Cutis rhomboidalis nuchae was assessed in a 65-year-old patient. Optical microscopy showed basophilic agglomerations in the reticular dermis with decreased elastic fibers. Transmission electron microscopy showed elongated, curved and fragmented structures, and in their interior the presence of electron-dense lumps was reduced and irregular, similar to modified elastic fibers, whereas the collagen fibers had a normal aspect. Scanning electron microscopy showed deposits between the bundles of collagen, resembling pebbles or stones. These findings demonstrate that, at one stage of the disease, the collagen remains normal and the alterations are seen in the elastic tissue.

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Oral inhibitors of epidermal growth factor receptor may have a wide range of cutaneous manifestations. Hair manifestations are observed in 10%–20% of the patients. At the ultrastructural level erlotinib-induced hair changes were already described as acquired pili torti et canaliculi. We examined a 78-year-old female patient, with lung carcinoma, taking gefitinib for 15 months. The treatment has no side effects with good tolerance and tumor response. Although the patient had not observed any change on the hairs under the therapy, some specimens were obtained to be examined in natura with scanning electron microscopy. Under low magnification incipient grooving was observed on the hair surface, tortions or angulations of the hair shaft were not found. With higher magnifications the surface grooving was even more evident. Our findings show that gefitinib may cause subclinical hair changes, similar to those described at the ultrastructural level with erlotinib.

McCune - Albright syndrome is a genetic disease with cutaneous mosaicism caused by post-zygotic activating mutations in GNAS locus, it has a triad of fibrous bone dysplasia, café-au-lait macules and precocious puberty. We examined a 22-year-old female patient with café au lait spot in right side of the abdomen, with a chessboard - like distribution, extending to right thigh with geographical contours, she has also an ovarian cyst, scoliosis and truncal obesity. Biopsies were taken from the hyperpigmented area and processed for light microscopy and for transmission electron microscopy. Light microscopy showed increased melanin pigment with HE staining. Immunohistochemistry with melanocytic markers (HMB-45 and Melan-A) revealed a normal number of melanocytes. Transmission electron microscopy demonstrated normal epidermal structures, such as desmosomes, cytokeratin filaments and hemidesmosomes. With high magnifications an irregular melanossomal contour was seen, with some indentations in their outline.

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