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Extramammary Paget disease is a rare neoplastic condition that more commonly affects postmenopausal Caucasian women. Although the vulvar area is the most frequently affected location, it corresponds solely to 1 to 2% of all vulvar malignancies. A 72-year-old female patient was observed in our outpatient clinic with a 2-year history of an erythematous and pruritic plaque on the vulva. Histopathology and immunohistochemistry studies were compatible with extramammary Paget disease of the vulva. Associated neoplastic conditions were excluded. Due to multiple relapses, the patient was submitted to three surgical interventions, including a total vulvectomy, and to external radiotherapy. The present case illustrates the chronic and recurrent nature of extramammary Paget disease despite aggressive procedures as well as the challenge in obtaining tumor-free resection margins.

African tick bite fever is caused by the intracellular bacteria Rickettsia africae. This bacterium is transmitted through the bite of the Amblyomma tick, which carries a high rate of R. africae infection. African tick bite fever is the second most frequent cause of fever in travelers returning from sub-Saharan Africa.We present the case of a 58-year-old man, returning from South Africa, with a three-day history of fever, generalized headache and cervical myalgia. On physical examination multiple inoculation eschars and tender inguinal lymph nodes were documented.Histological examination of a skin lesion was compatible with spotted fever and the diagnosis of R. africae infection was confirmed through polymerase chain reaction analysis.The global increase in international tourism, particularly to remote areas, predisposes to tick bites. In febrile tourists returning from endemic areas and after a thorough clinical examination, the diagnosis of African tick bite fever should be born in mind.

Introduction: The vulvar area may be affected by many noninfectious conditions with similar clinical appearance, requiring a cutaneous biopsy. Our goal was to characterize the noninfectious vulvar diseases that required a biopsy in a southwestern Europe Central Hospital during a 10-year period. Methods: A retrospective study of all the noninfectious vulvar diseases with histological confirmation diagnosed in our institution was conducted between January 1, 2008 and December 31, 2017. Results: The sample included a total of 323 biopsies from 317 patients, aged between 11 and 98 years (mean age of 54.2 years). A total of 36 vulvar diseases was identified. Neoplastic conditions were the most frequently found, particularly melanotic macules (22.3%). The most frequent malignant tumor was vulvar intraepithelial neoplasia (6.2%) and squamous cell carcinoma (5.6%). The most common dermatosis was lichen sclerosus (12.7%). Conclusion: Neoplasms were the most frequently diagnosed conditions affecting the vulvar area that required a biopsy. Ruling out malignancy was also the main reason to perform a biopsy. This study highlights the variety of noninfectious diseases that may affect the vulva and require a biopsy. Since vulvar diseases may be serious and carry high levels of patient distress a correct understanding of these conditions is crucial.

The bilobed flap has been extensively used in the reconstruction of distal nasal defects. It is a local flap that recruits skin from areas where there is relative skin mobility to close defects in areas where the skin has less plasticity. Besides its usefulness in the reconstruction of small to moderate cutaneous nasal defects it can also be used to reconstruct large defects located in other anatomical areas. We present a clinical case in which the bilobed skin flap was employed to reconstruct a large surgical defect of the neck resulting from excision of a basal cell carcinoma, with excellent functional and cosmetic results.

Sclerotic fibroma (SF) or storiform collagenoma is a rare and benign skin tumor. Clinically, it usually presents as an asymptomatic, slowly growing papule or nodule on the skin of the head, neck and upper extremities. Other locations have been described including the trunk, oral mucosa and nail bed. SF can present either as a solitary tumor or as multifocal cutaneous lesions and it may occur sporadically or in association with Cowden syndrome. Herein, we report a case of a solitary SF with typical clinical and histologic features, not associated with Cowden disease.

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