A high number of melanomas are transected at diagnosis, many of which lack visible tumor. The original Breslow's depth of transected melanomas without residual tumor on re-excision accurately predicts survival and prognosis.

Cutaneous paraneoplastic syndromes comprise a broad spectrum of cutaneous reactions to an underlying malignancy. These dermatoses are not the result of metastatic spread to the skin, but rather a reaction to the presence of malignancy. Cutaneous paraneoplastic syndromes often precede the identification of a malignancy. We describe the case of a 79-year-old man with a six-month history of recalcitrant treatment- resistant dermatitis. A complete blood count test performed at the time of initial presentation was normal. The patient ultimately presented with erythroderma and was diagnosed with acute myeloid leukemia (AML). The evolution of the dermatitis to erythroderma coincided with the clinical presentation of AML, and was therefore considered to be a paraneoplastic syndrome. The patient decided against therapy and died seven weeks after diagnosis. Physicians should consider a cutaneous paraneoplastic syndrome when faced with dynamic recalcitrant dermatoses that are difficult to treat and decide on laboratory testing accordingly. Patients should be evaluated regularly for two to three years after initial diagnosis with a physical exam and review of systems to monitor for signs and symptoms of malignancy.

A 64-year old man presented with 3 years of progressive redness, burning, and peeling of his palms and soles. His past medical history included cutaneous squamous cell carcinoma, malignant melanoma, gout, and polycythemia vera which had been diagnosed 10 years earlier and complicated by a significant gastrointestinal bleed. Genetic analysis demonstrated a mutant JAK-2 V617F allele. He had been treated with therapeutic phlebotomies and with hydroxyurea 1 g daily, with dose escalation to 1.5 g daily over the last 3 years for management of his polycythemia and worsening splenomegaly.On examination, he had desquamating erythema of the palms and soles, extending proximally to the flexures of the wrists and heels (Images 1A, 1B, 1C). The patient reported that his symptom worsened as the dose of hydroxyurea was increased over the previous 3 years. A diagnosis of hydroxyurea-associated acral erythema was made. The dorsal hands also demonstrate pink-red erythema with accentuation over the interphalangeal and metacarpophalangeal joints. (C) The bilateral soles also reveal consistent pink-red erythema with accentutation in areas of weightbearing and additional areas of hyperkeratosis and focal desquamation.

Two cases of a pseudoherpetic variant of Grover disease are presented. The first patient was a 60-year-old woman who had high fevers in combination with right lower lobe pneumonia. She developed an itchy papulovesicular rash on her back and upper abdomen. The second patient was a 68-year-old woman who while bedridden developed an itchy papulovesicular rash on her back. Vesiculobullous forms of dermatitis were clinically suspected in both cases, and herpetic vesicles were the lead diagnosis in one case. Pathologically, lesions from both patients revealed intraepidermal fluid-filled vesicles that at scanning magnification raised the suspicion of herpetic lesions. At higher magnification, acantholytic cells, some seemingly multinucleated, could be ppreciated. However, immunohistochemistry for herpes simplex virus and varicella zoster virus antigens proved negative. Moreover, some of the lesional cells revealed dyskeratosis more typical of the spongiotic/vesicular variant of Grover disease, and accordingly, this diagnosis was eventually established in both patients. Recognition of the pseudoherpetic variant of spongiotic/vesicular Grover disease is important in determining correct treatment, and therefore, subtle clues to its diagnosis should be sought in evaluation of such lesions.