Elastofibroma dorsi (ED) is an uncommon benign soft tissue tumor with an uncertain pathogenesis. It mostly occurs in the infrascapular region of elderly people with a female predominance. Typically bilateral, ED can also be unilateral. While many patients remain asymptomatic, ED can be responsible of a periscapular arch source of ache. The diagnosis of ED is set on magnetic resonance imaging, and the pathological study ensures the diagnosis after surgical excision and establishes the differential diagnosis with malignant neoplasic process. The prognosis is excellent with extremely rare recurrence cases. Herein we report a case of a 54-years-old woman with a bilateral painful ED. The diagnosis was based on clinical and MRI findings that revealed bilateral tumors. Surgery was decided due to the symptomatic nature of the tumors. Pathological study confirmed the diagnosis. The post operative course was uncomplicated. We update through a review of the literature aspects of the diagnostic and therapeutic care of Elastofibroma dorsi.

Background: Mycetoma is an uncommon chronic granulomatous infection of cutaneous and subcutaneous tissues that can be caused by filamentous bacteria (actinomycetoma) or fungi (eumycetoma). It is the prerogative of young men between the third and fourth decade and is transmitted through any trauma causing an inoculating point. The classic clinical triad associates a painless hard and swelling subcutaneous mass, multiple fistulas, and the pathognomonic discharge of grains. Although endemic in many tropical and subtropical countries, mycetoma can also be found in non-endemic areas as in Morocco, and causes then diagnosis problems leading to long lasting complications. Therefore, we should raise awareness of this neglected disease for an earlier management. Under medical treatment however, mycetoma has a slow healing and surgery is often needed, and relapses are possible. Case presentation: Herein we report a case of a 64 years old patient, with a history of eumycetoma occurring ten years ago treated with oral terbinafine coupled with surgery. A complete remission was seen after 2 years. He presented a relapse on the previous scar 6 months ago. There wasn't any bone involvement in the magnetic resonance imaging (MRI). The patient was put under oral terbinafine with a slow but positive outcome. Conclusion: Through this case report, we perform a literature review and highlight the importance of increase awareness of mycetoma in clinical practice especially in non-endemic regions.

A woman in her 50s presented with total scarring ulcerated alopecia evolving for 10 years, and a recent budding tumour on the lower lip. Clinical examination revealed an associated exfoliated and infiltrated erythroderma with ulcerated cutaneous tumours of the legs, palmoplantar hyperkeratosis, hepatosplenomegaly and diffuse lymphadenopathies.Dermatoscopy of the scalp, leg tumours and infiltrated skin showed a typical yellowish background overlaid by arborescent vessels and whitish areas. Cutaneous biopsies of the same areas found sarcoidotic granulomas. Lip biopsy found an associated well-differentiated squamous cell carcinoma. Investigations confirmed the diagnosis of systemic sarcoidosis with an elevated converting enzyme level, mediastinal calcified lymphadenopathies in CT scan and deep localisations in positron emission tomography scan (thyroid, lymph nodes, mediastinum, liver, spleen and adrenal glands).The patient was treated with oral prednisone for sarcoidosis and intramuscular bleomycin followed by surgery and radiotherapy for squamous cell carcinoma. Sarcoidotic lesions healed, but a recurrence of her carcinoma led to death.

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We report the case of a 34-year-old female patient with no medical history presented herself with a lesion near the intergluteal cleft evolving for more than five years and gradually increasing in size. An examination revealed a painless nodule 1.5 × 2 cm in size, of soft consistency, and with a flesh-colored pedicle base with central hyperpigmentation and a depigmented peripheral area (Fig. 1). Dermoscopy revealed a hyperpigmented cerebriform structure in the center surmounted by several white scales and bordered by an irregular melanocytic network and multiple ovoid nests (Fig. 2).

A thirty-year-old patient presented with an erythematous papule on the left nostril evolving for ten months. A clinical examination revealed an infiltrated, erythematous, well-limited plaque with a raised border, covered with multiple open and closed comedones. On dermoscopy, there was an erythematous background with some fine telangiectasias and horny plugs at the follicular orifices. A skin biopsy was performed, revealing orthokeratotic hyperkeratosis sinking into the follicular orifices dilated by sebum clumps with basal vacuolation associated with a subepidermal and periadnexal/perivascular lymphocyte band infiltrate. Direct immunofluorescence staining for immunoglobulin M was positive. The diagnosis of lupus comedones was retained, and the patient was put on topical tacrolimus 0.1% twice a day. A systemic damage assessment was negative. Our case highlighted, the importance of recognizing this rare variant of cutaneous lupus, confused with acne vulgaris, hence the delayed diagnosis, which may also be an early sign of a concomitant systemic involvement. Key words: Acne; Chronic Cutaneous Lupus Erythematosus; Comedonal Variant; Discoid Lupus Erythematosus

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