No abstract

The incidence of malignant melanoma is increasing at a faster pace than that of any other cancer in the United States. It is estimated that people born in the year 2000 will have a 1:75 risk of developing melanoma sometime during his or her lifetime. Stimulated by novel lymphatic mapping techniques, the surgical care of the melanoma patient is evolving toward more conservative resections that can provide the same staging information but without the added morbidity of more radical surgeries. This approach promises to yield positive results in the age of health care reform, outcome measurements, and cost:benefit considerations.

EAH is a rare hamartomatous neoplasma clinically similar to CH in appearance. Histopathologic examination of suspected lesions is recommended for delineation as CH generally involutes spontaneously whereas EAH may require surgical excision due to pain and hyperhidrosis.

A 28-year-old white man complained of the progressive development of lesions affecting the glans penis. He claimed he was treated for condylomata acuminata affecting the penile shaft 4 years previously. At the same time, he noticed a "roughened area" on the corona. This area did not enhance with 5% acetic acid and thus was not treated by his local dermatologist.Over the next 4 years, the affected area grew, encompassing the entire dorsal and lateral glans penis. Four months prior to the patient's presentation at our institution, a shave biopsy was performed and interpreted as showing changes consistent with condyloma acuminatum. The patient was referred to an urologist who ruled out urethral involvement. He was then unsuccessfully treated by a second dermatologist with podophyllin prior to referral.At the time of presentation at our institution, the patient and his wife were distressed about the resistant and progressive nature of his lesions. In addition, they desired children, yet were concerned about transmission of venereal warts.Gross examination showed a coarse "velvety" appearance of the glans penis with the exception of the previous biopsy site (Fig. 1). Stretching the skin of the glans laterally revealed uniform rows of soft flesh-colored filiform papules running radially from the urethral meatus to the corona. There were a few papules affecting the sulcus of the glans penis but there were no papules on the penile shaft.Histopathologic examination of tissue obtained at our institution from the glans penis disclosed compact orthokeratosis overlying an acanthotic epidermis. Hypergranulosis and focally elongated rete ridges were noted. Within an expanded papillary dermis, there was a proliferation of ectatic capillaries lined by variably thin to plump endothelium, as well as increased numbers of plump, stellate-shaped fibroblasts with occasional multinucleation (Fig. 2). The background collagen demonstrated Increased, thickened fibers, and there was an infiltrate of lymphocytes and mast From the