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Historically, the classification of the blistering disorders has been arbitrarily assigned by common clinical features (ie, vesicle, bullae), etiologic factors (ie, infectious, immunologic), or histologic parameters (ie, intraepidermal and subepidermal). There are distinct advantages to each of these classification systems, yet there remain a small number of either common conditions that rarely manifests as a blistering disorder or uncommon conditions that routinely blister, defying conventional classification. Such misfits comprise a miscellaneous group of blistering conditions that merit special consideration.

The spongiotic dermatoses including eczema and its clinicopathologic variants are capable of presenting in a variety of clinical guises and are pathologically defined by the presence of epithelial intercellular edema that may rarely form blisters. The mechanisms which underlie there pathogensis has only recently begun to be elucidated. Collectively, these disorders comprise an integral facet of dermatology and are the subject of discussion in this article.

Background: Nonmelanoma skin cancer is a common and important public health concern. Few long-term demographic studies to evaluate potential changes in the clinical or pathologic attributes of theses lesions have been initiated., Design: A computer-based archival search of nonmelanoma skin cancer (NMSC) diagnosed in 1972 and 2001 at a large VA medical center was examined with accompanying glass slides. The NMSC consisted of basal cell carcinoma (BCC), invasive squamous cell carcinoma (SCC) and squamous cell carcinoma in situ (SIS). Pathologic attributes examined included the histologic type of BCC (nodular, superficial, infiltrating), and histologic grade of SCC. Demographic features included age, and location. As the majority of patients were men, women were excluded from the study. The results were tabulated and statistically evaluated by the Students' t-test., Results: A total of 831 cases of NMSC diagnosed in 809 patients in 1972 compared to 1,712 cases in 1,011 patients in 2001. BCC accounted for 45%, SIS 23%, and SCC 32% in 1972 compared to 34% BCC (P = .04), 38% SIS (P = .01), and 28% SCC (P > .05) in 2001. Histologic subtypes of BCC included nodular accounted for 45%, superficial 37% and infiltrating 7% in 1972 compared to 35% (P = .05), 46% (P > .05) and 19% (P = .01) in 2001. Among SCC, 79% were well differentiated with 13% moderate and 7% poorly differentiated in 1972 compared with 82% (P > .05), 10% (P >.05), and 8% (P > .05)in 2001. The average age of patients in 1972 was 76.2 and 64.1 in 2001 (P = .02). The most common locations in 1972 are head and neck (H&N) (54%), extremities (24%); 2001 H&N (50%) and extremities (32%, P = .05)., Conclusions: The data would suggest that NMSC is being diagnosed at a younger age and more commonly on the extremities in Veteran's than in the past. The relative proportion of SIS and of superficial and infiltrating BCC is also increasing.

Background: Oncocytosis is a cellular feature characterized by the presence of a finely granular eosinophilic cytoplasm due to the accumulation of mitochondria. While this histologic trait can be found in normal tissues, it is also seen pathologically as a degenerative phenomenon. We recently reviewed a spectrum of oncocytic melanocytic nevi that did not have clinical significance. We now describe similar changes in melanoma., Methods: We retrospectively reviewed 12 melanomas noted to have prominent granular eosinophilic cytoplasm and completed ultrastructural studies. We obtained patient histories and clinical follow-up information from the patients' physicians., Results: All cases were primary melanomas and showed prominent oncocytosis in the majority of the lesional melanoma cells. Oncocytosis was observed in both melanoma in situ and invasive melanoma with a wide range of Breslow thicknesses (range, 0.45-5.05 mm). It occurred in the presence and absence of ulceration, regression, vascular invasion, and brisk tumor infiltrating lymphocytes. Ultrastructural studies revealed melanocytes with numerous distorted mitochondria., Conclusion: Melanoma is capable of presenting in a variety of histologic guises, including oncocytic change. While our observations are preliminary, this pathologic curiosity likely represents a degenerative phenomenon of little prognostic importance.