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Predicting progression of urticaria pigmentosa into systemic mastocytosis
P2317
P2319
Case report: Squamous cell carcinoma of the scrotum in chronic arsinicism Minh Hoang Van, MD, University of Medical and Pharmacy of Ho Chi Minh City Vietnam, Ho Chi Minh, Vietnam; Dinh Vo Quang, MD, University of Medical and Pharmacy of Ho Chi Minh City Vietnam, Ho Chi Minh, Vietnam; Phuoc Ha Van, MD, Department of Pathology, Dermatology Venereology Hospital of Ho Chi Minh City, Vietnam, Ho Chi Minh, Vietnam
Multiple eruptive keratoacanthomas, de novo Harries Matthew, MBChB, The Dermatology Centre, The University of Manchester, Manchester, United Kingdom; David Fitzgerald, MBChB, The Dermatology Centre, The University of Manchester, Manchester, United Kingdom
Cutaneous complications arising from exposure to Chinese proprietary medicines known to contain inorganic arsenic have been rarely reported, especially squamous cell carcinoma of the scrotum. Ingestion of inorganic arsenic has been long recognized as a cause of arsenical keratoses, pigmentary anomalies, Bowen’s disease, squamous cell carcinoma, and basal cell carcinoma and has been reported most often in Taiwan and Singapore. We report a case of squamous cell carcinoma of the scrotum as a consequence of chronic arsinicism due to ingestion of an arseniccontaining medication at Hospital of Dermatology and Venerelogy. A 43-year-old man was admitted with an ulcer on his scrotum. Examination showed an ulcer about 3 cm in diameter with undermined and indurated border localized at his left scrotum. Its base was clean, firm, and unpainful. There were multiple wart-like papules on his soles and a rain-drop figure on his trunk. He had a history of asthma from 13 years-of-age and had been treated by traditional Chinese medicine. Histopathology showed squamous cell carcinoma. Levels of arsenic in hair were 0.27 mg/g. This was the first case that we met in my country of Vietnam. Commercial support: None identified.
A 95-year-old man presented with a 5-month history of multiple asymptomatic nodules appearing on his lower legs and arms. The lesions started as small spots that had increased in size over time. A few of the lesions had spontaneously resolved prior to referral. There was no history of excessive sunlight exposure, chemical insult to the skin, treatment with tonics, or phototherapy in the past. There was no family history of similar lesions. Examination revealed multiple, flesh-coloured hyperkeratotic nodules scattered over the lower legs with a smaller number over the forearms and dorsum of the hands. No lymphadenopathy was present. Two lesions were excised and submitted for histological analysis. A cup-shaped endo- and exophytic-squamous proliferative lesion with associated dermal fibrosis and chronic inflammation was removed from the dorsum of his left hand. The histological features were consistent with a regressing keratoacanthoma. The other lesion, from his right medial calf, was reported as a well differentiated squamous cell carcinoma. During follow-up, some of the lesions had spontaneously resolved whilst others had flattened without any active treatment. Keratoacanthomas (KA) are epithelial neoplasms that are clinically and histologically often indistinguishable from squamous cell carcinoma (SCC). KA present as flesh-coloured nodules with a central keratin plug that appear and grow rapidly, then undergo spontaneous regression and eventually result in a cribriform scar. Historically, KA were regarded as benign, hairfollicle derived tumours that involute spontaneously. Most authorities now regard KA as a variant of SCC. Multiple KA have been described in several clinical forms including multiple self-healing epithelioma of Ferguson-Smith, generalised eruptive KA of Grzybowski type and multiple KA of Witten and Zak. Our patient does not readily fit any of these clinical forms. Two recently published case reports, however, each describe separate elderly patients with multiple eruptive KA on the legs [Wee SA. Dermatology online journal 2004;10:19. Chu DH, Hale EK, Robins P. Dermatology online journal 2003;9:36]. These cases are almost identical to that of our patient. The term ‘‘multiple eruptive keratoacanthomas, de novo’’ was given to this clinical form. We present a case of multiple eruptive keratoacanthomas, de novo and describe the clinical progression to date. Commercial support: None identified.
P2318 Amiodarone-induced skin pigmentation and multiple BCCs Keren Ben-Ari Maoz, MD, Ichilov Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sarah Brenner, MD, Ichilov Sourasky Tel Aviv Medical Center, Tel Aviv, Israel Amiodarone, an iodinated antiarrhythmic agent, is known to cause photosensitivity (in 25-75% of patients) and slate-grey cutaneous hyperpigmentation (in 2-10% of patients) of sun-exposed skin. Amiodarone induced photosensitivity was demonstrated at UVA-UVB range, as well as at visible light range. We present a case of a 74-year-old patient treated with amiodarone for persistant atrial fibrillation presenting with typical slate-gray hyperpigmentation and multiple BCCs. The patient was treated 8 years with amiodarone. He admitted to have been suffering from photosensitivity at the beginning of the treatment with hyperpigmentation appearing 6 years later. Overall 13 basaliomas were excised from the patient during a time span of 5 years, 3 years after commencing treatment with amiodarone. Most of the basaliomas were of the superficial type. A history of excessive sun exposure, arsenic, or radiation was excluded. Histologic sections of hyperpigmented skin were studied with light and electron microscopy. In addition, confocal microscopy was used to exhibit autofluorescence of amiodarone granules . Though few reports have been made, still there is no established relationship between amiodarone treatment and BCC appearance. We believe such striking findings of multiple BCCs in a photosensitized patient due to amiodarone therapy were more than just coincidental. Commercial support: None identified.
FEBRUARY 2007
P2320 Predicting progression of urticaria pigmentosa into systemic mastocytosis Aaron Bruce, DO, Nova SouthEastern University/Suncoast Hospital, Largo, FL, United States; Roger Sica, DO, Nova Southeastern University/Suncoast Hospital, Largo, FL, United States Mastocytosis refers to a spectrum of diseases related to an accumulation of mast cells. The range of diseases caused by mast cell aggregation and degranulation vary from relatively benign cutaneous forms to myelodysplastic disorders. The most common childhood form of mastocytosis, urticaria pigmentosa (UP), represents 6090% of cases. Typically UP resolves by puberty, however, rare cases have evolved into systemic disease in adulthood. We present a 25-year-old female with a history of adolescent onset urticaria pigmentosa, who presented to us complaining of recurrent episodes of flushing, pruritus, palpitations, wheezing, crampy abdominal pain, vomiting, syncope, and headache within the last year. Her skin lesions became raised, erythematous, and prurituc with exacerbations which coincide with ‘‘asthma attacks.’’ Exercise made her symptoms worse and naprosyn also reportedly induced an acute episode. Recent studies have revealed antibodies against CD2, CD25, antitryptase, and a c-kit mutation Asp-816-Val as possible markers of progression to systemic disease. We will describe the usefulness of such markers. Commercial support: None identified.
J AM ACAD DERMATOL
AB151
P2319
Case report: Squamous cell carcinoma of the scrotum in chronic arsinicism Minh Hoang Van, MD, University of Medical and Pharmacy of Ho Chi Minh City Vietnam, Ho Chi Minh, Vietnam; Dinh Vo Quang, MD, University of Medical and Pharmacy of Ho Chi Minh City Vietnam, Ho Chi Minh, Vietnam; Phuoc Ha Van, MD, Department of Pathology, Dermatology Venereology Hospital of Ho Chi Minh City, Vietnam, Ho Chi Minh, Vietnam
Multiple eruptive keratoacanthomas, de novo Harries Matthew, MBChB, The Dermatology Centre, The University of Manchester, Manchester, United Kingdom; David Fitzgerald, MBChB, The Dermatology Centre, The University of Manchester, Manchester, United Kingdom
Cutaneous complications arising from exposure to Chinese proprietary medicines known to contain inorganic arsenic have been rarely reported, especially squamous cell carcinoma of the scrotum. Ingestion of inorganic arsenic has been long recognized as a cause of arsenical keratoses, pigmentary anomalies, Bowen’s disease, squamous cell carcinoma, and basal cell carcinoma and has been reported most often in Taiwan and Singapore. We report a case of squamous cell carcinoma of the scrotum as a consequence of chronic arsinicism due to ingestion of an arseniccontaining medication at Hospital of Dermatology and Venerelogy. A 43-year-old man was admitted with an ulcer on his scrotum. Examination showed an ulcer about 3 cm in diameter with undermined and indurated border localized at his left scrotum. Its base was clean, firm, and unpainful. There were multiple wart-like papules on his soles and a rain-drop figure on his trunk. He had a history of asthma from 13 years-of-age and had been treated by traditional Chinese medicine. Histopathology showed squamous cell carcinoma. Levels of arsenic in hair were 0.27 mg/g. This was the first case that we met in my country of Vietnam. Commercial support: None identified.
A 95-year-old man presented with a 5-month history of multiple asymptomatic nodules appearing on his lower legs and arms. The lesions started as small spots that had increased in size over time. A few of the lesions had spontaneously resolved prior to referral. There was no history of excessive sunlight exposure, chemical insult to the skin, treatment with tonics, or phototherapy in the past. There was no family history of similar lesions. Examination revealed multiple, flesh-coloured hyperkeratotic nodules scattered over the lower legs with a smaller number over the forearms and dorsum of the hands. No lymphadenopathy was present. Two lesions were excised and submitted for histological analysis. A cup-shaped endo- and exophytic-squamous proliferative lesion with associated dermal fibrosis and chronic inflammation was removed from the dorsum of his left hand. The histological features were consistent with a regressing keratoacanthoma. The other lesion, from his right medial calf, was reported as a well differentiated squamous cell carcinoma. During follow-up, some of the lesions had spontaneously resolved whilst others had flattened without any active treatment. Keratoacanthomas (KA) are epithelial neoplasms that are clinically and histologically often indistinguishable from squamous cell carcinoma (SCC). KA present as flesh-coloured nodules with a central keratin plug that appear and grow rapidly, then undergo spontaneous regression and eventually result in a cribriform scar. Historically, KA were regarded as benign, hairfollicle derived tumours that involute spontaneously. Most authorities now regard KA as a variant of SCC. Multiple KA have been described in several clinical forms including multiple self-healing epithelioma of Ferguson-Smith, generalised eruptive KA of Grzybowski type and multiple KA of Witten and Zak. Our patient does not readily fit any of these clinical forms. Two recently published case reports, however, each describe separate elderly patients with multiple eruptive KA on the legs [Wee SA. Dermatology online journal 2004;10:19. Chu DH, Hale EK, Robins P. Dermatology online journal 2003;9:36]. These cases are almost identical to that of our patient. The term ‘‘multiple eruptive keratoacanthomas, de novo’’ was given to this clinical form. We present a case of multiple eruptive keratoacanthomas, de novo and describe the clinical progression to date. Commercial support: None identified.
P2318 Amiodarone-induced skin pigmentation and multiple BCCs Keren Ben-Ari Maoz, MD, Ichilov Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sarah Brenner, MD, Ichilov Sourasky Tel Aviv Medical Center, Tel Aviv, Israel Amiodarone, an iodinated antiarrhythmic agent, is known to cause photosensitivity (in 25-75% of patients) and slate-grey cutaneous hyperpigmentation (in 2-10% of patients) of sun-exposed skin. Amiodarone induced photosensitivity was demonstrated at UVA-UVB range, as well as at visible light range. We present a case of a 74-year-old patient treated with amiodarone for persistant atrial fibrillation presenting with typical slate-gray hyperpigmentation and multiple BCCs. The patient was treated 8 years with amiodarone. He admitted to have been suffering from photosensitivity at the beginning of the treatment with hyperpigmentation appearing 6 years later. Overall 13 basaliomas were excised from the patient during a time span of 5 years, 3 years after commencing treatment with amiodarone. Most of the basaliomas were of the superficial type. A history of excessive sun exposure, arsenic, or radiation was excluded. Histologic sections of hyperpigmented skin were studied with light and electron microscopy. In addition, confocal microscopy was used to exhibit autofluorescence of amiodarone granules . Though few reports have been made, still there is no established relationship between amiodarone treatment and BCC appearance. We believe such striking findings of multiple BCCs in a photosensitized patient due to amiodarone therapy were more than just coincidental. Commercial support: None identified.
FEBRUARY 2007
P2320 Predicting progression of urticaria pigmentosa into systemic mastocytosis Aaron Bruce, DO, Nova SouthEastern University/Suncoast Hospital, Largo, FL, United States; Roger Sica, DO, Nova Southeastern University/Suncoast Hospital, Largo, FL, United States Mastocytosis refers to a spectrum of diseases related to an accumulation of mast cells. The range of diseases caused by mast cell aggregation and degranulation vary from relatively benign cutaneous forms to myelodysplastic disorders. The most common childhood form of mastocytosis, urticaria pigmentosa (UP), represents 6090% of cases. Typically UP resolves by puberty, however, rare cases have evolved into systemic disease in adulthood. We present a 25-year-old female with a history of adolescent onset urticaria pigmentosa, who presented to us complaining of recurrent episodes of flushing, pruritus, palpitations, wheezing, crampy abdominal pain, vomiting, syncope, and headache within the last year. Her skin lesions became raised, erythematous, and prurituc with exacerbations which coincide with ‘‘asthma attacks.’’ Exercise made her symptoms worse and naprosyn also reportedly induced an acute episode. Recent studies have revealed antibodies against CD2, CD25, antitryptase, and a c-kit mutation Asp-816-Val as possible markers of progression to systemic disease. We will describe the usefulness of such markers. Commercial support: None identified.
J AM ACAD DERMATOL
AB151