We present the case of a 50-year-old-man with pemphigus vulgaris involving the oropharyngolaryngeal mucosa and oesophagus. Oesophageal involvement of pemphigus vulgaris is relatively uncommon, especially in subjects in clinical remission, and has been rarely described in the literature. Endoscopic examination should be performed to avoid inappropriate therapy due to misdiagnosis of steroid-induced oesophagitis and peptic ulcers.

The main epiluminescence microscopy (ELM) patterns observed on volar acquired melanocytic naevi are the parallel-furrow, the lattice-like and the fibrillar patterns. Because of the peculiar arrangement and configuration of epidermal rete ridges in the glabrous skin, the traditional histological picture does not provide an exact correlation with ELM features. In particular, the fibrillar pattern lacks a histopathological correlate. To clarify the microscopic features of the fibrillar pattern, we used transverse histological sectioning to study an acquired compound melanocytic naevus of the sole, characterized by a mixed parallel-furrow/fibrillar pattern on ELM. Low-magnification images of transverse sections allowed us to highlight the typical anatomical arrangement of the volar skin clearly, while high-magnification images demonstrated that the fibrillar pattern corresponded to parallel striae of intensely pigmented corneocytes arranged obliquely to the cutaneous surface.

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A 44‐year‐old white woman was admitted to our hospital for the investigation of many roundish, pale‐colored, nodular lesions of different sizes, ranging from a few millimeters to some centimeters, symmetrically grouped on the shoulders (Fig. 1), trunk, upper limbs, and abdomen. The lesions first appeared at 20 years of age on the upper chest around the clavicular region, and thereafter gradually increased on the trunk and upper limbs; they were completely asymptomatic, appearing on normal skin without a previous history of inflammation and/or trauma. No scarring or atrophy was evident. The smaller lesions exhibited a miliaria‐like shape, being evident in particular on stretching of the skin; the larger ones showed a firm‐elastic density, no adhesion to surrounding tissue, and deep localization in the skin. No hypopigmented macules or sebaceous adenoma‐like lesions were present. Skin biopsy of a nodular lesion from the right shoulder revealed a normal epidermis and a dermis filled with bundles of dense and coarse collagen fibers (Fig. 2). Elastic fibers appeared thin and decreased in number under Verhoeff–van Gieson stain (Fig. 3). A diagnosis of cutaneous collagenoma was proposed. Routine laboratory investigations were within the normal range. Chest and skeleton (hands, pelvis, and long bones) X‐ray, electrocardiogram, and echocardiogram showed no abnormality. 1 Nodular papules localized on the right shoulder 2 Histology of a lesion taken from the right shoulder. The picture demonstrates dense and coarse collagen bundles (hematoxylin and eosin stain; original magnification, × 200) 3 Elastic fibers are clearly diminished in number, thin, and fragmented (Verhoeff–van Gieson stain; original magnification, × 400) In order to evaluate a possible familial cutaneous collagenoma, the 19‐year‐old son of the patient was also examined. He had a 3‐month history of numerous, asymptomatic, skin‐colored nodules, ranging from 0.5 to 2 cm, on the upper back. Skin biopsy of a nodular lesion showed the same features as observed in the mother's biopsy. Routine blood and serum tests and X‐ray examinations were within normal limits. Electrocardiogram revealed an early R‐wave transition, and echocardiogram showed a left ventricular dilation with thickened aorta; aortic steno‐insufficiency was diagnosed under cardiologic examination. The diagnosis of familial collagenoma was confirmed, and similar cutaneous lesions were found in the mother's grandmother and aunt.