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A pore of Winer is a common, benign epidermal appendageal tumor arising from a hair follicle. We present a case where routine removal of a pore of Winer revealed the presence of a trichoid basal cell carcinoma. We describe the history of these lesions, discuss clinical and histologic differential diagnoses, and propose an explanation for the presence of these tumor cells. No prior report of basal cell carcinoma within a pore of Winer has been documented in the literature.

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BACKGROUND: Merkel cell carcinoma (MCC) is a rare, aggressive, cutaneous neoplasm. The primary form of initial treatment is wide surgical excision. The use of Mohs micrographic surgery as the primary form of treatment in MCC has been controversial. The course of MCC is often aggressive, with early metastasis, widespread disease, and death. Despite the poor prognosis, spontaneous regression has occasionally been reported. OBJECTIVE: We describe the clinical course of two patients with Merkel cell carcinoma who underwent treatment with Mohs micrographic surgery for the primary MCC. Metastases were excised in the first case and spontaneously regressed in the second. Both patients are without clinical disease at the time of this report. METHODS: Histopathology, clinical records, and the current literature are reviewed. RESULTS: One patients was without recurrence of MCC for 13 years of follow-up. The other patient experienced clinical spontaneous remission after nodal spread of the disease, with no recurrence for 18 months after clinical remission and 24 months after surgery. CONCLUSION: The treatment of Merkel cell carcinoma with Mohs micrographic surgery (MMS) has been successful for the control of primary skin disease, and is at least comparable to wide excision. Spontaneous regression may occur in the course of this usually relentless and aggressive disease. The explanation for spontaneous regression of MCC is unknown.

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BACKGROUND: Reconstruction of defects of the distal nose/columella region present a challenge both esthetically and functionally. OBJECTIVE: To describe the use of nasal floor tissue as an inferiorly based transposition flap for closure of distal nose/columella defects. METHODS: Mohs micrographic surgery for excision of basal cell carcinoma was performed on the distal nose/columella area of a patient. The resultant defect was closed using an inferiorly based transposition flap elevated from the nasal floor. Other closure options for this region are discussed. CONCLUSION: The nasal floor flap allowed the reconstruction of a properly contoured columella and distal nose.

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BACKGROUND: One option for the treatment of cutaneous tumors in the very elderly has been simple observation. However, the combination of an increasing elderly population and a concomitant high incidence of skin cancer will make this problem more common. OBJECTIVE: To assess the suitability of Mohs micrographic surgery as a treatment modality for skin cancer in the 90 years and older age group. METHODS: A group of patients who underwent Mohs surgery from January 1988 to August 1996 aged 90 years and older was identified, and tumor type, site, comorbid medical conditions, medications, and surgical complications were recorded. RESULTS: A total of 106 basal cell carcinomas (BCCs), 33 squamous cell carcinomas (SSC), six melanomas, and one basosquamous carcinoma were resected from 115 patients with an average age of 92.4 years. The overall ratio of BCC/SCC was 3.2 BCCs occurred most commonly on the face; SCCs were found more frequently on the cheeks. Patients had an average of 1.9 comorbid medical conditions and took an average of 2.3 regular medications. One complication occurred. CONCLUSION: Mohs surgery is a safe and effective therapy for those over 90 years of age.

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Overexposure to ultraviolet and visible radiation causes sunburn. Aspirin and other nonsteroidal anti-inflammatory drugs, cool baths and topical steroids offer only mild relief. Long-term sun exposure causes chronic inflammatory skin changes. Photodamage, rather than the normal aging process, may account for 90 percent of age-associated cosmetic skin problems. Physicians should stress to their patients that all ultraviolet exposure (including sun beds and tanning salons) causes skin damage. Regular sunscreen use during childhood and adolescence may result in an 80 percent reduction in the lifetime incidence of ultraviolet-induced skin damage, including nonmelanoma skin cancers.

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Telangiectases have been noted as a cutaneous manifestation of the acquired immunodeficiency syndrome and are characteristically distributed across the upper chest in a crescentic pattern between the clavicles. We describe the observation of diffuse upper body telangiectasia in a forty-seven-year-old, human immunodeficiency virus-seropositive man. Histopathologic examination revealed dermal telangiectasia with perivascular plasma cells. Although we are aware of the association between telangiectases and human immunodeficiency virus seropositive findings, we believe that this is the first documented observation of diffuse upper body telangiectasia in a human immunodeficiency virus-seropositive patient.

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Information concerning the racial distribution, family background, sexual history, education, and employment status of 27 New Zealand, male-to-female preoperative transsexual prostitutes was obtained by interview and questionnaire. Subjects lived in Wellington, New Zealand, and Sydney, Australia. Subjects recalled childhoods with maternal dominance, paternal absence, being youngest sons, and being dressed in girls' clothes by female relatives. Further, an early history of homosexual intercourse and cross-dressing behavior occurred significantly often. Moreover, it was apparent that the Maori race, which forms 9.0% of the total New Zealand population, was disproportionately represented; approximately 90% of the transsexual prostitute population in Wellington is Maori. Various explanations are offered for the racial inequality. It is concluded that cultural influences have an effect on the number of transsexual prostitutes in New Zealand. Further research is needed to assess whether these factors also influence the etiology and development of transsexualism.

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