We report a 38-year-old man who presented with a generalized papular eruption that was clinically and histologically consistent with lichen nitidus. This patient's condition had been persistent for approximately 1 year; however, soon after assuming employment that entailed significant, regular sun exposure, the patient noted marked clearing of his lesions in sun-exposed areas. This case corroborates previous reports that suggest that generalized lichen nitidus can be successfully managed with ultraviolet light therapy.

A-50-year-old Hispanic man presented to the dermatology clinic with a 0.6-cm eroded, erythematous, scaly plaque on the left side of his neck. On shave biopsy, the lesion was composed of intra-epidermal and invasive dermal cells characterized by a signet-ring appearance. One area suggestive of typical squamous cell carcinoma prompted the inclusion of that entity in the differential diagnosis. Mucicarmine stains were negative, while the extra-vacuolar cytoplasm focally reacted with periodic acid-Schiff staining, the positive reaction for which was abolished by diastase, consistent with glycogen. Malignant cells expressed keratins by reacting to antibodies, Mak6, AE1/AE3, Ker 903, and CAM5.2. Additionally, weak reactivity occurred with antibodies to CEA and EMA. Tumor cells did not express S-100, HM-B45, Leu M1, or actin. By ultrastructural examination, the large vacuoles corresponded to markedly dilated endoplasmic reticulum. A diagnosis of signet-ring squamous cell carcinoma, a rare form of cutaneous squamous cell carcinoma which has been described in only one case report in the last 10 years, was made. Immunohistochemical staining provided information useful in differentiating this lesion from other clear cell and signet-ring cell tumors which involve the skin.

Dermatologists treat actinic keratoses to prevent non-melanoma skin cancer. Evaluation of actinic keratosis therapy depends on reliable measures of the lesions. The commonly used method of directly counting all visible lesions has been shown to be unreliable. We performed a prospective, single-blinded study to explore the reliability of body surface area involvement and direct counting of lesions measuring greater than 0.5 cm. Consecutively available subjects with >2% body surface area involvement of both upper extremities were recruited from the Albuquerque, NM Veterans Administration Dermatology Clinic upon their arrival. Blinded investigators evaluated 37 subjects during two visits, baseline and 2 weeks later, using both methods. Data were analyzed using the 26 pairs where evaluating physician was the same at both time points. Both methods correlated well when comparing the two time points. Our results did not change when we added the pairs where the evaluating physician differed in the two time points. Our study demonstrates that both methods are viable ways to evaluate actinic keratoses, even when the investigators differ at different time points, a practical matter in clinical trials. Our study provides a promising option to evaluate emerging new actinic keratoses therapies. However, given that the method was only tested on upper extremities of a veteran population, further testing must be performed in different anatomical locations and in non-veteran populations.

Simple excision of primary mucinous carcinoma of the skin is associated with a high recurrence rate. Given the low rate of metastasis and characteristic histologic tumor continuity associated with primary mucinous carcinoma of the skin, as well as the tendency for the tumor to involve cosmetically sensitive areas, such as the face and eyelids, MMS appears to represent a preferable treatment alternative for this particular sweat gland tumor. MMS appears to be associated with a very low risk of tumor recurrence.

References1 Wade TR, Kopf AW, Ackerman AB. Bowenoid papulosis of the genitalia. Arch Dermatol 1979; 115:306-8. 2 Kreuter A, Brockmeyer NH, Hochdorfer B et al. Clinical spectrum and virologic characteristics of anal intraepithelial neoplasia in HIV infection. J Am Acad Dermatol 2005; 52:603-8. 3 Weissenborn SJ, Funke AM, Hellmich M et al. Oncogenic human papillomavirus DNA loads in human immunodeficiency virus-positive women with high-grade cervical lesions are strongly elevated. J Clin Microbiol 2003; 41:2763-7. 4 Patterson JW, Kao GF, Graham JH, Helwig EB. Bowenoid papulosis: a clinicopathologic study with ultrastrucural observations. Cancer 1986; 57:823-36. 5 Yoneta A, Yamashita T, Jin HY et al. Development of squamous cell carcinoma by two high-risk human papillomaviruses (HPVs), a novel HPV-67 and HPV-31 from bowenoid papulosis. Br J Dermatol 2000; 143:604-8. 6 Hama N, Ohtsuka T, Yamazaki S. Elevated amount of human papillomavirus 31 DNA in a squamous cell carcinoma developed from bowenoid papulosis. Dermatology 2004; 209:329-32. 7 Sano T, Oyama T, Kashiwabara K et al. Expression status of p16 protein is associated with human papillomavirus oncogenic potential in cervical and genital lesions. Am J Pathol 1998; 153: 1741-8. 8 Snijders PJ, Hogewoning CJ, Hesselink AT et al. Determination of viral load thresholds in cervical scrapings to rule out CIN 3 in HPV 16, 18, 31 and 33-positive women with normal cytology. Int J Cancer 2006; 119:1102-7. 9 Jacobs MV, Snijders PJ, van den Brule AJ et al. A general primer GP5+/GP6(+)-mediated PCR-enzyme immunoassay method for rapid detection of 14 high-risk and 6 low-risk human papillomavirus genotypes in cervical scrapings. J Clin Microbiol 1997; 35: 791-5. 10 van den Brule AJ, Pol R, Fransen-Daalmeijer N et al. GP5+/6+ PCR followed by reverse line blot analysis enables rapid and highthroughput identification of human papillomavirus genotypes. SIR, The inflammatory vesicobullous first stage of incontinentia pigmenti (IP) can recur, albeit rarely. It has previously been described only in infants and young children under the age of 18 months and it has usually been preceded by a systemic infection.A 5-year-old schoolgirl presented with a 2-day history of a linear rash on her right leg extending from the medial knee to the buttock and consisting of vesicobullous lesions arising on inflamed skin (Fig. 1). There was no history of anteceding