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This case report presents a case in which a collision tumor consisting of three separate pathological entities—a verrucous carcinoma (VC), syringocystadenoma papilliferum (SCAP), and a basal cell carcinoma (BCC). The presentation of this collision tumor is unexpected. It presented as an exophytic mass on the scalp. While collisions of SCAP and VC are present in the literature, this case included an additional pathologic entity. The association of these entities and the unreported location of the lesion may provide some further insight as to the etiology of VC.

Although the argument against poetry may have had its locus classicus in Plato’s Republic, the philosophical qualms against poetry are deeply rooted and are not unique to Plato’s philosophy. We begin by considering the reasons why some philosophers once believed that philosophy was superior to poetry, and then we regard some of these prejudices and how they have been debunked in contemporary philosophy. Our main purpose in this paper is to move beyond this inadequate understanding of poetry to a deeper philosophical appreciation of it.Keywords: poetry; philosophy; education

As the nation's health system moves away from earlier models to one grounded in population health and market-based systems of care, new challenges arise for public health professionals, primary care practitioners, health plan and institutional managers, and community leaders. Among the challenges are the need to develop creative concepts of organization and accountability and to assure that dynamic, system-oriented structures support the new kind of leadership that is required. Developing tomorrow's integrated community health systems will challenge the leadership skills and integrative abilities of public health professionals, primary care practitioners, and managers. These leaders and their new organizations must, in turn, assume increased accountability for improving community health.

Collaborative partnerships for environmental education and implementation between Land Grant University programs, tribal colleges and the tribes themselves which manage land and waters within their borders have proven difficult to establish and maintain. Lack of trust among the parties results, in part, from lack of knowledge about tribal culture, authority and decision-making mechanisms. Cooperation between Kansas State University, Haskell Indian Nations University and the Prairie Band Potawatomi Nation in a successful riparian restoration project which has become the basis for ongoing collaboration to improve natural resource management demonstrates that trust can be built.

In early 2001, the community of educational programs offering master's-level education in healthcare management began an odyssey to modernize its approach to the organization and delivery of healthcare management education. The community recognized that cumulative long-term changes within healthcare management practice required a careful examination of healthcare management context and manpower requirements. This article suggests an evidence-based rationale for defining the distinctive elements of healthcare management, thus suggesting a basis for review and transformation of master's-level healthcare management curricula. It also suggests ways to modernize these curricula in a manner that recognizes the distinctiveness of the healthcare business enterprise as well as the changing management roles and careers within these complex organizations and systems. Through such efforts, the healthcare management master's-level education community would be better prepared to meet current and future challenges, to increase its relevance to the management practice community, and to allocate scarce faculty and program resources more effectively.

We report a case of persistent, raised, annular, erythematous plaques in a patient taking chlorpropamide. A diagnosis of lichenoid drug eruption was made

The concept of a mononuclear phagocytic system consisting of a continuum of cells arising from the bone marrow monoblast and terminating in the mature tissue macrophage is being actively investigated. The presentation of documented acute monocytic leukemia 18 months following the confirmed diagnosis of histiocytosis X in a 39-year-old man strongly supports the concept of the mononuclear phagocytic system lineage.

A scabies epidemic was studied in a university hospital dialysis unit. Itching in patients was initially attributed to uremic pruritus, and diagnosis of the epidemic was delayed until cases occurred among the staff. Sixteen cases (seven patients and nine staff) were identified by survey questionnaire and dermatologic examination. Application of 1 % lindane lotion (Kwell, Reed and Carnrick, Piscataway, NJ) to all patients dialyzed in the unit and the entire staff eradicated the epidemic. A dialysis unit-associated nosocomial scabies epidemic has not been reported before and may mimic uremic pruritus in dialysis patients.

The behavior of the basement membrane in diseases of the skin and oral mucosa has been discussed. These diseases are lichen planus, erythema multiforme, lupus crythematosus, pemphigus vulgaris, benign mucous membrane pemphigoid, and epidermolysis bullosa simplex. The basement membrane has been evaluated by light microscopy using the PAS and silver stain techniques. While the number of lesions in four of the diseases is small, this study illustrates the value of silver stains for studying the basement membrane in patients with skin and mucous membrane diseases.

THE combination of multiple basal-cell carcinomas, cysts of the jaw, and skeletal deformities forms an uncommon disorder often referred to as the basal-cell nevus syndrome . The condition can be recognized in early childhood and is thought to be inherited as a highly penetrant, autosomal dominant gene with multiple and variable effects. 1 Cases have been described with scoliosis, prominent frontal bosses, short metacarpal bones, nasal deformity, agenesis of the corpus callosum, calcification of the falx cerebri, medulloblastoma, mental changes, hypertelorism, gonadal dysplasia, milia, and dyskeratosis of the palms and soles. 2-10 It has recently been suggested that this syndrome may be a variant of pseudohypoparathyroidism because of (1) certain gross similarities, including body habitus, short metacarpal bones, ectopic calcification, and mental abnormalities, and (2) the failure to respond to infusions of parathyroid hormone with a phosphorus diuresis. 8,9 We have studied a boy with multiple basal-cell carcinomas and bone defects.

Lichen planus is a pruritic disease often prolonged and frustrating for the physician and patient. Emotions play an important role in its cause and control, and some drugs may be etiologic agents. Treatment depends on the course and stage of the disease.

We report a case of squamous cell carcinoma of the lung associated with the sudden appearance of seborrheic keratosis and acquired ichthyosis. We conclude that the sign of Leser-Trelat is a rare cutaneous manifestation of internal malignant disease. ( JAMA 238:236-237, 1977)

• A study of tinea versicolor organisms was conducted in one patient by scanning electron microscopy. Morphologic changes in the organisms during treatment with topical clotrimazole and miconazole nitrate consisted of initial wrinkling of the surface, followed by fragmentation. These changes may have reflected cell wall alterations resulting from inhibited ergosterol synthesis induced by both treatment agents. The two drugs were effective in eliminating the organisms. ( Arch Dermatol 1984;120:1057-1058)

To the Editor.— It has been previously demonstrated that alopecia areata can be treated with dinitrochlorobenzene (DNCB) as well as other contact allergens. The mechanism of action of these agents has not been conclusively demonstrated. Recently, concern about the possible mutagenicity of DNCB has developed. We would like to note our recent experience with a case of apparent systemic manifestations of topical DNCB therapy. Report of a Case.— A 25-year-old man in excellent general health had a long history of alopecia. Alopecia areata had first developed when he was 8 years old and resolved completely without treatment. At the age of 10 years, alopecia areata developed involving the scalp and gradually progressed to alopecia universalis. He received various topical and intradermal adrenal steroids, with little permanent improvement. Subsequently, in 1978, he experienced regrowth of all hair except the hair on his scalp while he was taking 8 mg of oral

• Four patients with psoriasis were treated with continuous ambulatory peritoneal dialysis (CAPD). Two were being treated for renal failure; the other two had normal renal function and were being treated exclusively for psoriasis. With CAPD at a rate of three to four exchanges per day, the psoriasis cleared completely in the two patients with renal failure and improved in the other two. In the patients without renal failure, low-flow peritoneal dialysis (one exchange per day) seemed to be of some value in maintaining remission but was ineffective in treating more active disease. Long-term therapy (≥12 weeks) with three or four daily exchanges may be needed for initial complete remission, and continuous treatment may be needed to prevent relapse. Thus, CAPD shows promise for the study of psoriasis and may be a last-resort treatment for severe, disabling cases. ( Arch Intern Med 1986;146:1177-1179)

To the Editor.— We wish to communicate briefly the results of an open clinical trial, performed with informed consent, using tolmetin sodium to treat chonic furunculosis and hidradenitis suppurativa. Four patients, ages 4 to 30 years, had histories of furunculosis of several years' duration with minimal response to repeated courses of various antibiotics. All patients experienced nearly complete clearing of their lesions within days to weeks after the institution of tolmetin sodium therapy. Their furunculosis flared up after cessation of treatment, but cleared again after the tolmetin sodium therapy was resumed. Subsequently, the patients were treated with gradually decreasing dosages during a period of months and the furunculosis did not flare up after treatment was discontinued. All patients have remained nearly lesion-free for periods of up to one year after stopping treatment. Two patients with long-standing hidradenitis suppurativa, aged 24 and 26 years, were similarly treated. Both demonstrated notable improvement

To the Editor.— Recent letters have argued the merits of lumping vs splitting in porokeratosis (Porokeratosis, LETTERS TO THE EDITOR. Arch Derm 105:296, 1972). Here presented is some evidence for lumping. This 36-year-old woman developed a linear porokeratosis at age 5 following the measles (Fig 1). After puberty, she developed the small lesions of disseminated superficial actinic porokeratosis (DSAP) on the arms and legs, with exacerbation in the summer (Fig 2). Biopsies of both areas showed the coronoid lamella. Three of her sisters were also examined and had biopsies. They had DSAP on the extremities, with onset soon after puberty. Four brothers and a younger sister were not affected. The parents had no DSAP.

To the Editor: I write with reference to the paper by Stanley Schoenfeld and Philip C. Hoszberger entitled "Palatal Leukokeratosis Secondary to Candela pa Den" [Arch Derm90:89 (July) 1964]. In keeping with the exotic flavor of local dialects, I use the term from Southern India, "Adda Poga," meaning "reverse smoking." I wish to point out to the authors that this habit of smoking with the lit end inside the mouth has been reported in the literature: Reddy, D. G.; Reddy, D. B.; and Rao, P. R.: Experimental Production of Cancer With Tobacco, Tar, and Heat, Cancer 13:263, 1960. Reddy, D. G., and Rao, V. K.: Cancer of Palate in Costal Andhra Due to Smoking Cigars With Lit End Inside the Mouth, Indian J Med Science 11:791, 1957) Holzberger and Schoenfeld state, "It seems remarkable that such abuse, though producing a baroque version of a precancerous lesion

This case of actinomycosis involving the hand and arm is noteworthy because of the unique location. Not only was the skin affected but also the subcutaneous tissue, muscle, periosteum, and axillary node of the right arm. No discernible history could be elicited of any injury, occupational contact, or endogenous foci. Most cases of actinomycosis of the skin, reported in the literature, reveal a history of farm work or of trauma due to human bites or of fist blows to the mouth. The cases resulting from oral contact include three involving the hand; in each instance the patient had hit another person on the mouth (Cope, 1 McWilliams, 2 and Burrows 3 ). Others in which oral contact was suspected were 14 cases of primary actinomycosis of the breast, reported by Davies, 4 and one, described by Robinson, 5 in which the infection was traced to a human bite. Farm