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Melanoma is the most aggressive form of skin cancer affecting patients worldwide and has the potential to metastasize to virtually any organ in the body. Early detection is of paramount importance to minimize patient morbidity and mortality. However, there has been increasing evidence highlighting that geographical and ethnic variations in the clinical presentation of melanoma do exist. Unlike the Western population, the major subtype of melanoma affecting the Asian population is in fact, acral lentiginous melanoma (ALM) and not superficial spreading melanoma (SSM).We hereby present a case of left hallux subungual melanoma with scalp metastasis. This case underscores the importance of the examination of acral skin and the nail apparatus for melanoma in Asians.

We report an unusual case of drug-associated granulomatous CD30+ T-cell pseudolymphoma secondary to amlodipine. A 55-year-old Chinese man presented with a 6-month eruption of disseminated erythematous dermal papulonodules and annular infiltrated plaques over his neck and limbs symmetrically. Histopathology revealed a perivascular and interstitial infiltrate of histiocytes, eosinophils and morphologically normal lymphocytes associated with CD30 expression. The eruption improved rapidly after discontinuation of amlodipine and did not recur.

Confluent and reticulated papillomatosis (CRP) of Gougerot and Carteaud was first typified in 1927. With the help of electron microscopy, it has been elucidated that CRP arises due to aberrant keratinization. However, till date, there is no clear consensus on the etiologic trigger for CRP. Prevailing postulates include a bacterial trigger by Dietzia papillomatosis (type strain N 1280(T)), an exaggerated cutaneous response to Malassezia furfur, an endocrine basis stemming from insulin resistance, ultraviolet light-induced epidermal change, amyloid deposition, and a loss-of-function mutation in keratin 16. CRP typically presents as asymptomatic hyperpigmented papules and plaques with peripheral reticulation over the nape, axillae, upper chest, and upper back, occasionally with extension superior to the forehead and inferior to the pubic region. Dermoscopy may be used in the evaluation of CRP, but its diagnosis is made on clinical grounds given its nonspecific histopathological findings. Although successful treatment with topical keratolytics, retinoids, or antifungals has been reported, antibiotics, such as minocycline, at anti-inflammatory doses have emerged as a preferred therapeutic option. In this article, we review the diagnostic considerations in CRP and its therapeutic options.

History of the presenting symptom The patient had a 6-month history of unsteady gait and generalized weakness with constitutional symptoms of loss of weight and appetite. He consulted his general practitioner 2 months later. Laboratory investigations then showed normal complete blood count and liver and thyroid function tests. Magnetic resonance imaging (MRI) of the brain with contrast fluid-attenuated inversion recovery (FLAIR) sequences and diffusion-weighted imaging showed multiple nonspecific foci of an abnormal signal seen in the white matter of both cerebral hemispheres. VDRL serology was nonreactive. The only abnormal investigation was an elevated serum sodium level at 148 mmoles/liter (reference interval 135–145). He was referred to a neurologist, who made a diagnosis of multiple system atrophy based on features of cerebellar dysfunction and dysautonomia, which included orthostatic hypotension and erectile dysfunction. His serum vitamin E level was 11.3 mg/liter (reference interval 5.5–18.0). He was commenced on highdose oral vitamin E therapy as an antioxidant for multiple system atrophy. He subsequently presented to the general medicine department and was admitted for progression of symptoms. Medical history He had been attending long-term followup visits with his general practitioner for hyperlipidemia and type 2 diabetes mellitus for 10 years. Glycosylated hemoglobin (HbA1c) 2 months prior to admission was 11.8%. His regular medications included lovastatin, glipizide, and vitamin E tablets. He had no recent exposure to anyone with tuberculosis or history of pulmonary tuberculosis.

Background: Hypohidrosis is a risk factor for developing heat-related illnesses. Objective: To determine the prevalence of hypohidrosis in heat injury. Methods: Soldiers from the Singapore Armed Forces who developed heat injury between January 1, 2012 and December 31, 2013 were invited to participate in the study. Subjects were induced to sweat through exercising in a temperature- and humidity-regulated room, and then atomized starch-iodine powder was administered over their whole body to detect hypohidrosis. If this was found to be present, investigations to elucidate the cause of anhidrosis were performed. Results: Out of 65 males, 30 consented to participation. One was excluded because an exogenous cause resulted in heat injury. Nine (31%) demonstrated hypohidrosis. Of these, 1 (11%) had miliaria profunda, 2 (22%) had acquired idiopathic generalized anhidrosis and 6 (67%) manifested a new phenotype which we termed acquired symmetrical hypohidrosis (ASH). Conclusion: Thirty-one percent of healthy soldiers who developed heat injury had hypohidrosis. Concurrently, a new clinical phenotype of ASH was identified.