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Notes: A pair of monozygous male twins concordant for dermatitis herpetiformis (DH) and gluten-sensitive enteropathy (GSE) are reported. Presentation of DH in the twins was asynchronous, with one affected at the age of 20, the other at the age of 27. Neither twin had symptoms of malabsorption but duodenojejunal villous atrophy was confirmed histologically.

Notes: Sixteen cases of malignant melanoma which showed prominent desmoplastic and/or neurotropic features occurring throughout the tumour were compiled from the St John's Dermatology Centre histopathological archives. A further nine melanomas in which both conventional and desmoplastic melanoma were present concomitantly were also studied (three tumours with 66% desmoplastic change, two with 50%, and four with less than 50%). There were 14 males and 11 females, with a mean age of 64 years (range 39–86). The mean interval between presentation and diagnosis was 8 months. Eighteen of the 25 tumours were located on the head and neck, three were on the trunk, one was on the upper limb and three were on the lower limb. Histological review revealed 21 of 25 tumours with overlying atypical lentiginous hyperplasia, lentigo maligna melanoma, or superficial spreading malignant melanoma. Neurotropism was present in nine tumours, with the changes confined to local recurrences in two instances; neuroid differentiation was present in four tumours, and neural and perineural tumour spread was present in four tumours. The depth of invasion exceeded 6 mm in seven tumours, and was 2–6 mm in 16, and less than 2 mm in two. Eighteen of the 25 tumours were incompletely excised at the time of the first excision. Lymphoid aggregates were present in 16 tumours, but in most cases were limited to a few lymphoid foci. Melanin was identified in the dermal component of only five tumours, but not in areas showing typical histological features of desmoplastic malignant melanoma. Treatment was by surgical excision in all cases, and was preceded by radiotherapy in one case. Details of follow-up were obtained in all cases, and the duration ranged from 9 months to 10 years (mean, 3 years 11 months). Eleven patients had died: nine from melanoma and two from other causes. One patient was alive, with deep, inoperable local recurrence. Thirteen patients were alive and clinically free from tumour, including two patients in whom there had been local recurrence. A lower rate of neurotropism was present in the nine patients with partial desmoplastic change compared with those with desmoplastic change throughout the tumour, and represented the only significant difference between the two groups of patients.

Notes: A case is reported of a 14-year-old boy with a mass arising from the umbilicus, which was a large, well-organized candidal granuloma. Cell markers showed normal numbers and distribution of peripheral T and B lymphocytes but there was no reaction to intradermal injection of Candida, suggesting a specific T-cell defect such as occurs in chronic mucocutaneous candidiasis.

Notes: A case in which oesophageal webs preceded the development of carcinoma and rupture of the oesophagus in a 77-year-old woman with cicatricial pemphigoid is reported. Oesophageal webs in cicatricial pemphigoid have been reported but are rare.1 Clinical, histological, radiological and post-mortem features are described. Western immunoblotting of serum demonstrated a 180-kDa antigen which comprises one of the antigens reported in cicatricial pemphigoid.2

Notes: We present two patients who developed pseudoporphyria whilst taking isotretinoin (Roaccutane). At that time, both patients were receiving other agents which could be incriminated as causing their pseudoporphyria. However, it is significant that these other agents had been longstanding and that the porphyria-like cutaneous changes did not develop until after the introduction of the isotretinoin (Roaccutane). In both cases, withdrawal of the isotretinoin resulted in clinical improvement of their cutaneous signs. The interaction of isotretinoin and another agent, rather than isotretinoin independently, may be involved in the development of pseudoporphyria.

Notes: The distributions in deposition of immunoreactants in bullous pemphigoid before and after initiating treatment were investigated. Punch biopsies of skin were performed on each patient from up to the different sites and studied by direct immunofluorescence (DIF). Both groups showed the highest diagnostic yield for DIF from perilesional biopsies, with positively of 78% from the pretreatment group and 83% from the post-treatment group. The percentage of positive DIF for remaining sites in the pre-treatment group were as follows: 50% lower back, 62% oral mucosa, 70% flexor aspect of forearm, 70% anterior aspect of thigh. The post-treatment group had positive DIF of other sites biopsied as follows: 59% anterior aspect of thigh, 64% flexor aspect of forearm, 68% back. We conclude that a single perilesional biopsy is usually sufficient to provide positive DIF and more than two biopsies is seldom justified as it is unlikely to increase the yield of positive DIF. If it is not possible to obtain a perilesional biopsy, then the anterior aspect of thigh or flexor aspect of forearm is a suitable alternative site. If a second biopsy is considered after initialing treatment, it should be taken from the oral mucosa as this has been shown in a separate study to have a higher rate of positive DIF than uninvolved skin.1