Biomedical subjects
Publications and source records attributed to A B Ackerman.
Histologic material was studied from 30 patients with metastasizing cutaneous superficial spreading malignant melanoma in an attempt to establish reproducible criteria for the accurate diagnosis of the disease. This paper details the criteria for the histologic diagnosis of primary superficial spreading malignant melanoma of the skin.
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A white cyst, partially covered by jet black splotches and streaks, had a surface appearance of vanilla fudge ice cream. Histologically, the cyst was lined with two distinctly different types of follicular epithelium--one identical to that of the infundibulum and the other to that of the matrix. The black pigment was melanin, produced by numerous dendritic melanocytes that were situated only in the region of the epithelium-resembling matrix.
Nine cases of cutaneous xanthogranuloma in adults are reported. These lesions were histologically indistinguishable from the xanthogranulomas in infants and children (juvenile xanthogranuloma), and, like those in the young, they were not associated with abnormalities of serum lipids. Unlike juvenile xanthogranuloma, however, in our small sample there was no concomitant involvement of the eye in adult xanthogranuloma.
Herpes gestationis is a pruritic, blistering eruption of pregnancy and the puerperium. In three patients with immunologically verified disease, the clinical presentation consisted of widespread erythematous, edematous papules and plaques, grouped vesicles on erythematous bases, and tense bullae. Histologically, these lesions showed a moderately dense, mixed-inflammatory cell infiltrate around superficial and deep dermal blood vessels, and focal necrosis of epidermal basal cells. Papillary dermal edema, subepidermal bullae, and spongiosis were prominent. Eosinophils were frequently present in the subepidermal and intrepidermal vesicles. Differentiation of herpes gestationis from other blistering diseases and other dermatitides of pregnancy may be difficult.
Scabies can be easily mistaken for dermatitis herpetiformis because the two conditions have features in common, namely, pruritic papules, vesicles, and crusted erosions in the sacral and gluteal regions. In five patients with scabies who were initially judged clinically to have dermatitis herpetiformis, histological examination was decisive in the eventual correct diagnosis.
Histological markers enable the correct diagnosis of a pigmented lesion that histologically resembles a superficial spreading malignant melanoma and yet behaves in a wholly benign way. This pseudomelanoma occurs in young adults within a few weeks following partial surgical-shave excision of an intradermal melanocytic nevus.
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