He had a history of allergic contact dermatitis to nickel; therefore, he assumed that the metal bridge section of his glasses contained nickel and he bought a pair of plastic-framed glasses. Because the eruption persisted, he sought medical attention and presented to the dermatology clinic in early April 1989. It was learned that he was employed as a grounds attendant at a resort area. The patient's physical examination revealed a verrucous plaque with overlying crust involving the bridge of his nose (Figs 1 and 2). The remainder of his examination showed unremarkable findings. The findings from his serologic examinations were normal; the histopathologic examination revealed severe pseudoepitheliomatous hyperplasia and a severe chronic inflammatory and granulomatous reaction with multinucleated giant cells and intraepidermal microabscesses (Fig 3). Many

A 72-year-old white man complained of redness, soreness, and irritation of his lower lip for more than 10 years. Physical examination revealed a diffuse erythematous crusted patch involving the lower lip, with a 1.2-cm centrally located palpable area (Fig 1). Cervical adenopathy was not noted. A biopsy performed in 1981 showed actinic keratosis, and the area was treated with liquid nitrogen and fluorouracil. In 1985, two lip biopsy specimens showed squamous cell carcinoma in situ, and actinic keratosis with severe dysplasia, for which he was treated with liquid nitrogen. Several lip biopsy specimens obtained in 1988 demonstrated ulcerated squamous cell carcinoma, Broder's grade 1. The tumor was 0.9 cm at its greatest depth. At about the same time, a 2-cm noncalcified nodule in the right middle lobe was seen on a chest roentgenogram ordered as preoperative screening for cataract surgery, and it was feared that squamous cell carcinoma had metastasized

To the Editor.— Adult-onset leukoderma was attributed to a visceral malignancy; however, 1 year later an acral lentiginous melanoma was noted. Report of a Case.— A 68-year-old black man presented to the John L. McClellan Veterans Administration Hospital, Little Rock, Ark, during July 1988. At that time he was evaluated by the otolaryngology service for hoarseness of 2 months' duration. A diagnosis of squamous cell carcinoma of the larynx, stage T3, NO, MO, was made that would require a total laryngectomy and subsequent radiation. Prior to surgery, the dermatology service was consulted because of patchy pigmentary loss that the patient had developed over the 2 months prior to hospital admission. Cutaneous examination showed widespread hypopigmented and depigmented macules and patches, mostly above the waist (Fig 1). His soles were not inspected. The simultaneous occurrence of hoarseness and the striking widespread leukoderma was felt to be more than coincidental, and the

The incidence of congenital cutaneous lesions was ascertained by a single dermatologist in each of 830 sequential newborn infants over a 3-month period at the Oklahoma Teaching Hospitals. Lesions were observed in 57% of infants (77% of blacks and 49% of nonblacks). Vascular lesions were the most frequent, occurring in 44% of neonates. Pigmented lesions other than mongolian spots were observed in 15.8% of blacks and in 1.6% of whites. Clinical criteria do not readily distinguish nevus cell nevi from other pigmented lesions. Wood's light examination did not enhance the identification of congenital lesions. Inadequate examination of infants and marked underreporting of congenital lesions in newborn infants are widespread.

Muir-Torre syndrome patients have multiple internal malignancies along with cutaneous sebaceous proliferations and keratoacanthomas. We describe a 62-year-old male with nine primarily internal malignancies who survived eight years after his initial tumor was identified. His sebaceous lesions ranged from innocuous adenomas to an anaplastic carcinoma of the chin which recurred and spread locally to involve the mandible and the right parotid region.

Becker's melanosis can be associated with hypoplastic abnormalities. In our patient (the first case report), it occurred in association with an absent pectoralis major muscle. Although more common in males, this patient demonstrates that Becker's melanosis can occur in females and may be congenital.

To the Editor.— Based on the information and photograph presented by Drs Feldman and Ajani 1 in their PHOTO/ESSAY, I am unable to accept their conclusion that this represents a "toxic reaction to fluorouracil." A hyperkeratotic erythematous eruption involving the feet in a "moccasin distribution" and the palmar aspect of the hands is much more likely to be dermatophytosis or pityriasis rubra pilaris. No evidence was presented that would eliminate the possibility of a fungal etiology for these lesions. The biopsy results as stated do not rule out either dermatophytosis or pityriasis rubra pilaris. The photographed foot the authors present does not resemble bleomycin-associated Raynaud's phenomenon or the "peculiar acral erythema" described by Burgdorff et al. 2

To the Editor.— In the August 1988 issue of theArchives, Slue et al 1 describe a method of recording total body photographs of dysplastic nevi. This letter is submitted because we feel that several aspects of the article require further consideration. While Nikon equipment was used, any modern single-lens reflex camera body fitted with a macro lens is satisfactory. Macro lenses are actually close-focusing and ultraclose-focusing lenses, essentially all of which have reproduction ratios printed on their focusing rings, along with distances listed in feet and meters. Rather than standardizing by selecting a focusing distance of 2.5 ft, we would suggest using a reproduction ratio of 1:10. This is close to the image size obtained with a 55-mm lens (Micro Nikor) focused at 2.5 ft. A standardized reproduction ratio would allow similar photographs be taken easily with any brand or focal length macro lens. Studio lighting is preferred by