788
Journal o~ the American Academy of Dermatology
Correspondence
8. Itayemi SO, Oluwasanmi JO. Basal cell carcinoma in Negro Nigerians. Trop Geogr Med 1974;26:425-8. 9. Isaacson C. Cancer of the skin in urban blacks of South Africa. Br J Derraatol 1979;100:347-50. 10. Itayemi SO, AbioyeAA, Daramola JO, et al. Aggressive basal celt carcinoma in Nigerians. Br J Dermatol 1979; 10t:465-8. 11. Keeler CE. Albinism, xeroderma pigrnentosum, and skin cancer. Monogr Nail Cancer Inst 1963;10:349-59.
Severe sun sensitivity and the presence of antinuclear antibodies in patients with polymorphous light eruption-like lesions To the Editor." I read with interest the article by Petzelbauer et al. (J A_~ ACAD DEP2~ATOL 1992;26:68-74). Although there are patients with polymorphous light eruption (PMLE) who have a positive antinuclear antibody (ANA) in low titer, it is rare to have a persistently positive, high-titer ANA. Furthermore, the presence of the anti-Ro (SS-A) antibody is incompatible with a diagnosis of PMLE. In fact, of the seven patients with a positive anti-Ro (SS-A), in the five who had a skin biopsy, the specimen revealed a pattern compatible with a diagnosis of cutaneous lupus erythematosus. That the lesions in these patients "healed spontaneously without scarring" is also compatible with a diagnosis of subacute cutaneous lupus erythematosus (SCLE). 1,2 Thus these patients should not be considered to have PMLE but rather the nonscarring variant of cutaneous LE known as SCLE. Finally, I use the presence of the anti-Ro (SS-A) antibody in a patient with presumed PMLE as a criterion for the diagnosis cutaneous LE. Jeffrey P. Callen, MD University of Louisville School of Medicine Division of Dermatology Louisville, Kentucky
REFERENC~ 1. Ca[tenJP, KleinJ. Subacute cutaneouslupus eythematosus: clinical, serologic, immunogenetic,and therapeutic considerations. Arthritis Rheum 1988;31:1007-13. 2. SontheimerRD, Maddison PJ, Reichlin M, et at. Serologic and HLA associationsin subaeutecutaneouslupus erythematosus:a clinicalsubsetof lupus erythematosus.Ann Intern Med 1982;97:664-71.
Onset of psoriasis in the tenth decade of life To the Editor." Psoriasis may make its first appearance at any age.I, 2 However, the average time of onset is during the third decade of life.2 The onset of psoriasis after the
age of 90 years is rare. Recently we observed the initial occurrence of psoriasis in a 92-year-old patient. A 92-year-old woman had erythematous, scaly plaques on the trunk and limbs of 4 weeks' duration. She had pitting of the nails of both hands. We were unable to ascertain the duration of nail pitting. She began taking a beta blocker (Inderal) for her hypertension 2 months before the appearance of psoriasis. She related that her father had scaly Iesions on the elbows and scalp. A diagnosis of psoriasis was made. We initiated therapy with tar ointments, topical steroids, and UVB. The beta blocker was replaced by a calcium channel blocker. The patient improved significantly. For the last 6 months she has had minimal psoriasis, for which she receives maintenance UVB therapy once or twice a week and a coal tar ointment daily. The relative contributions of inheritable and environmental factors in the development of psoriasis is uncertain. However, a triggering factor such as beta-blocker medication in this patient may have played a key role in initiating her psoriasis. An unanswered question is whether psoriasis would have appeared in the absence of the betablocker medication.
Siba P. Raychaudhuri, MD, and Eugene M. Farber, AID Psoriasis Research Institute 600 Town and Country Village Palo Alto, CA 94301
REFERENCES 1. Buntin DM, Skinner RB Jr, Rosenberg EW. Onset of psoriasis at age 108 [Letter]. J AM ACAD Dm~MATOL 1983; 9:276-7. 2. Farber EM, Nail ML. The natural history of psoriasis in 5,600 patients. Dermatologica. 1974;148:1-18.
Metastatic basal cell carcinoma To the Editor." We were surprised to read a letter to the Editor (J AM ACAD DERMATOL1992;26:509-10) written by Nahass et al. regarding our article on metastatic basal cell carcinoma (BCC) (J AM AeAD DERMA'rOL 1991; 24:715-9). First, we apologize for including two references that were cited out of context when we listed six references on metastatic BCC originating from the scrotum. This was an unfortunate oversight when the original manuscript was revised. Second, we disagree with Nahass et at. that, because there are so few reported cases, no definitive statement can be made regarding the metastatic potential of scrotal BCC when metastases occurred in 3 of 24 primary scrotal BCCs (13%). Primary scrotal BCC is rare as they al-
Volume 27 Number 5, Part 1 November 1992
Correspondence
ready documented. As reported in his book, Dr. Mohs 1 treated five BCCs of the scrotum, yielding an overall incidence of 0.065% (N = 7674).We believe that there is a greater risk of metastatic BCC when the primary BCC is located on the scrotum.
Jacob S. Lo, MD Stephen iV. Snow, MD The Mohs Surgery Clinic University of Wisconsin Hospital 2880 University Ave. Madison, WI 53705
789
REFERENCES 1. Pennington DG, Waner M, Knox A. Photodynamic therapy for multiple skin cancers. Plast Reconstr Surg 1988;82:106771. 2. Robinson P J, Carruth JAS, Fairris GM. Photodynamie therapy: a better treatment for widespread Bowen's disease. Br J Dermatol 1988;119:59-61. 3. McCaughan JS, Guy .IT, Hicks W, et al. Photodynamic therapy for cutaneous and subcutaneous malignant neoplasms. Arch Surg 1989;124:211-6. 4. Gross DJ, Warier M, Schosser R_H, et al. Squamous cell carcinoma of the lower lip involvinga large cutaneous surface. Arch Dermatol 1990;126:1148-50.
REFERENCE
Mid-dermal elastalysis
1. Mohs FE. Chemosurgery: microscopioaltycontrolled surgery for skin cancer. Springfield, Ill: Charles C Thomas, 1978.
To the Editor." I read with interest the recent article on mid-dermal elastolysis by Kim and Su (J AM AeAD DERMATOL1992;26:169-73). I was surprised to note that an article of mine (published in early 1990) documenting two "classic" cases of mid-dermal elastolysis was not ineluded in their extensive bibliography.1 Since the "accepted for publication" date for Dr. Kim's article was July 1991, I daresay that there was plenty of time during revision and "galley proofing" of their article for the two cases I reported to have been added to this "review of the literature."
Biology of cutaneous squamous cell carcinoma To the Editor: The recent review of squamous cell carcinoma (SCC) by Kwa et al. (J AM ACAD DERMATOL 1992;26:1-26) is comprehensive and well researched. In general, it provides insight into the biologic behavior and treatment of this tumor. However, we take exception with the generally negative comments presented concerning the use of photodynamic therapy (PDT) in the treatment of cutaneous SCC. A study in which one of us (M. W.) participated was used to support the overall position that PDT shows little potential as a therapeutic modality for SCC. 1It should be known that the poor results of this particular study could be attributed to the use of too low laser energy density and that other investigators have had considerably more encouraging results in the treatment of SCC with PDT. 2, 3 Such studies, 2, 3 as well as single case reports4 in which PDT was used to treat in situ and invasive SCC, have yielded, good results. Indeed, we have learned from our earlier experiences with PDT. David J. Gross, MD, a and Milton Waner, MD, b Kaiser Permanente, Tucker, Georgia,a and the Department of Otolaryngology and Head & Neck Surgery, University of Arkansas for Medical Sciences Little Rock, Arkansas b
Robert L Rudolph, MD 1134 Penn Ave. Wyomissing, PA 19610
REFERENCE 1. Rudolph RI. Mid-dermal elastolysis. J AM ACADDERMATOL 1990;22:203-6.
Reply To the Editor." When we first searched the literature, the excellent article by Dr. Rudolph on mid-dermal elastolysis had not appeared. We became aware of this article after we submitted our paper to the JOURNAL. W e intended to include Dr. Rudolph's paper at the galleyproof stage but forgot to do so. it was our mistake, and we apologize for it. ,long Min Kim, MD, and W.. P. Daniel Su, M D Department of Dermatology Mayo Clinic and Mayo Foundation Rochester, M N 55905
Journal o~ the American Academy of Dermatology
Correspondence
8. Itayemi SO, Oluwasanmi JO. Basal cell carcinoma in Negro Nigerians. Trop Geogr Med 1974;26:425-8. 9. Isaacson C. Cancer of the skin in urban blacks of South Africa. Br J Derraatol 1979;100:347-50. 10. Itayemi SO, AbioyeAA, Daramola JO, et al. Aggressive basal celt carcinoma in Nigerians. Br J Dermatol 1979; 10t:465-8. 11. Keeler CE. Albinism, xeroderma pigrnentosum, and skin cancer. Monogr Nail Cancer Inst 1963;10:349-59.
Severe sun sensitivity and the presence of antinuclear antibodies in patients with polymorphous light eruption-like lesions To the Editor." I read with interest the article by Petzelbauer et al. (J A_~ ACAD DEP2~ATOL 1992;26:68-74). Although there are patients with polymorphous light eruption (PMLE) who have a positive antinuclear antibody (ANA) in low titer, it is rare to have a persistently positive, high-titer ANA. Furthermore, the presence of the anti-Ro (SS-A) antibody is incompatible with a diagnosis of PMLE. In fact, of the seven patients with a positive anti-Ro (SS-A), in the five who had a skin biopsy, the specimen revealed a pattern compatible with a diagnosis of cutaneous lupus erythematosus. That the lesions in these patients "healed spontaneously without scarring" is also compatible with a diagnosis of subacute cutaneous lupus erythematosus (SCLE). 1,2 Thus these patients should not be considered to have PMLE but rather the nonscarring variant of cutaneous LE known as SCLE. Finally, I use the presence of the anti-Ro (SS-A) antibody in a patient with presumed PMLE as a criterion for the diagnosis cutaneous LE. Jeffrey P. Callen, MD University of Louisville School of Medicine Division of Dermatology Louisville, Kentucky
REFERENC~ 1. Ca[tenJP, KleinJ. Subacute cutaneouslupus eythematosus: clinical, serologic, immunogenetic,and therapeutic considerations. Arthritis Rheum 1988;31:1007-13. 2. SontheimerRD, Maddison PJ, Reichlin M, et at. Serologic and HLA associationsin subaeutecutaneouslupus erythematosus:a clinicalsubsetof lupus erythematosus.Ann Intern Med 1982;97:664-71.
Onset of psoriasis in the tenth decade of life To the Editor." Psoriasis may make its first appearance at any age.I, 2 However, the average time of onset is during the third decade of life.2 The onset of psoriasis after the
age of 90 years is rare. Recently we observed the initial occurrence of psoriasis in a 92-year-old patient. A 92-year-old woman had erythematous, scaly plaques on the trunk and limbs of 4 weeks' duration. She had pitting of the nails of both hands. We were unable to ascertain the duration of nail pitting. She began taking a beta blocker (Inderal) for her hypertension 2 months before the appearance of psoriasis. She related that her father had scaly Iesions on the elbows and scalp. A diagnosis of psoriasis was made. We initiated therapy with tar ointments, topical steroids, and UVB. The beta blocker was replaced by a calcium channel blocker. The patient improved significantly. For the last 6 months she has had minimal psoriasis, for which she receives maintenance UVB therapy once or twice a week and a coal tar ointment daily. The relative contributions of inheritable and environmental factors in the development of psoriasis is uncertain. However, a triggering factor such as beta-blocker medication in this patient may have played a key role in initiating her psoriasis. An unanswered question is whether psoriasis would have appeared in the absence of the betablocker medication.
Siba P. Raychaudhuri, MD, and Eugene M. Farber, AID Psoriasis Research Institute 600 Town and Country Village Palo Alto, CA 94301
REFERENCES 1. Buntin DM, Skinner RB Jr, Rosenberg EW. Onset of psoriasis at age 108 [Letter]. J AM ACAD Dm~MATOL 1983; 9:276-7. 2. Farber EM, Nail ML. The natural history of psoriasis in 5,600 patients. Dermatologica. 1974;148:1-18.
Metastatic basal cell carcinoma To the Editor." We were surprised to read a letter to the Editor (J AM ACAD DERMATOL1992;26:509-10) written by Nahass et al. regarding our article on metastatic basal cell carcinoma (BCC) (J AM AeAD DERMA'rOL 1991; 24:715-9). First, we apologize for including two references that were cited out of context when we listed six references on metastatic BCC originating from the scrotum. This was an unfortunate oversight when the original manuscript was revised. Second, we disagree with Nahass et at. that, because there are so few reported cases, no definitive statement can be made regarding the metastatic potential of scrotal BCC when metastases occurred in 3 of 24 primary scrotal BCCs (13%). Primary scrotal BCC is rare as they al-
Volume 27 Number 5, Part 1 November 1992
Correspondence
ready documented. As reported in his book, Dr. Mohs 1 treated five BCCs of the scrotum, yielding an overall incidence of 0.065% (N = 7674).We believe that there is a greater risk of metastatic BCC when the primary BCC is located on the scrotum.
Jacob S. Lo, MD Stephen iV. Snow, MD The Mohs Surgery Clinic University of Wisconsin Hospital 2880 University Ave. Madison, WI 53705
789
REFERENCES 1. Pennington DG, Waner M, Knox A. Photodynamic therapy for multiple skin cancers. Plast Reconstr Surg 1988;82:106771. 2. Robinson P J, Carruth JAS, Fairris GM. Photodynamie therapy: a better treatment for widespread Bowen's disease. Br J Dermatol 1988;119:59-61. 3. McCaughan JS, Guy .IT, Hicks W, et al. Photodynamic therapy for cutaneous and subcutaneous malignant neoplasms. Arch Surg 1989;124:211-6. 4. Gross DJ, Warier M, Schosser R_H, et al. Squamous cell carcinoma of the lower lip involvinga large cutaneous surface. Arch Dermatol 1990;126:1148-50.
REFERENCE
Mid-dermal elastalysis
1. Mohs FE. Chemosurgery: microscopioaltycontrolled surgery for skin cancer. Springfield, Ill: Charles C Thomas, 1978.
To the Editor." I read with interest the recent article on mid-dermal elastolysis by Kim and Su (J AM AeAD DERMATOL1992;26:169-73). I was surprised to note that an article of mine (published in early 1990) documenting two "classic" cases of mid-dermal elastolysis was not ineluded in their extensive bibliography.1 Since the "accepted for publication" date for Dr. Kim's article was July 1991, I daresay that there was plenty of time during revision and "galley proofing" of their article for the two cases I reported to have been added to this "review of the literature."
Biology of cutaneous squamous cell carcinoma To the Editor: The recent review of squamous cell carcinoma (SCC) by Kwa et al. (J AM ACAD DERMATOL 1992;26:1-26) is comprehensive and well researched. In general, it provides insight into the biologic behavior and treatment of this tumor. However, we take exception with the generally negative comments presented concerning the use of photodynamic therapy (PDT) in the treatment of cutaneous SCC. A study in which one of us (M. W.) participated was used to support the overall position that PDT shows little potential as a therapeutic modality for SCC. 1It should be known that the poor results of this particular study could be attributed to the use of too low laser energy density and that other investigators have had considerably more encouraging results in the treatment of SCC with PDT. 2, 3 Such studies, 2, 3 as well as single case reports4 in which PDT was used to treat in situ and invasive SCC, have yielded, good results. Indeed, we have learned from our earlier experiences with PDT. David J. Gross, MD, a and Milton Waner, MD, b Kaiser Permanente, Tucker, Georgia,a and the Department of Otolaryngology and Head & Neck Surgery, University of Arkansas for Medical Sciences Little Rock, Arkansas b
Robert L Rudolph, MD 1134 Penn Ave. Wyomissing, PA 19610
REFERENCE 1. Rudolph RI. Mid-dermal elastolysis. J AM ACADDERMATOL 1990;22:203-6.
Reply To the Editor." When we first searched the literature, the excellent article by Dr. Rudolph on mid-dermal elastolysis had not appeared. We became aware of this article after we submitted our paper to the JOURNAL. W e intended to include Dr. Rudolph's paper at the galleyproof stage but forgot to do so. it was our mistake, and we apologize for it. ,long Min Kim, MD, and W.. P. Daniel Su, M D Department of Dermatology Mayo Clinic and Mayo Foundation Rochester, M N 55905
![[Metastatic basal cell carcinoma].](/assets/img/hold.png)
