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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: The cause of lichen sclerosus et atrophicus (LSA) is unknown, but on the penis it is associated with chronic occlusion, that is, phimosis. Microscopic changes of LSA were seen unexpectedly in two acrochordons. OBJECTIVE: Our purpose was to further characterize this phenomenon. METHODS: A total of 449 acrochordons examined in our histopathologic laboratory in the past 2 years were studied for changes of LSA, and clinical data were collected. RESULTS: Eight additional cases were found. All of the acrochordons exceeded 0.5 cm, and three were 1 cm or larger. At least six were under chronic occlusion or pressure. The dermal changes of LSA predominated over the epidermal changes. All showed collagenous homogenization, sclerosis, and inflammation. Elastic fibers were characteristically decreased. CONCLUSION: These observations strengthen the evidence that LSA in flaccid skin may be caused by chronic occlusion.

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We report a case of basal cell carcinoma and intradermal melanocytic nevus in the same lesion. A review of the literature indicates that the simultaneous occurrence of two or more neoplasms in one specimen is a relatively infrequent finding. The pathogenesis of simultaneously occurring neoplasms remains the subject of speculation. Based on currently available evidence, we believe that the coexistence of lesions in this particular patient is most likely coincidental.

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Immunofluorescence, especially direct immunofluorescence of skin, has been widely used for diagnosis of connective tissue diseases. It is principally of value for LE and may be used also as a prognostic test for SLE. It is of relatively little value for diagnosis of other connective tissue diseases and appears not to predict the outcome of undifferentiated connective tissue disease. Cutaneous immunofluorescence is widely available and has an established place in the field of dermatopathology. As with other microscopic interpretations, substantial experience, along with an understanding of basic immunopathologic principles, is necessary for reliable results. Antibodies to certain ultrastructural components of the basement membrane zone are now available. These are being evaluated for further diagnostic applications to LE and other diseases that involve the epidermal basement membrane zone.

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We have reevaluated the previously reported conclusion that direct immunofluorescence in bullous pemphigoid is often negative in biopsy specimens from the legs. Duplicate tests from the trunk and legs were generally of equal intensity in a prospectively evaluated series of eight patients with generalized bullous pemphigoid. Also, in 36 patients evaluated retrospectively, the intensity of the direct immunofluorescence reaction correlated roughly with extent of disease, rather than with specific anatomic region. Localized disease predictably required less vigorous treatment to achieve control, but the intensity of the immunofluorescence reaction was not similarly predictive. Direct immunofluorescence is a less useful diagnostic test in localized bullous pemphigoid than in generalized bullous pemphigoid.

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We retrieved the records of 20 cases of lichen sclerosus et atrophicus of the penis from pathology service files at five metropolitan hospitals. Histologic sections were available for study in 16 cases. All patient records were available. All cases except one (that of a 14-year-old boy) occurred in men aged 34 to 77 years. Most of the patients (14) were circumcised for phimosis, often with meatal stenosis, and the diagnosis was made on the foreskin specimen. The remaining six patients had already been circumcised, at ages 32 to 54 years, and had lichen sclerosus et atrophicus of the glans penis. Therefore in this series of patients, the condition occurred only in patients circumcised late in life. This must be considered when a decision about neonatal circumcision is made.

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A 23-year-old woman was noted to have a hypoesthetic patch over the right mandible. A biopsy specimen revealed alopecia mucinosa. Anesthesia in the involved area has been reported rarely in the literature.

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Seventy-one patients with discoid lupus erythematosus were studied for anatomic regional variations in the lupus band test. The test was positive in 82% of biopsies from the scalp, face, neck, and upper extremity. Only three out of fourteen biopsies (21%) from the trunk were positive. Discoid lupus erythematosus could be confirmed or strongly suspected in the light microscopic sections from all cases. Truncal lesions should not be selected for the lupus band test in discoid lupus erythematosus if there are other choices.

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Forty-six patients with clinical and histologic criteria of bullous pemphigoid, and on whom direct immunofluorescence testing had been done, were analyzed by anatomic region of the lesions and by the region from which the immunofluorescence biopsy specimens were taken. One third of immunofluorescence tests from the lower extremities were negative, compared with only 3% from all other areas. The possible reasons for this result are discussed. The lower extremity should probably be avoided as a biopsy site for immunofluorescence in bullous pemphigoid.

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The lupus band test is widely regarded as a sensitive test in the diagnosis of lupus erythematosus, particularly as applied to cutaneous lesions. It is commonly said to be positive in 90% or more of lesions in discoid and systemic lupus. Other criteria for diagnosis are often not specified in previous studies. This and the subjective element of immunofluorescence microscopy raise some doubts about the sensitivity of the test for skin lesions. In this comparative light microscopy and immunofluorescence study, the lupus band test was positive in only 67% of discoid lesions and 73% of lesions in systemic lupus. The test was occasionally positive where light microscopy was inconclusive and was positive in 82% of systemic lupus patients' uninvolved skin. IgM was an infrequent reactant in the lupus band. The significance of these findings is discussed.

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