Giant congenital melanocytic nevi (GCMN) are a rare type of melanocytic nevus that covers a large body surface, often with satellite nevi scattered on the rest of the skin. There are several complications associated with GCMN, including malignant melanoma and neurocutaneous melanosis. The management of GCMN is very complex because of the cosmetic appearance and the associated psychological distress, the risk of severe complications, and the need for long-term follow-up. We report a case of a 43-year-old active-duty female with a GCMN reporting new and symptomatic satellite lesions with atypical features on dermoscopy.

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A 20-year-old man presented to the emergency department in May 2013 with a new rash that had gradually progressed over 1 day. He also noted several days of sore throat, fever, malaise, and cervical lymphadenopathy preceding the rash. He lived in Maryland, his medical history was unremarkable, and he denied any new medications. On physical exam, he had enlarged tonsils and cervical lymphadenopathy. He had no hepatosplenomegaly. In addition, his skin showed erythematous papules too numerous to count, as well as plaques of varying size and morphology on his face, trunk, palms, and extremities, yet there were no lesions on his mucus membranes or genitals (Figures 1-3). The lesions were nonblanching and mildly pruritic. Initial laboratory evaluation in the emergency department

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Microcystic adnexal carcinoma (MAC) is an uncommon adnexal neoplasm with a predilection for the head and neck. The tumor rarely metastasizes but is locally aggressive and commonly demonstrates perineural invasion. MAC occurs most often in older adults. This report describes a young woman with a MAC in her left axilla who required two stages of Mohs micrographic surgery followed by a wide local excision because of persistent perineural invasion in close proximity to the brachial plexus. Other cases presenting in the pediatric age group are discussed.