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The case of a child with a familial anomalous hyperemia of the optic disk simulating early papilledema is presented. Idiopathic diabetes insipidus and headaches were also present. When one is confronted by a patient whose ocular findings suggest papilledema, frequent observation of his fundi over an extended period as well as examinations of other members of the family may help determine whether this is true papilledema, or a familial anomaly such as hyperemia of the disk.

To the Editor.— While the basic premise of the study by DiBisceglie et al in the July 1986 issue of theArchives, that pityriasis rotunda may be a paraneoplastic phenomenon, is plausible, there are serious problems with the study and its test data that lead to questioning its validity. 1 The authors suggested that the macular, scaling, arcuate lesions on the torso of ten patients, seven of whom had hepatocellular carcinoma, might be cutaneous markers of their underlying disease, but the suggestion was made without submitting data to show that another source of such lesions, dermatophytosis, was considered in their differential diagnosis. Where are the results of such basic studies as their potassium hydroxide preparations, Sabouraud's fungal cultures, or cutaneous biopsies with periodic acid-Schiff stain and diastase digestion? The published photomicrograph of a cutaneous biopsy specimen is compatible with tinea when only a hematoxylin-eosin stain is used; the legend

• A patient with a laryngeal tumor first diagnosed as squamous cell carcinoma was subsequently found to have North American blastomycosis. Diagnosis of this condition eventuated in eradication of the lesion as well as removal of a tracheostomy, which was thought to be permanent. (Arch Dermatol114:1370-1371, 1978)