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• A 58-year-old man had an atypical fibroxanthoma of the face. Light microscopic and ultrastructural studies disclosed that the tumor was composed of three types of cells: spindle-shaped fibroblasts, histiocytes, and multinucleated giant cells with histiocytic features. Langerhans-like granules were observed in occasional histiocytes in this tumor.(Arch Dermatol 1984;120:234-239)

• The abrupt onset of acanthosis nigricans (AN) or of multiple seborrheic keratoses in middle-aged or older people is often associated with underlying malignant neoplasms. We describe a 64-year-old woman who developed a large number of verrucous papillomas on the trunk and extremities, followed within a few months by the sudden appearance of both the lesions of AN and those of multiple seborrheic keratoses. Laparotomy disclosed a gastric adenocarcinoma. A number of similar cases have been described in the literature. It is emphasized that patients with suddenly appearing verrucous papillomas should be examined carefully for an underlying cancer. To call attention to this eruption, which may be mistaken for generalized warts, we suggest the term "florid cutaneous papillomatosis."(Arch Dermatol 114:1803-1806, 1978)

• A 72-year-old man with a previous history of an amelanotic melanoma on his left forearm had an erythematous plaque excised from his right shoulder. Although the clinical impression was a dermatitis, a biopsy specimen revealed an amelanotic lentigo maligna melanoma. To our knowledge, this is the first patient described with an amelanotic lentigo maligna melanoma as a second primary tumor to an apparent previous amelanotic melanoma, manifesting as a dermatitislike plaque.(Arch Dermatol 1983;119:423-425)

• A 45-year-old man was seen in a hospital emergency room with regularly arranged rows of yellow hairs on his arm. A detailed investigation disclosed the occurrence of cactus bristle implantation from a house cactus. This implantation resulted in a severe acute dermatitis that evolved during a four-week period into a chronic granulomatous foreign-body reaction.(Arch Dermatol 1983;119:152-154)

• Werner's syndrome is an autosomal recessive disease characterized by juvenile cataracts, scleroderma-like skin changes, and a high incidence of neoplasms. A 57-year-old man had Werner's syndrome associated with a fibrosarcoma of the mediastinum and multiple basal cell epitheliomas. In two of these basal cell epitheliomas, since the sclerotic skin made it difficult to assess the extent of the tumor, microscopically controlled excision (Mohs' chemosurgery technique) was employed.(Arch Dermatol 1982;118:106-108)

• Immunosuppressed patients are at risk of acquiring Kaposi's sarcoma. We describe here a 66-year-old man with bronchial asthma who was receiving immunosuppressive medication (prednisone given for systemic effect) and in whom Kaposi's sarcoma developed. The literature on this subject is reviewed.(Arch Dermatol 116:1280-1282, 1980)

• Localized areas of indurated skin, which were adherent to the underlying tissues of the upper extremities, suddenly developed in a 55-year-old woman. Histologic examination of these bound-down areas disclosed a thickening and inflammation of the deep fascia. There was an associated eosinophilia and a marked clinical improvement after 18 months of oral steroid therapy. These gross and microscopic findings, as well as the peripheral eosinophilia and clinical response while oral steroids were administered, are all characteristics of the recently described entity called eosinophilic fasciitis. Its recognition is important since it may be steroid responsive.(Arch Dermatol 114:1047-1049, 1978)

Kaposi's sarcoma is a distinctive malignant neoplasm of multifocal origin that most commonly affects the skin and gastrointestinal tract tissues.1-3 It classically presents as violaceous patches, plaques, or nodules that usually occur initially on the lower extremities.4 Less commonly, the disease first appears in other cutaneous or extracutaneous sites. This neoplasm has been given considerable attention in recent years because of its apparent association with immunosuppression. In this report, a patient who was chronically immunosuppressed had an unusual clinical variant of this disorder, which consisted of fleshcolored and erythematous telangiectatic papules and nodules. REPORT OF A CASE A 69-year-old man was hospitalized in November 1980 for the treatment of pneumonia. On admission, he was noted to have multiple flesh-colored nodules on the left lower extremity of uncertain duration. Myasthenia gravis had been diagnosed in 1963 and was initially treated with pyridostigmine bromide. In 1974, a Coombs'-positive hemolytic anemia

IN REPLY.— We appreciate Dr Hussey's interest in our article on a histologically specific transitional cell metastasis to the skin from a primary tumor of the urinary tract. Whether this cutaneous metastasis resulted from direction extension from an underlying regional lymph node or by direct hematogenous spread remains unclear. The underlying lymph nodes were never examined microscopically, and the patient has not, to our knowledge, died.We certainly agree with Dr Hussey that the vertebral venous system may have accounted for the clinical lesion. We consider hematogenous spread, including spread through the vertebral venous system, a reasonable possibility. Clearly, the clinical experiments of Batson,1 demonstrating the vertebral venous system, are worth recalling. That is, metastases may spread through this valveless system of veins, which may not lead through the lungs, to produce what might otherwise be considered unusual metastatic spread. For example, injection of dye into the deep dorsal

TO THE EDITOR.— We describe here two patients with generalized granuloma annulare who responded favorably to treatment with dapsone. REPORT OF CASES.—CASE 1.— A 16-year-old girl came to us in April 1978 with a two-month history of a progressive asymptomatic papular eruption on her thighs, buttocks, and hips. She was in good health and denied recent illnesses or the ingestion of medications. The eruption consisted of multiple erythematous to slightly yellow, dome-shaped papules ranging in size from 0.5 to 1 cm. Initially, no lesions demonstrated central clearing. A skin biopsy specimen demonstrated histologic changes consistent with granuloma annulare. The patient returned one month later because more lesions had appeared on her arms, legs, and in the original areas. Several lesions were now 1.5 to 2 cm in size and demonstrated central clearing. Findings from laboratory studies, which included a 12-factor automated chemical analysis, complete blood cell (CBC) count,