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EditorFolliculitis decalvans (FD) is a neutrophilic primary cicatricial alopecia (CA) affecting mostly middle-aged males. Key features include confluent areas of CA, surrounded by polytrichia Figure 1 Folliculitis decalvans. Non-lesional occipital scalp shows inflammatory infiltrate with lymphocytes and histiocytes around the isthmus and vessels. Horizontal section. HE, 200x. Abbreviation: HE, Haematoxylin and eosin staining.

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attracts neutrophils to the site of tumour. Neutrophil granules contain vascular endothelial growth factor (VEGF) which activates endothelial cells and promotes endothelial growth, which is enhanced by TNF alpha and CXCL chemokines. Direct neutrophil to endothelial cell interaction followed by binding of the adhesion molecule ICAM-1 on the endothelium with integrin on the neutrophils allows the neutrophil to activate the endothelial cell and promote angiogenesis. 7 The adhesion of malignant melanocytes to endothelial cells followed by tumour spread is facilitated by laminins located within the amorphous matrix. The role of laminins includes cell adhesion, migration, signalling, outgrowth and metastasis. In vitro experiments showed that the C16 peptide c1 laminin chain has angiotropic, extravascular migration promoting activity in melanoma. Angiotropic melanoma cells over-express some laminins and laminin receptors. 8 The mechanism is similar to that occurring in embryogenesis, in which melanoblasts derived from Schwann cell precursors in the neural tube migrate along the dorsolateral pathway to the skin by travelling alongside microvascular channels. 9 Extravascular migratory metastasis is associated with regional and distant metastases in primary cutaneous melanoma. In a retrospective study, the presence of EVMM was associated with distant metastases and disease progression; however, overall survival was not affected. 10 Extravascular migratory metastasis is probably more common than reported. A recent study suggested that up to 37% of cases of melanoma exhibit EVMM when immunohistochemical stains for melanocytic and vascular markers were employed. 10 The larger medical community should be made aware of this feature.