Patients may seek "alternative" or "non-traditional" therapies for dermatologic problems, frequently in search of a miraculous cure. However, many of these medicaments contain unknown compounds with questionable benefit and a potential for significant harm. We describe a patient who developed a large ulceration on her nose after applying "black and yellow salves" obtained from Mexico in an attempt to self-treat a basal cell carcinoma.
Apocrine nevus is a rare tumor composed of increased mature apocrine glands and ductal structures within a fibrous stroma, located predominantly in the reticular dermis. They have been reported in association with apocrine carcinoma, extramammary Paget disease, and syringocystadenoma papilliferum; less commonly a pure apocrine nevus is identified, unassociated with another apocrine proliferation. Clinically apocrine nevi may appear as solitary or multiple nodules or plaques on the scalp, presternal skin, though they are seen most commonly in the axillae. We describe 4 cases of pure apocrine nevus, all of which appeared clinically as painless or mildly tender skin-colored axillary masses, 2 of which were bilateral. In each case, the lesions appeared in adulthood, and patients denied knowledge of congenital or childhood presence. Patients denied pruritis, discharge, bleeding, or antecedent trauma. Grossly, the specimens consisted of subcutaneous, multicystic ill-defined nodules. Biopsy showed prominent apocrine glands composed of irregularly columnar luminal cells with eosinophilic cytoplasm arranged in a somewhat organoid pattern filling the reticular dermis and extending into the subcutaneous adipose tissue. The glandular luminal cells displayed decapitation secretion. There was a paucity of pilosebaceous units. In one case, the overlying epidermis was papillomatous. The deepest portion of one specimen had lactational change simulating a lactational adenoma. No atypia was seen in either the glandular structures or the stroma. The adjacent sebaceous and eccrine structures were normal. The histologic features and immunohistochemical profile in relation to other apocrine lesions will be reviewed.
Overproduction of a vascular endothelial growth factor secreted by neoplastic cells in some plasma cell neoplasms is postulated to be responsible for the syndrome of polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes and the rarer syndrome of adenopathy and extensive skin patch overlying a plasmacytoma. The authors present a case of a 57-year-old man who presented with an erythematous left flank skin patch and subsequent discovery of an underlying 10th rib plasmacytoma with lambda light chain restriction. The tumor was strongly positive for CD31, a marker known to be involved in angiogenesis and cell adhesion. Immunohistochemical studies were initially confounding and later shown to be due to the effects of decalcification procedures. The authors discuss the natural history of this unusual entity and the diagnostic challenges in evaluating this lesion. The authors finally postulate whether strong CD31 expression could be related to paraneoplastic phenomena associated with some plasma cell lesions.
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