The FIP1L1-PDGFRα fusion tyrosine kinase in hypereosinophilic syndrome and chronic eosinophilic leukemia: implications for diagnosis, classification, and management

Unusual variants of malignant melanoma

Tumors of the epidermis

The blue (or purple) toe syndrome consists of the development of blue or violaceous discoloration of one or more toes in the absence of obvious trauma, serious cold-induced injury, or disorders producing generalized cyanosis. The major general categories are: (1) decreased arterial flow, (2) impaired venous outflow, and (3) abnormal circulating blood. Depending on its pathogenesis, the discoloration may be blanching or nonblanching. An accurate diagnosis is critical, because many of the causes threaten life and limb, but the patient's medical history, accompanying nondermatologic findings on physical examination, and a discriminating use of laboratory tests are usually more important than the nature of the cutaneous abnormalities in determining the cause. Learning objectives After completing this learning activity, participants should be able to define the blue (or purple) toe syndrome, categorize the causes, and recognize the important historical, clinical, and laboratory findings that differentiate the causes and lead to the correct diagnosis.

https://www.jaad.org/article/S0190-9622(08)01218-8/pdf

Blue (or purple) toe syndrome

Importance Infective endocarditis (IE) is a rare disease with poor prognosis. When IE is suspected, skin examination is mandatory to look for a portal of entry and classic skin lesions to help diagnose and manage the condition. Objectives To describe the prevalence of and factors associated with dermatological manifestations in patients with definite IE. Design Observational, prospective, population-based epidemiological study between January 1 and December 31, 2008. Subsequently, collected dermatological data were subjected to post hoc analysis. Setting and Participants Patients (n = 497) diagnosed in 7 French regions and hospitalized in France for definite IE satisfying modified Duke criteria. Main Outcomes and Measures Patient and disease epidemiological information was collected, focusing on the most classic dermatological manifestations of IE (Osler nodes, Janeway lesions, purpura, and conjunctival hemorrhages). Disease outcome was also recorded. Results Among 497 definite IE cases, 487 had known dermatological status. Of 487 cases, 58 (11.9%) had skin manifestations, including 39 (8.0%) with purpura, 13 (2.7%) with Osler nodes, 8 (1.6%) with Janeway lesions, and 3 (0.6%) with conjunctival hemorrhages (5 patients had 2 skin manifestations). Patients with skin manifestations had a higher rate of IE-related extracardiac complications than patients without skin manifestations, particularly cerebral emboli (32.8% vs 18.4%, P  = .01), without increased mortality. Patients with purpura had larger cardiac vegetations (18.1 vs 13.7 mm, P  = .01), and Janeway lesions were associated with more extracerebral emboli (75.0% vs 31.8%, P  = .02). Conclusions and Relevance Specific skin manifestations of IE are associated with a higher risk of complications and should alert physicians to examine for extracardiac complications, notably with cerebral imaging.

https://jamanetwork.com/journals/jamadermatology/articlepdf/1819586/doi130089.pdf

Prognostic Value of Skin Manifestations of Infective Endocarditis

We report a case of malignant melanoma associated with seborrheic keratosis. This has been reported rarely in the literature, with disagreement regarding whether it is coincidental or whether malignant transformation occurs. Because seborrheic keratoses are common and association with malignant melanoma is very rare, we conclude that the association is coincidental. However, because of the association of other malignancies, a biopsy of any suspect or changing seborrheic keratosis is essential.

Malignant melanoma arising in a seborrheic keratosis

Septic microemboli in a Janeway lesion of bacterial endocarditis

REPORT OF A CASE A 61-year-old white man presented in 1985 with persistent sacral pain that was first attributed to arthritis. The pain worsened and a computed tomographic scan revealed a sacral mass. Surgical excision followed by radiation therapy was performed. The mass recurred locally and reexcision was performed in 1990. In 1991, skin lesions began appearing. The skin growths expanded rapidly. The photograph shown inFigure 1was taken in 1992. The photograph inFigure 2was taken in 1993, approximately 1 year later. A biopsy specimen was obtained (Figure 3andFigure 4). What is your diagnosis? DIAGNOSIS: Chordoma cutis. HISTOPATHOLOGIC FINDINGS Hematoxylin-eosin—stained sections (Figure 3 and Figure 4) demonstrated a diffuse neoplastic process that was partially encapsulated. The neoplasm was composed of numerous lobules and nests of large polygonal cells that were progressively compartmentalized by fibrous septae. Characteristic physaliphorous cells, which are large multivacuolated polygonal cells, some of which

Multiple Smooth Skin Nodules

/pdf/pseudofolliculitis-of-the-beard-2fv25217pn.pdf

Richard P. Vinson

Papers

Malignant melanoma arising in a seborrheic keratosis

Septic microemboli in a Janeway lesion of bacterial endocarditis

Multiple Smooth Skin Nodules

Pseudofolliculitis of the Beard