Development of neuroendocrine (Merkel cell) carcinoma mixed with squamous cell carcinoma in erythema ab igne

Squamous cell carcinoma and neuroendocrine (Merkel cell) carcinoma are cutaneous neoplasms that have only occasionally been reported to coexist. Squamous cell carcinoma, but not neuroendocrine (Merkel cell) carcinoma, is a rare complication of erythema ab igne. This report describes the development of both neoplasms arising within the same tumor mass in an area of erythema ab igne.     

Two cases of squamous cell carcinoma arising from erythema ab igne

This report describes two female patients, 69 and 79 years old, with squamous cell carcinoma (SCC) developing from erythema ab igne (EAI) due to thermal irradiation from a sunken hearth (irori in Japanese) or an underfloor brazier covered with a quilt (kotatsu in Japanese). EAI on the knees and lower thighs showed reticular pigmentation at its periphery and poikiloderma in the center with many keratotic nodules. In both cases, the SCCs were located almost symmetrically on an anterior site 1/3 of the way down both lower thighs. They were surrounded by many keratotic nodules. Histologically, these nodules showed an atypia of the epidermal cells, indicating carcinoma in situ resembling actinic keratosis ro Bowen's disease. It was also strongly suggested that the SCCs in these patients had developed from the keratotic nodules. EAI appeared to have played a pathogenetic role in the cutaneous carcinoma.     

Squamous cell carcinoma developing in thermal keratosis

Two cases of squamous cell carcinoma (SCC), both of them developed from thermal keratosis arising in areas of erythema ab igne (EAI) are reported. The lesions were located on the legs of two elderly Japanese women who had histories of chronic exposure to heat from a “kotatsu”, a type of leg-warmer widely used in Japan. In one case, metastasis to regional lymph nodes occurred. It is emphasized that keratotic lesions arising in an area of EAI should be excised or biopsied because of the possibility of metastasizing SCC developing from them.     

Laptop-induced erythema ab igne: Report and review of literature

Erythema ab igne is an erythematous, reticular hyperpigmentation that results from prolonged thermal radiation exposure insufficient to cause a burn. Historically, lesions were found on individuals exposed to open fires or stoves, but more recently, erythema ab igne has been described in patients using portable electronics devices including laptops. We report a 21-year-old woman who presented with net-like hyperpigmentation on her thighs caused by prolonged laptop use. We also review the literature that describes other individuals with laptop-induced erythema ab igne and discuss the features of this condition.     

A reticulate vascular abnormality in patients with lymphoedema: observations in eight patients

Summary We describe eight patients with lymphoedema who had prominent compressible ridges of tissue in a reticulate pattern, situated predominantly on the upper part of the lower leg. In five patients the lymphoedema was primary, two patients had circumferential venous ulceration, and one had marked venous disease with a small ulcer. One patient had a squamous cell carcinoma of the medial thigh and dysplastic keratoses in the distribution of the reticulate ridges. In three of the four cases in whom histological examination of the ridges was performed, the skin at these areas was demonstrated to contain grossly dilated angular vessels in the mid-dermis, many with valves visible. The vessel walls had a single layer of endothelial cells (anti-factor VIII-related antigen positive) and a basement membrane containing type IV collagen. Abnormal elastic tissue in these biopsies was similar to that in erythema ab igne. Indirect lymphography in one case did not demonstrate dilated lymphatic vessels. The body site distribution and clinical pattern of the abnormality appeared to be similar to erythema ab igne but associated with an underlying abnormality of lymphatic rather than blood vasculature. We propose that our cases may represent 'lymphoedema ab igne'.     

Erythema ab igne

Erythema ab igne is a reticulated, erythematous or hyperpigmented dermatosis that results from chronic and repeated exposure to low levels of infrared radiation. Multiple heat sources have been reported to cause this condition, which include heated reclining chairs, heating pads, hot water bottles, car heaters, electric space heaters, and, more recently, laptop computers. Treatment consists of withdrawing the inciting heat source. Although erythema ab igne carries a good prognosis, it is not necessarily a self-limited diagnosis as patients are at long-term risk of developing subsequent cutaneous malignant conditions, which include squamous cell and merkel-cell carcinomas.     

Optimum Treatment Strategies for Actinic Keratosis (Intraepidermal Squamous Cell Carcinoma)

Actinic keratoses are superficial squamous cell carcinomas. Treatment of these lesions is indicated to prevent the cells from invading the dermis and possibly metastasizing. If a lesion exhibits evidence of possible dermal invasion, such as marked erythema, ulceration, tenderness, bleeding, and especially induration, the physician should always consider performing a biopsy. Cryosurgical destruction, the most common treatment employed, has been shown to be 98.8% effective in eliminating the lesions. Adverse reactions such as scarring, textural changes, infection, and pigmentation alteration rarely occur. Physical destruction using electrodesiccation and curettage is particularly effective when the patient has hyperkeratotic lesions. When a patient has a multitude of actinic keratoses, the use of other treatments including fluorouracil, nonsteroidal anti-inflammatory preparations, immune response modifiers, and photodynamic therapy should be considered. However, none of these treatments has proven to be as effective overall as cryosurgical destruction. If a lesion does not respond to treatment, obtaining a biopsy of the lesion should be considered to be certain that the lesion is not an invasive squamous cell carcinoma.     

Erythema Ab Igne induced by a laptop computer in an adolescent

Erythema ab igne is a pigmented reticular skin lesion with telangiectasias caused by prolonged exposure to heat. This report describes the case of a 12-year-old adolescent girl with erythema ab igne induced by a laptop computer. The paper also discusses how computers generate heat and how important it is for the manufacturers of these devices to warn consumers of the potential hazards that could occur if the equipment is misused.     

Bullous erythema ab igne

Erythema ab igne is a localized, cutaneous condition, consisting of reticulate hyperpigmentation, dusky erythema, epidermal atrophy, and telangiectasia, all the result of repeated exposures to heat. We describe a patient with a bullous form of erythema ab igne: bullae and crusts within a localized area of reticular, brown, macular pigmentation on the lateral side of the left leg, an area that had repeated close exposure to an electrical heater over the previous 3 months. We believe that bullous erythema ab igne, something rarely reported in the literature, should be considered a well-defined variant of erythema ab igne; it may be more common than the literature suggests.     

Bullous lichen planus developed on erythema ab igne

Lichen planus developed on erythema ab igne which was induced by repeated exposures to a stove. The clinical and histopathological features of the eruption were an admixture of typical lichen planus and erythema ab igne. Subepidermal bullae were also found on the lichen planus. Direct immunofluorescence tests revealed deposits of fibrin in the basement membrane zone and IgM in the colloid bodies. Indirect immunofluorescence studies detected no circulating antibodies against cutaneous structures in the patient's serum. This study indicates that repeated thermal exposure over a prolonged period may produce lichen planus lesions.     

Plattenepithelkarzinome bei Erythema ab igne

Erythema ab igne (EAI) is a red-brown net-like hyperpigmentation due to repetitive exposure to submaximal heat over a long period of time. This rash is typically seen on the anterior lower legs of people who sit in front of open fireplaces or coal stoves and on the trunk of patients with chronic disorders who seek pain relief by long-term use of hot-water bottles or heating pads. EAI can not only be a diagnostic sign for underlying internal diseases including malignant tumors but can also give rise to cutaneous malignancies. We report on a 75-year-old female patient who developed several thermal keratoses and squamous cell carcinomas at the site of erythema ab igne caused by chronic heat exposure over several years.     

Laptop induced erythema ab igne

Erythema ab igne is a reticular, pigmented dermatosis caused by prolonged and repeated exposure to infrared radiation that is insufficient to produce a burn. The use of laptop computers has increased manifold in the recent past. Prolonged contact of the laptop with the skin can lead to the development of erythema ab igne. We present a case of erythema ab igne secondary to laptop use in an Indian student.     

Laptop computer--associated erythema ab igne

A 40-year-old woman presented with an asymptomatic reticulated eruption on the thighs. After an extensive workup, she was diagnosed with erythema ab igne caused by laptop computer use. The eruption ultimately cleared several months after discontinuation of direct placement of the laptop computer on her thighs. Erythema ab igne is becoming increasingly associated with exposure to modern heat sources. A thorough history of patients with suspicious lesions should include questioning for contact with alternative heat sources to avoid an unnecessary workup for this condition.     

Laptop computer-induced erythema ab igne: a case report

Erythema ab igne is a condition characterized by reticulated telangiectasia and hyperpigmentation caused by repeated long-term exposure to infrared radiation insufficient to produce a burn. We report a case of laptop computer-induced erythema ab igne.     

The wages of warmth: changes in erythema ab igne

Biopsies from 20 patients with erythema ab igne (EAI) were examined and compared with biopsies from the legs of 7 elderly control subjects. Epidermal thinning and flattening of the dermo-epidermal junction were seen in most of the tissues examined but were more prominent in the EAI biopsies. Basal cell degenerative change with vacuolation was frequently observed in the EAI specimens. Epidermal atypia amounting to preneoplastic change was observed in 4 EAI biopsies. The dermis was thinned and showed (a) marked oedema and connective tissue disruption and (b) accumulation of elastic staining material. Both haemosiderin and melanin were found within the dermis. The small blood vessels showed a striking abnormality in 7 patients and 2 control biopsies in that the endothelial cells were enlarged and the nuclei were hyperchromatic and irregular in size and shape. This change may be due more to stasis than to chronic heating.     

Hot pop brown spot: erythema Ab igne induced by heated popcorn

Erythema ab igne is caused by chronic heat exposure and presents with reticulated pigmentation. Although various causes of erythema ab igne have been reported, in the United States, its incidence has been declining due to the advent of central heating. When seen, it is usually in the setting of local applications of a heated source, such as a hot water bottle, to treat muscular or arthritic pains. We report a novel cause of erythema ab igne occurring in a patient with chronic arthritic pains. This patient applied popcorn kernels, heated in a microwave, to his right wrist and knee for 30 minutes at a time for over four months.     

Cutaneous horn and thermal keratosis in erythema AB igne

A 46-year-old Kashmiri lady developed erythema ab igne on both legs. She subsequently developed multiple keratoses and a cutaneous horn in the involved skin. An uncommon association of these three clinical conditions is being presented.     

Sinonasal carcinoma masquerading as fungal sinusitis

A 26-year-old man presented with swelling of his face and nose of three months duration. He had multiple hyperpigmented, hyperkeratotic plaques over the swelling, of one-month duration and an erythematous indurated plaque below the left nostril for two weeks. Based on a biopsy taken from the antral mass with special stain for fungus, he was treated as fungal sinusitis with intravenous amphotericin-B, but the lesion did not regress. Later a skin biopsy from the indurated lesion showed moderately differentiated squamous cell carcinoma. A diagnosis of sinonasal carcinoma was made and chemotherapy was started.     

Squamous Cell Carcinoma Developing within Lesions of Disseminated Superficial Actinic Porokeratosis

Disseminated superficial actinic porokeratosis (DSAP) consists of multiple annular, hyperkeratotic lesions that have a bilateral distribution on sun-exposed areas, particularly the extremities. DSAPs have a wider distribution than porokeratosis of Mibelli and usually develop during the 3rd or 4th decade of life. Squamous cell carcinoma that arises in the classical type of porokeratosis of Mibelli is well-documented, but there are only a few reports of squamous cell carcinoma in DSAP. Here, we describe a 62-year-old man with DSAP who developed squamous cell carcinoma on his right forearm.     

The Histopathologic Differentiation of Keratoacanthoma and Squamous Cell Carcinoma of the Skin

The classification of skin tumors as keratoacanthoma or squamous cell carcinoma may be difficult and, albeit rarely, lesions classified as keratoacanthoma do metastasize. In order to review the reproducibility of the pathologic classification, 100 keratoacanthomas and 100 squamous cell carcinomas of the skin were randomized and reclassified. In 81% of the keratoacanthomas and 86% of the squamous carcinomas the original diagnosis was confirmed. The presence or absence of 10 histologic criteria was recorded for all cases. Almost all of the confirmed keratoacanthomas had invaginating keratin-filled craters with epidermal proliferation at the sides and the bottom of the lesion and significant atypia and mitotic activity was rare. Most of the confirmed squamous cell carcinomas showed considerable cellular anaplasia and pleomorphism and many displayed significant mitotic activity. It is concluded that a definite diagnosis of keratoacanthoma or squamous cell carcinoma can be made objectively on histologic grounds but that some tumors are atypical or borderline lesions which must be indicated in the pathologic report.