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Objective To assess whether an erythematous eruption in the vicinity of or distant from a melanoma lesion might be related to the vascular endothelial growth factor, the platelet-derived endothelial cell growth factor, or both. Methods Biopsy specimens from 13 patients with primary melanoma, 6 of whom had erythematous eruptions and 7 who did not, were studied by immunohistochemistry for the expression of vascular endothelial growth factor and platelet-derived endothelial cell growth factor. Results Vascular endothelial growth factor was positive in 3 of 6 patients (50%) with melanoma and redness (Brenner sign) and in 4 of 7 patients (57%) with melanoma without redness. Platelet-derived endothelial cell growth factor was positive in all 6 patients (100%) with melanoma and redness and in 4 of 7 patients (57%) with melanoma without redness. Conclusion Platelet-derived endothelial cell growth factor may have a part in the pathogenesis of the redness observed in patients with melanoma, called Brenner sign , by affecting vasculature function.

Background: High doses of interferon alfa are used to treat Kaposi's sarcoma in patients with immunodeficiency, whereas low doses are generally ineffective. Following low-dose recombinant interferon alfa treatment for lymphoma, two patients showed a regression of their hematologic malignancy-associated Kaposi's sarcoma. This observation prompted us also to try lowdose interferon alfa treatment in uncomplicated classic Kaposi's sarcoma, and two additional patients were thus treated on an outpatient basis. Observations: Initial response was noted after 3 to 13 weeks of treatment. Remission was achieved after 4 to 6 months of low-dose interferon alfa treatment and its duration was 8 to 14 months. Recurrences were treated again and additional remissions were obtained after only 5 to 8 weeks of treatment. Conclusion: Low-dose interferon alfa treatment may represent an effective therapeutic modality for the treatment of patients with both lymphoma-associated and uncomplicated classic Kaposi's sarcoma. ( Arch Dermatol. 1993;129:1297-1300)

REPORT OF A CASE A 58-year-old man was referred to us because of a widespread papulosquamous eruption. His history included mild diabetes for 12 years for which he had been receiving glyburide (15 mg/d) and metformin (850 mg/d). Three years ago, he had a myocardial infarction and began receiving acetylsalicylic acid (325 mg/d) and dipyridamole (75 mg three times daily). Oral quinidine bisulfate in sustained-action tablets had been added to therapy 1 month before admission for the management of premature ventricular contractions. On examination, erythematous scaly plaques were noted on his trunk and extremities ( Figure 1 ). A biopsy specimen of a plaque showed focal parakeratosis and absence of granular cells at these areas, elongation of the rete ridges and the papillae with dilated capillaries within them, and a perivascular infiltrate composed of lymphocytes in the dermis ( Figure 2 ). What is your diagnosis? DIAGNOSIS: Psoriasiform eruption induced by quinidine. CLINICAL COURSE Since an adverse reaction to quinidine had been suspected, he was instructed to discontinue this therapy. The lesions

To the Editor.— In the article "Kaposi Sarcoma and Polymyositis,"Archives(110:605-607, 1974), Dr. Dantzig states that, to his knowledge, Kaposi sarcoma has not "been reported with any of the cutaneous or muscular signs of malignant tumor." 3 We would like to point out that acquired ichthyosis has been described by us ( Dermatologica 147:348-351,1973) as a skin marker of Kaposi sarcoma. We have since noted the association of ichthyosis and Kaposi sarcoma in two additional patients. In one patient, an 85-year-old man, pronounced ichthyosiform changes had begun to appear three years prior to development of the widespread plaques, nodules and tumors of Kaposi sarcoma (Figure). In the other patient, a 77-year-old man, plaques of Kaposi sarcoma on the palms, legs and feet, and ichthyosis of the legs and feet have developed simultaneously over the last two years. The diagnoses of Kaposi sarcoma and ichthyosis (the latter indistinguishable from dominant ichthyosis

To the Editor.— Lipoma is a common tumor composed of mature fat cells usually found in the subcutaneous tissue or, less commonly, in internal organs. A diffuse multilobular lipomatosis involving the back of the neck and the shoulders in a capelike distribution has been described among wine porters in France and brewery workers elsewhere 1 and is referred to as Madelung's neck. I describe herein a patient in whom such a multilobular lipoma developed on the left shoulder, due possibly to long-term, intermittent trauma caused by a heavy purse carried over this shoulder for many years. Report of a Case.— A 39-year-old woman was seen because of a tumor on her left shoulder that she had noticed about three months earlier. There had been no associated symptoms. The patient stated that she had carried a heavy handbag on this shoulder for about 15 years. Examination disclosed that the tumor was