Nerve block is superior to cold air and is an easy, safe, effective means of controlling the pain associated with PDT.

IMPORTANCEThe lymphatic and the hematogenous pathways have been proposed for disease progression in cutaneous melanoma, but association with recurrence has not been studied separately to date.OBJECTIVE To identify the risk factors associated with lymphatic and hematogenous metastasis.

Multinucleate cell angiohistiocytoma (MCAH) was first described by Smith and Wilson-Jones in 1985. It is an uncommon entity but probably underdiagnosed because of lack of recognition by clinicians and pathologists. We report a 47-year-old man with asymptomatic grouped violaceous papules on the dorsum of the hands for 3 years. The histopathological and immunopathological features of our case revealed characteristics of MCAH similar to the initial description of Smith and Wilson-Jones and other reports.

Two cases of metastatic umbilical carcinoma (Sister Mary Joseph's nodule) are reported. In one of the cases, the umbilical metastasis was the first sign of the disease, whereas in the other case, the patient had a 5-year history of internal malignancy when the umbilical nodule appeared. In both cases, the cutaneous metastasis was followed by death in a short period of time.

Prurigo pigmentosa is a rare inflammatory disease of unknown origin, first reported from Japan, with only 33 cases described in non-Japanese patients. We describe a 13-year-old girl with a pruriginous symmetrical eruption of papules and vesicles affecting her back, neck and chest of 1 month duration. She remembered a similar, but lighter eruption, 2 months before. As the initial diagnosis was of a vesiculobullous form of Darier disease, treatment with isotretinoin 40 mg/day was started with good response. Histological study showed a superficial perivascular and interstitial dermatitis composed predominantly of lymphocytes. The epidermis was spongiotic, with exocytosis of lymphocytes and some neutrophils and necrotic keratinocytes. All these findings were consistent with prurigo pigmentosa. The lesions resolved leaving a light brown reticulate hyperpigmentation. Prurigo pigmentosa has never been reported in prepubescent patients, the vesiculobullous forms are unusual, and the only treatments used previously are sulphonamides, tetracyclines and macrolides. We report a 13-year-old Caucasian girl with vesiculobullous prurigo pigmentosa successfully treated with isotretinoin.