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Two cases of pigmented Bowen disease
P2921
P2923
Concomitant Merkel cell carcinoma and cutaneous angiosarcoma Kait Arefiev, MD, Christiana Care Health System, Newark, DE, United States; Dirk Elston, MD, Geisinger Medical Center, Danville, PA, United States; Nektarios Lountzis, MD, Geisinger Medical Center, Danville, PA, United States; Patricia Malerich, MD, Geisinger Medical Center, Danville, PA, United States
A case of metastasis of squamous carcinoma arising in actinic cheilitis Gyong Moonn Kim, PhD, St. Vincent’s Hospital, Suwon, South Korea; Na Hyun Kwon, MD, St. Vincent’s Hospital, Suwon, South Korea; Si Yong Kim, MD, St. Vincent’s Hospital, Suwon, South Korea Actinic keratosis is a common sun-induced premalignant lesion that has a strong likelihood of transforming into a malignancy. The risk for progression of actinic keratosis to squamous carcinoma reported in the literature varies from \1 % to 20 %. Clinically, induration, pain, larger size, marked hyperkeratosis, ulceration, bleeding, rapid growth, and recurrence or persistence may be a marker of progression to squamous carcinoma. Squamous carcinoma arising in actinic keratoses rarely metastasize, with rates of 0.5% to 3%. Squamous carcinoma of the lip is more prone to metastasize compared to squamous carcinoma of skin, with rates of 3% to 20%. A 66-year-old Korean male presented with a 5-month history of a burning sensation caused by a 1.0 3 1.0 cm, erythematous, scaly plaque on the lower lip. Biopsy finding revealed as an actinic cheilitis. After 30 months, he presented with a persistent lesion on the lower lip. We performed excision. Biopsy findings revealed squamous carcinoma. Six months later after excision, he visited with a soft submandibular mass. Excisional biopsy of the submandibular mass showed a lymph node metastasis of squamous carcinoma. The patient is currently undergoing adjuvant radiation therapy. After 2 months of follow-up, there is no evidence of local recurrence and no appearance of similar lesions elsewhere on the body. We herein report a case of a 66-year-old male with metastasis of squamous carcinoma arising in actinic cheilitis, a rare case.
Merkel cell carcinoma and cutaneous angiosarcoma are both rare and aggressive tumors that share a similar predilection for sun-exposed areas of elderly white males. Despite the apparent similar risk factors, and that Merkel cell carcinoma has been associated with an increased risk of developing other primary neoplasms, to the best of our knowledge this is the first case describing concomitant Merkel cell carcinoma and cutaneous angiosarcoma. We report and discuss the case of a 75-year-old white male with a Merkel cell carcinoma of the right elbow and subsequent angiosarcoma of the face. The Merkel cell carcinoma was treated with wide local excision following a negative sentinel lymph node biopsy, and the angiosarcoma showed temporary remission under a clinical trial of bevacizumab with adjuvant radiation therapy. Commercial support: None identified.
Commercial support: None identified.
P2924 Malignant fibrous histiocytoma occurring on a digit Melissa Wise, Geisinger Medical Center, Danville, PA, United States; Michele Maroon, MD, Geisinger Medical Center, Danville, PA, United States
Pigmented Bowen disease (BD) is characterized by increased melanin pigment in the epidermis or reticular dermis in addition to the typical findings of BD. This disorder is infrequently reported and represents \2% of cases of BD. It develops on sun-exposed areas of face and neck and sun-unexposed areas like trunk, extremities, perianal area, umbilicus, scrotum, and nails. We experienced two patients who presented with pigmented BD. One, a 36-year-old male, presented with a several month history of a well defined, verrucous, hyperpigmented plaque on the umbilicus. Histopathologic findings showed hyperkeratosis, parakeratosis, and atypical keratinocytes arranged disorderly throughout the epidermis. Increased melanin pigment was noted throughout the basal layer of epidermis and upper dermis. From these findings, we diagnosed this case as pigmented BD. He was referred to department of plastic surgery in our hospital and the plaque was removed by wide resection. The other, a 47-year-old female, presented with 2-month history of multiple dark brown colored plaques on her vulva accompanied by itching sensation. The histologic features showed similar findings as observed in the first case and therefore were consistent with the diagnosis of pigmented BD. The lesion was treated by CO2 laser ablation. We report two cases of pigmented BD in umbilicus and vulva, which, although rare, should be considered in the differential diagnosis of similar lesions.
Malignant fibrous histiocytoma (MFH) is a high-grade sarcoma that most commonly occurs in the deep soft tissues or muscles of the proximal extremities, occurring more frequently in lower extremities. Upper extremity and hand involvement is rare. We report a case of an 84-year-old female who presented for evaluation of a nodule that had been present for 1 year with recent rapid enlargement. Exam revealed a 2-cm firm, erythematous nodule with moist granulation-like tissue over the right index proximal interphalangeal joint. Histology showed large atypical spindle cells throughout the dermis, multinucleated giant cells and atypical mitoses. Immunohistochemical staining was negative for S-100, MART-1, cytokeratin 903, and S100-A6. MIB-1 showed a high proliferation fraction and multinucleated tumor giant cells stained positive with CD68 PGM-1 and antichymotrypsin. The spindle cells also stained with antichymotrypsin. Based on the immunohistochemical profile, high mitotic rate, and the size and depth of the tumor, this was classified as a high-grade sarcoma with features of malignant fibrous histocytoma. Tumor was not identified in the metacarpal head, subcutaneous tissue, or fascia of the thenar skin. A staging computed tomographic scan of the thorax was negative for metastatic disease, so digital amputation was preformed. Six months postoperatively, she has not experienced local recurrence or metastatic disease. MFH is the most common soft tissue sarcoma of late adult life and typically is encountered by a dermatologist as a nodule in the deep tissues of the extremities. Sarcomas of the upper extremity are rare and occurrence on the hand is even more uncommon. It has been estimated that only 14% of soft tissue sarcomas arise in the upper extremity. In a recent review, 6714 musculoskeletal sarcomas were identified over a 30-year period at Massachusetts General Hospital. One hundred twenty-three (1.8%) of these were primary malignant tumors of the hand or wrist. The most commonly diagnosed hand malignancies were epithelioid sarcoma (23), synovial cell sarcoma (21), and MFH (15). The exact location of hand involvement was not reported; therefore, the rate of digital occurrence cannot be calculated. However, because MFH typically originates in deep soft tissues, we suspect that a minority of the cases were associated with digital involvement.
Commercial support: None identified.
Commercial support: None identified.
P2922 Two cases of pigmented Bowen disease Kwang-Yeoll Yeo, Department of Dermatology, Hanyang University Guri Hospital, Guri, South Korea; Chan Sagong, MD, Department of Dermatology, Hanyang University Guri Hospital, Guri, South Korea; Hee-Joon Yu, MD, PhD, Department of Dermatology, Hanyang University Guri Hospital, Guri, South Korea; Joung-Soo Kim, MD, PhD, Department of Dermatology, Hanyang University Guri Hospital, Guri, South Korea
AB140
J AM ACAD DERMATOL
MARCH 2009
P2923
Concomitant Merkel cell carcinoma and cutaneous angiosarcoma Kait Arefiev, MD, Christiana Care Health System, Newark, DE, United States; Dirk Elston, MD, Geisinger Medical Center, Danville, PA, United States; Nektarios Lountzis, MD, Geisinger Medical Center, Danville, PA, United States; Patricia Malerich, MD, Geisinger Medical Center, Danville, PA, United States
A case of metastasis of squamous carcinoma arising in actinic cheilitis Gyong Moonn Kim, PhD, St. Vincent’s Hospital, Suwon, South Korea; Na Hyun Kwon, MD, St. Vincent’s Hospital, Suwon, South Korea; Si Yong Kim, MD, St. Vincent’s Hospital, Suwon, South Korea Actinic keratosis is a common sun-induced premalignant lesion that has a strong likelihood of transforming into a malignancy. The risk for progression of actinic keratosis to squamous carcinoma reported in the literature varies from \1 % to 20 %. Clinically, induration, pain, larger size, marked hyperkeratosis, ulceration, bleeding, rapid growth, and recurrence or persistence may be a marker of progression to squamous carcinoma. Squamous carcinoma arising in actinic keratoses rarely metastasize, with rates of 0.5% to 3%. Squamous carcinoma of the lip is more prone to metastasize compared to squamous carcinoma of skin, with rates of 3% to 20%. A 66-year-old Korean male presented with a 5-month history of a burning sensation caused by a 1.0 3 1.0 cm, erythematous, scaly plaque on the lower lip. Biopsy finding revealed as an actinic cheilitis. After 30 months, he presented with a persistent lesion on the lower lip. We performed excision. Biopsy findings revealed squamous carcinoma. Six months later after excision, he visited with a soft submandibular mass. Excisional biopsy of the submandibular mass showed a lymph node metastasis of squamous carcinoma. The patient is currently undergoing adjuvant radiation therapy. After 2 months of follow-up, there is no evidence of local recurrence and no appearance of similar lesions elsewhere on the body. We herein report a case of a 66-year-old male with metastasis of squamous carcinoma arising in actinic cheilitis, a rare case.
Merkel cell carcinoma and cutaneous angiosarcoma are both rare and aggressive tumors that share a similar predilection for sun-exposed areas of elderly white males. Despite the apparent similar risk factors, and that Merkel cell carcinoma has been associated with an increased risk of developing other primary neoplasms, to the best of our knowledge this is the first case describing concomitant Merkel cell carcinoma and cutaneous angiosarcoma. We report and discuss the case of a 75-year-old white male with a Merkel cell carcinoma of the right elbow and subsequent angiosarcoma of the face. The Merkel cell carcinoma was treated with wide local excision following a negative sentinel lymph node biopsy, and the angiosarcoma showed temporary remission under a clinical trial of bevacizumab with adjuvant radiation therapy. Commercial support: None identified.
Commercial support: None identified.
P2924 Malignant fibrous histiocytoma occurring on a digit Melissa Wise, Geisinger Medical Center, Danville, PA, United States; Michele Maroon, MD, Geisinger Medical Center, Danville, PA, United States
Pigmented Bowen disease (BD) is characterized by increased melanin pigment in the epidermis or reticular dermis in addition to the typical findings of BD. This disorder is infrequently reported and represents \2% of cases of BD. It develops on sun-exposed areas of face and neck and sun-unexposed areas like trunk, extremities, perianal area, umbilicus, scrotum, and nails. We experienced two patients who presented with pigmented BD. One, a 36-year-old male, presented with a several month history of a well defined, verrucous, hyperpigmented plaque on the umbilicus. Histopathologic findings showed hyperkeratosis, parakeratosis, and atypical keratinocytes arranged disorderly throughout the epidermis. Increased melanin pigment was noted throughout the basal layer of epidermis and upper dermis. From these findings, we diagnosed this case as pigmented BD. He was referred to department of plastic surgery in our hospital and the plaque was removed by wide resection. The other, a 47-year-old female, presented with 2-month history of multiple dark brown colored plaques on her vulva accompanied by itching sensation. The histologic features showed similar findings as observed in the first case and therefore were consistent with the diagnosis of pigmented BD. The lesion was treated by CO2 laser ablation. We report two cases of pigmented BD in umbilicus and vulva, which, although rare, should be considered in the differential diagnosis of similar lesions.
Malignant fibrous histiocytoma (MFH) is a high-grade sarcoma that most commonly occurs in the deep soft tissues or muscles of the proximal extremities, occurring more frequently in lower extremities. Upper extremity and hand involvement is rare. We report a case of an 84-year-old female who presented for evaluation of a nodule that had been present for 1 year with recent rapid enlargement. Exam revealed a 2-cm firm, erythematous nodule with moist granulation-like tissue over the right index proximal interphalangeal joint. Histology showed large atypical spindle cells throughout the dermis, multinucleated giant cells and atypical mitoses. Immunohistochemical staining was negative for S-100, MART-1, cytokeratin 903, and S100-A6. MIB-1 showed a high proliferation fraction and multinucleated tumor giant cells stained positive with CD68 PGM-1 and antichymotrypsin. The spindle cells also stained with antichymotrypsin. Based on the immunohistochemical profile, high mitotic rate, and the size and depth of the tumor, this was classified as a high-grade sarcoma with features of malignant fibrous histocytoma. Tumor was not identified in the metacarpal head, subcutaneous tissue, or fascia of the thenar skin. A staging computed tomographic scan of the thorax was negative for metastatic disease, so digital amputation was preformed. Six months postoperatively, she has not experienced local recurrence or metastatic disease. MFH is the most common soft tissue sarcoma of late adult life and typically is encountered by a dermatologist as a nodule in the deep tissues of the extremities. Sarcomas of the upper extremity are rare and occurrence on the hand is even more uncommon. It has been estimated that only 14% of soft tissue sarcomas arise in the upper extremity. In a recent review, 6714 musculoskeletal sarcomas were identified over a 30-year period at Massachusetts General Hospital. One hundred twenty-three (1.8%) of these were primary malignant tumors of the hand or wrist. The most commonly diagnosed hand malignancies were epithelioid sarcoma (23), synovial cell sarcoma (21), and MFH (15). The exact location of hand involvement was not reported; therefore, the rate of digital occurrence cannot be calculated. However, because MFH typically originates in deep soft tissues, we suspect that a minority of the cases were associated with digital involvement.
Commercial support: None identified.
Commercial support: None identified.
P2922 Two cases of pigmented Bowen disease Kwang-Yeoll Yeo, Department of Dermatology, Hanyang University Guri Hospital, Guri, South Korea; Chan Sagong, MD, Department of Dermatology, Hanyang University Guri Hospital, Guri, South Korea; Hee-Joon Yu, MD, PhD, Department of Dermatology, Hanyang University Guri Hospital, Guri, South Korea; Joung-Soo Kim, MD, PhD, Department of Dermatology, Hanyang University Guri Hospital, Guri, South Korea
AB140
J AM ACAD DERMATOL
MARCH 2009