Shane A Meehan, M.D.

Amelanotic melanoma: a detailed morphologic analysis with clinicopathologic correlation of 75 cases
Cheung, Wang L; Patel, Rishi R; Leonard, Aimee; Firoz, Bahar; Meehan, Shane A
2012 Jan;39(1):33-39, Journal of cutaneous pathology
Amelanotic melanoma can have a varied appearance both clinically and microscopically. Here, we present our experiences with 75 cases of amelanotic melanoma defined clinically as a non-pigmented lesion and histopathologically as a tumor lacking significant melanization. We evaluated microscopic features such as morphology, mitotic count, nuclear atypia and presence of solar elastosis. Our amelanotic melanomas exhibited the following morphology: epitheloid (72%), spindled (18.7%) or desmoplastic (5.3%). In addition, we obtained patient information and clinical presentations on most of the cases (74/75; 98.7%) and follow-up data on 40% (30/75) of the cases. The majority of amelanotic melanomas in men were found on the trunk (13/45; 29%), head and neck (12/45; 26.7%), and lower limb (13/45; 29%) and in women were found on the lower limb (12/30; 40%), upper limb (10/30; 33.3%) and head and neck (6/30; 20%). In addition, we found that an increase in mitotic index correlated with worse survival (p < 0.026), whereas there were no differences in survival for other pathological features, such as nuclear atypia or solar elastosis. Furthermore, in cases with available tissue, all amelanotic melanoma expressed microphthalmia-associated transcription factor and tyrosinase, suggesting that the tumor cells retained melanocytic lineage and an enzyme in melanin formation, respectively. As the occurrence of amelanotic melanoma and the expression melanoma markers were similar to pigmented melanoma, we favor that amelanotic melanoma represents a subtype of melanoma rather than poorly differentiated or de-differentiated melanoma. Cheung WL, Patel RR, Leonard A, Firoz B, Meehan SA. Amelanotic melanoma: a detailed morphologic analysis with clinicopathologic correlation of 75 cases
— id: 148729, year: 2012, vol: 39, page: 33, stat: Journal Article,

Polyurethane foam: an underrecognized cause of foreign body granulomas
Hale, Christopher S; Patel, Rishi R; Meehan, Shane
2011 Oct;38(10):838-839, Journal of cutaneous pathology
— id: 137069, year: 2011, vol: 38, page: 838, stat: Journal Article,

Metastatic balloon cell malignant melanoma: a case report and literature review
Lee, Lili; Zhou, Fang; Simms, Anthony; Wieczorek, Rosemary; Fang, Yanan; Subietas-Mayol, Antonio; Wang, Beverly; Heller, Patricia; Huang, Hongying; Pei, Zhiheng; Osman, Iman; Meehan, Shane; Lee, Peng
2011 Mar;4(3):315-321, International journal of clinical & experimental pathology
A case of metastatic balloon cell malignant melanoma (BCMM) is presented. The balloon melanoma cells (BMC) were absent in the shave biopsy of the primary lesion and present as a minor component in the wide and deep excision. A subsequent right neck lymph node metastasis showed complete replacement of the lymph node by large, foamy cells. Though the tumor was amelanocytic and Fontana-Masson stain failed to reveal melanin, it stained positively for S-100, HMB-45, and Melan-A. Ultrastructurally, the foamy cells were characterized by cytoplasmic vacuolization and a lack of melanosomes. The differential diagnosis of metastatic balloon cell malignant melanoma is broad, and clinicopathologic correlation may play a critical role in achieving the correct diagnosis
— id: 133175, year: 2011, vol: 4, page: 315, stat: Journal Article,

Annular Lichenoid Dermatitis of Youth: Case Report and Review of the Literature
Gonzalez, Mercedes E.; Leger, Marie C.; Hunt, Raegan D.; Meehan, Shane; Schaffer, Julie V.
2010 SEP-OCT ;27(5):584-585, Pediatric dermatology
— id: 124113, year: 2010, vol: 27, page: 584, stat: Journal Article,

Dysregulation of the microvascular as assessed by expression of protective and injury associated markers is reflected in the non-lesional non-sunexposed skin of patients with lupus nephritis
Izmirly P.M.; Meehan S.; Xu S.X.; Askanase A.D.; Merrill J.T.; Buyon J.P.; Clancy R.M.
2010 ;62:1190-1190, Arthritis & rheumatism
Purpose: Coagulation is one of the first pathways to be elicited by vascular injury, and its activation is followed by proinflammatory phenomena, in part due to loss of the anti-inflammatory activity of both the Protein C pathway and membrane Endothelial Protein C receptor (mEPCR). It has been recently demonstrated that mEPCR is highly expressed in the cortical peritubular capillaries of kidneys from patients (pts) with active lupus nephritis compared to normal human kidney. Profound upregulation of mEPCR was observed even in areas absent tubulointerstitial damage. This study addressed the hypothesis that changes in the microvasculature extend beyond the clinically targeted organ and that dysregulation is a fundamental characteristic of SLE. Methods: The study included SLE pts in whom renal disease was considered active as assessed by proteinuria and urinary sediment. Renal biopsies were performed in all pts. Thirty skin biopsies from non-lesional nonsunexposed skin (buttocks) were obtained in 26 pts (23 females, 3 males) and five healthy controls (4 females, 1 male). The paraffin skin sections were individually stained with specific antibodies against mEPCR and adiponectin (protective markers), ICAM-1 (proinflammatory) and CD31 (pan endothelial marker). Immunohistochemistry (IHC) was scored by counting peroxidase-brown labeled blood vessels (10-20 microns in diameter) without knowledge of the clinical information associated with the biopsy. The number of blood vessels with an intensity of at least 1+ were quantitatively scored with ranges 1-12. To account for the number of blood vessels per slide, the CD31 count had to be 12 to be included in the analysis. Results: The 28 renal biopsies comprised the following ISN/RPS classifications: 4 Class III, 7 Class IV, 8 Class V, I Class VI, 3 Class III/V, 3 Class IV/V. Nineteen percent of the pts had a GFR <60 (mean GFR, 82 ml/min). Abnormal laboratory values for complement and anti-dsDNA antibodies were reported in 72% and 75% of pts, respectively. Nephrotic range proteinuria was present in 37%. For IHC skin assessments of the controls, the mean score for mEPCR was 1 (highest 2), ICAM-1 was 4 (highest 7) and adiponectin was 1 (highest 2). In 17/25 (68%) of the SLE non-lesional non-sun exposed skin sections, mEPCR was expressed above the highest control. In 16/30 (53%) ICAM-1 staining exceeded 7. In contrast, only 6/25 (19%) expressed adiponectin above 2. For each specific stain there were no apparent differences between biopsy class, degree of proteinuria, presence of anti dsDNA or low complement levels. However, pts with mEPCR staining above 2 had higher GFR measurements than those with staining < 2 (88 ml/min +/- 31 versus 53 +/- 32, p= 0.0168). In contrast, GFR was unrelated to ICAM-1 and adiponectin expression. Conclusion: These data are consistent with the notion that there is widespread activation of the microvasculature. The capacity of endothelial cells to utilize anticoagulation pathways is not restricted to the kidney and expression of mEPCR in the microcirculation likely represents an attempt to limit microvascular inflammation in kidney and skin
— id: 130932, year: 2010, vol: 62, page: 1190, stat: Journal Article,

Undifferentiated pleomorphic sarcoma in a child with type 1 neurofibromatosis
Patel, R R; Meehan, S; Orlow, S J
2010 Aug;163(2):431-433, British journal of dermatology
— id: 111345, year: 2010, vol: 163, page: 431, stat: Journal Article,

Necrolytic acral erythema
Patel, Utpal; Loyd, Aaron; Patel, Rishi; Meehan, Shane; Kundu, Roopal
2010 ;16(11):15-15, Dermatology online journal
Necrolytic acral erythema (NAE) is a recently recognized dermatosis almost exclusively associated with hepatitis C virus (HCV) infection and closely related to a group of necrolytic erythemas and metabolic syndromes. NAE is characterized by pruritic, symmetric, well-demarcated, hyperkeratotic, erythematous-to-violaceous, lichenified plaques with a rim of dusky erythema on the dorsal aspects of the feet and extending to the toes. Based on morphology and histopathologic features, NAE can be difficult to distinguish from certain groups of necrolytic erythemas, which include necrolytic migratory erythema, acrodermatitis enteropathica, biotin deficiency, niacin deficiency, and essential fatty acid deficiencies. The condition is particularly important for clinicians to diagnose because the majority of the patients present to dermatologists without a known history of HCV infection. Thus, NAE can serve as a cutaneous marker for underlying HCV infection. Resolution of NAE can be achieved by treatment of the underlying HCV infection and the use of oral zinc therapy
— id: 115805, year: 2010, vol: 16, page: 15, stat: Journal Article,

Pityriasis rotunda
Batra, Priya; Cheung, Wang; Meehan, Shane A; Pomeranz, Miriam
2009 ;15(8):14-14, Dermatology online journal
A 42-year-old man presented with asymptomatic, sharply-demarcated, round, scaly lesions on his forearms that had been present for several months. A skin biopsy specimen was consistent with pityriasis rotunda. Pityriasis rotunda is a disorder of keratinization, which is thought to be a form of acquired ichthyosis, a delayed presentation of congenital ichthyosis, or a cutaneous manifestation of systemic disease. Patients with pityriasis rotunda may be classified into one of two groups, which are based on ethnicity, number of lesions, family history, and association with systemic diseases. Treatment is challenging, but the use of lactic acid lotion and oral vitamin A has shown some promise
— id: 115800, year: 2009, vol: 15, page: 14, stat: Journal Article,

Lichenoid drug eruption
Brauer, Jeremy; Votava, Henry J; Meehan, Shane; Soter, Nicholas A
2009 ;15(8):13-13, Dermatology online journal
A 78-year-old man presented with an eight-month history of folliculocentric, pink, hyperkeratotic papules and plaques with thick white scale that involved the entire body, with confluence on the buttocks and genitalia. A biopsy specimen demonstrated superficial and focal, mild perivascular and perifollicular, band-like lymphocytic infiltrate and eosinophils. There were lymphocytes extending to the dermo-epidermal junction with vacuolar changes. A diagnosis of lichenoid drug eruption secondary to a proton-pump inhibitor was made. To the best of our knowledge, only one other case of lichenoid drug eruption secondary to a proton-pump inhibitor has been reported
— id: 115875, year: 2009, vol: 15, page: 13, stat: Journal Article,

AMELANOTIC MELANOMA: AN ANALYSIS OF 75 CASES
Cheung, W; Meehan, S
2009 JAN ;36(1):141-141, Journal of cutaneous pathology
— id: 91495, year: 2009, vol: 36, page: 141, stat: Journal Article,

Generalized discoid lupus erythematosus
Farley-Loftus, Rachel; Mahlberg, Matthew; Merola, Joseph F; Votava, Henry J; Meehan, Shane; Stein, Jennifer; Shupack, Jerome L
2009 ;15(8):18-18, Dermatology online journal
A 79-year-old woman presented with a four-year history of generalized, erythematous, indurated plaques on the malar areas, back, and extremities. The lesions had been recalcitrant in the past to topical glucocorticoid therapy. A skin biopsy specimen was diagnostic of discoid lupus erythematosus (DLE). A minority of patients with DLE progress to develop systemic lupus erythematosus although generalized DLE is more frequently associated with systemic involvement than is limited disease. Standard therapy of cutaneous lupus includes broad spectrum sunscreens, topical and intralesional glucocorticoids, and antimalarial agents
— id: 108419, year: 2009, vol: 15, page: 18, stat: Journal Article,

Histopathology and X-ray microanalysis of foreign material on facial keratoses
Fernandez, Martin P; Wang, Nadia S; Terzakis, John A; Meehan, Shane A; Kamino, Hideko
2009 May;31(3):232-235, American journal of dermatopathology
Opaque exogenous material was frequently observed on the surface of keratoses during routine sign out by one of us (H.K.). To investigate this material further, 300 consecutive seborrheic keratoses were reviewed: 100 cases from the face of women, 100 cases from the face of men, and 100 cases from the trunk of men and women. All cases were evaluated by light microscopy for the presence and quantity of exogenous material, and 14 cases were studied by x-ray microanalysis to assess its composition. The material was present on 54% of facial keratoses from predominantly older women (mean age 67 years), 5% of facial keratoses from men, and 9% of truncal keratoses from men and women. The x-ray microanalysis showed the presence of a variety of elements, including titanium (13 cases), silicon (12 cases), iron (9 cases), aluminum (8 cases), magnesium (8 cases), zinc (4 cases), barium (2 cases), and bismuth (2 cases). We believe that the exogenous material represents cosmetic products such as colored facial cosmetics, sunscreens, and moisturizers. Further, because the exogenous material was found predominantly on facial keratoses of older women, the presence of this material in a specimen may serve as a clue to the patient's gender, age, and biopsy site
— id: 108281, year: 2009, vol: 31, page: 232, stat: Journal Article,

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes)
Liang, Christine; Gonzalez, Mercedes; Patel, Rishi; Meehan, Shane; Kamino, Hideko; Franks, Andrew G Jr
2009 ;15(8):9-9, Dermatology online journal
A 62-year-old woman with hypothyroidism presented with a seven-year history of paresthesias, itching, and edema of the skin. Physical examination showed indurated, edematous plaques on the lower extremities. A biopsy specimen showed increased mucin deposition that was consistent with myxedema, and monoclonal IgM was observed on immunofixation. The constellation of findings, which included paresthesias, endocrinopathy, monoclonal gammopathy, and skin changes was consistent with POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome, which is a rare multisystemic disease that is associated with an underlying plasma-cell dyscrasia
— id: 105293, year: 2009, vol: 15, page: 9, stat: Journal Article,

Mixed immunobullous disorder most consistent with the IgA-form of epidermolysis bullosa acquisita
Rizzo, Carina; Votava, Henry J; Meehan, Shane A; Kundu, Roopal; Franks, Andrew G Jr
2009 ;15(8):19-19, Dermatology online journal
We describe a case of non-scarring, generalized, cutaneous and mucosal subepidermal bullous dermatosis that is characterized histopathologically by a neutrophilic infiltrate and strong linear staining with both IgA and IgG along the basement-membrane zone. Autoantibodies to collagen VII of both the IgA and IgG4 subtypes were detected by indirect immunofluorescence test, which led led to a diagnosis of epidermolysis bullosa aquisita (EBA). EBA is a subepidermal bullous disorder that is mediated by autoantibodies, which are directed against type VII collagen. The distinct clinical presentations of EBA are reviewed and discussed in the context of the unique autoantibody profile of this case
— id: 107722, year: 2009, vol: 15, page: 19, stat: Journal Article,

Traumatic neuromas of the penis: a clinical, histopathological and immunohistochemical study of 17 cases
Salcedo, Eduardo; Soldano, Anthony C; Chen, Lesley; Rokhsar, Cameron K; Tam, Sam T; Meehan, Shane A; Kamino, Hideko
2009 Feb;36(2):229-233, Journal of cutaneous pathology
We present 17 penile traumatic neuromas. The mean patient age at presentation was 38 years (range 23-59 years). The most common site involved was the penile shaft. The lesions ranged from 1 to 7 mm in greatest dimension. The clinical diagnosis in all cases included condyloma acuminatum. In all cases, a history of trauma because of prior biopsy and/or circumcision was found. Histologically, all lesions showed similar features consisting of an increased number of dermal nerve bundles embedded within a fibrous stroma. Often, single or multiple Meissner corpuscle-like structures were noted in the papillary dermis. Our study suggests that circumcision or other forms of trauma to the skin of the penis likely plays an important role in the pathogenesis and clinical presentation of this peculiar neural neoplasm. We call attention to this entity because it is often clinically misdiagnosed as condyloma acuminatum
— id: 95422, year: 2009, vol: 36, page: 229, stat: Journal Article,

Cutaneous piloleiomyomata
Smith, Gideon; Heidary, Noushin; Patel, Rishi; Rosenman, Karla; Meehan, Shane A; Kamino, Hideko; Sanchez, Miguel
2009 ;15(8):10-10, Dermatology online journal
A 49-year-old man presented with an eight-month history of intermittently painful, subcutaneous nodules that were increasing in size, number, and pain intensity. A biopsy specimen showed smooth muscle proliferation, which also stained positive for actin, and was consistent with piloleiomyoma. The patient was placed initially on gabapentin and then nifedipine with very limited success in pain control. The lesions continued to proliferate, and the patient was referred to surgery for excision
— id: 105292, year: 2009, vol: 15, page: 10, stat: Journal Article,

A CASE OF BASIDIOBOLOMYCOSIS
Votava, H; Paddock, C; Meehan, S
2009 JAN ;36(1):135-135, Journal of cutaneous pathology
— id: 91494, year: 2009, vol: 36, page: 135, stat: Journal Article,

Familial benign chronic pemphigus (Hailey-Hailey disease)
Warycha, Melanie; Patel, Rishi; Meehan, Shane; Merola, Joseph F
2009 ;15(8):15-15, Dermatology online journal
A 57-year-old woman presented with a 27-year history of vesicles and crusted erosions of the intertriginous folds. Prior treatments had included topical glucocorticoids, mupirocin, and minocycline, all of which provided minimal relief. A skin biopsy specimen was consistent with Hailey-Hailey disease. Hailey-Hailey disease is the result of mutations in the ATP2C1 gene and is characterized by recurrent vesicles and erosions in intertriginous areas. Whereas topical and/or systemic antibiotic/antifungal agents in combination with topical glucocorticoids is the mainstay of treatment, case reports have documented dramatic improvement with oral retinoids, calcitriol, and tacrolimus
— id: 105290, year: 2009, vol: 15, page: 15, stat: Journal Article,

Inflammatory morphea in the context of Raynaud phenomenon
Abbasi, Naheed; Firoz, Bahar; Bossenbroek, Nicole M; Meehan, Shane A; Kamino, Hideko; Franks, Andrew G Jr
2008 ;14(10):11-11, Dermatology online journal
A 37-year-old woman presented with a one-year history of asymptomatic, red-brown patches and plaques on the abdomen and extremities, in the context of Raynaud phenomenon and anti-centromere antibodies. Two biopsy specimens confirmed the diagnosis of inflammatory morphea. Even in the absence of initial symptoms to support systemic disease, patients presenting with morphea in the setting of Raynaud phenomenon or anti-centromere antibodies deserve close surveillance for the possibility of CREST syndrome and systemic sclerosis
— id: 95419, year: 2008, vol: 14, page: 11, stat: Journal Article,

Proliferating trichilemmal cyst with focal calcification
Anolik, Robert; Firoz, Bahar; Walters, Ruth F; Meehan, Shane A; Tsou, Hui C; Whitlow, Michael; Wainwright, Brent
2008 ;14(10):25-25, Dermatology online journal
A 64-year-old man presented with a superficial, well-demarcated, skin-colored tumor on the left posterior scalp that measured 4 x 5 x 6 cm. The tumor was nearly hairless, rubbery, non-tender, and mobile over the underlying subcutaneous tissues. The lesion had grown slowly since arising approximately 30 years ago. Treatment options were declined in the past. However, with relatively more rapid growth over the past five years, the nodule began to cause intermittent pain and interfere with the patient's ability to lie on his back. The patient denied a history of similar lesions in himself or his family. A biopsy specimen showed a ruptured proliferating trichilemmal cyst with focal calcification. Complete excision is recommended for all benign proliferating variants owing to their potential for locally aggressive behavior and malignant transformation
— id: 95417, year: 2008, vol: 14, page: 25, stat: Journal Article,

A case of plexiform fibrohistiocytic tumor
Bossenbroek, N; Meehan, S
2008 JAN ;35(1):123-123, Journal of cutaneous pathology
— id: 87187, year: 2008, vol: 35, page: 123, stat: Journal Article,

Chronic cutaneous lupus erythematosus in vitiligo
Johnson, Hillary; Bossenbroek, Nicole M; Rosenman, Karla; Meehan, Shane A; Robles, Mirin; Pomeranz, Miriam K
2008 ;14(10):10-10, Dermatology online journal
A 49-year-old woman presented with a seven-year history of pruritic, erythematous, scaling plaques on sun-exposed skin that localized only to pre-existing depigmented patches. Histopathologic examination showed changes consistent with cutaneous lupus erythematosus with lichenoid features and confirmed contiguous vitiligo. Diagnosis of chronic cutaneous lupus erythematosus localized to areas of vitiligo was determined by clinicopathologic correlation and may reflect an autoimmune diathesis. Consequently, hydroxychloroquine and topical glucocorticoids therapy were initiated with reported improvement in pruritus, erythema, and scale. Clinical monitoring for development of squamous-cell carcinoma in areas of chronic inflammation and sun-exposure is imperative
— id: 95420, year: 2008, vol: 14, page: 10, stat: Journal Article,

Lichen planopilaris and psoriasis
Lane, Tameka K; Kamino, Hideko; Walters, Ruth F; Meehan, Shane; Pomeranz, Miriam K
2008 ;14(10):4-4, Dermatology online journal
A 34-year-old woman presented with large, scaly patches of alopecia with a peripheral rim of violaceous, folliculocentric papules and appreciable pruritus of one-year duration. Histopathologic examination showed changes consistent with lichen planopilaris and psoriasis, which was suggested by neutrophilic spongiosis. Consequently, cyclosporine and betamethasone valerate topical 0.12 percent foam twice daily were initiated. A short time after, there was clinical reduction of perifollicular erythema and attenuation of pruritus. However, there was no decrease of scale. Although LLP is classified in the lymphocytic group of cicatricial alopecias, this case demonstrates a clinical and histopathologic overlap with a psoriasiform dermatosis which may represent a collision of two diseases
— id: 95642, year: 2008, vol: 14, page: 4, stat: Journal Article,

Traumatic penile neuromas clinicopathological correlation of 17 cases
Meehan, S; Soldano, A; Kamino, H
2008 JAN ;35(1):146-146, Journal of cutaneous pathology
— id: 87189, year: 2008, vol: 35, page: 146, stat: Journal Article,

Exogenous ochronosis
Merola, Joseph F; Meehan, Shane; Walters, Ruth F; Brown, Lance
2008 ;14(10):6-6, Dermatology online journal
A 55-year-old woman with melasma develops biopsy-proved exogenous ochronosis in the setting of prolonged topical hydroquinone use. A limited number of similar reports exist in the US literature and are the basis for an FDA call to review hydroquinone-based products. This case underscores the difficult therapeutic dilemma which this diagnosis presents to dermatologists
— id: 115716, year: 2008, vol: 14, page: 6, stat: Journal Article,

Tufted angioma
Schaffer, Julie V; Fangman, William; Bossenbroek, Nicole M; Meehan, Shane A; Kamino, Hideko
2008 ;14(10):20-20, Dermatology online journal
A 4-month-old girl developed coalescing, red-purple, firm plaques with irregular borders and superimposed papules in the left groin. The lesions were tender to palpation and they slowly expanded and became thicker over the next year. Histopathologic evaluation showed multiple, discrete lobules of tightly packed capillaries in a 'cannonball' pattern within the dermis, which confirmed the diagnosis of tufted angioma. The clinical and histopathologic features, natural history, and treatment options for tufted angiomas are reviewed; their relationship to kaposiform hemangioendotheliomas is discussed
— id: 95418, year: 2008, vol: 14, page: 20, stat: Journal Article,

Cutaneous solitary fibrous tumor: a report of 2 cases and review of the literature
Soldano, Anthony C; Meehan, Shane A
2008 Feb;30(1):54-58, American journal of dermatopathology
Solitary fibrous tumor is an uncommon mesenchymal neoplasm that can arise in both pleural and extrapleural locations. Composed of spindled cells intimately admixed with collagen bundles arranged in a 'patternless pattern,' this heterogeneous tumor can mimic a variety of benign and malignant mesenchymal neoplasms. We present the histological and immunohistochemical findings of two primary cutaneous solitary fibrous tumors, discuss the differential diagnosis, and review the literature. Although solitary fibrous tumors in cutaneous and subcutaneous regions are extremely rare, it should be considered in the differential diagnosis of primary spindle cell neoplasms of the skin
— id: 76461, year: 2008, vol: 30, page: 54, stat: Journal Article,

Steroid-responsive facial eruption with cornoid lamellae--a possible new entity
Tran, Hien; Bossenbroek, Nicole M; Rosenman, Karla; Meehan, Shane A; Sanchez, Miguel; Prystowsky, Stephen
2008 ;14(10):9-9, Dermatology online journal
The histopathologic presence of a cornoid lamella is often associated with a diagnosis of porokeratosis. However, this feature is not pathognomonic for porokeratosis and can be found in a number of other dermatologic conditions, which include seborrheic keratosis, verruca vulgaris, actinic keratosis, squamous-cell carcinoma in situ, basal-cell carcinoma, milia, and scar. Notably, the etiology of none of these entities is inflammatory. Wade and Ackerman consider cornoid lamellation to be a distinctive histopathologic reaction pattern that reflects the disordered progression of epidermal cells during cornification. As such, this pattern is not specific for any given disease process. We report a case in which the lesions appeared inflammatory clinically as well as histopathologically, did not resemble porokeratosis despite the presence of cornoid lamellae, and responded to topical glucocorticoids
— id: 95421, year: 2008, vol: 14, page: 9, stat: Journal Article,

Cutaneous and systemic plasmacytosis
Leonard, Aimee L; Meehan, Shane A; Ramsey, David; Brown, Lance; Sen, Filiz
2007 Feb;56(2 Suppl):S38-S40, Journal of the American Academy of Dermatology
— id: 71335, year: 2007, vol: 56, page: S38, stat: Journal Article,

Cutaneous solitary fibrous tumor: A report of two cases and review of the literature
Soldano, A; Meehan, S
2007 JAN ;34(1):135-135, Journal of cutaneous pathology
— id: 71042, year: 2007, vol: 34, page: 135, stat: Journal Article,

Neutrophilic eccrine hidradenitis masquerading as facial cellulitis
Srivastava, Monika; Scharf, Susan; Meehan, Shane A; Polsky, David
2007 Apr;56(4):693-696, Journal of the American Academy of Dermatology
Neutrophilic eccrine hidradenitis typically manifests as erythematous plaques on the face, trunk, or extremities. This eruption has been associated with numerous factors, but most commonly is seen with chemotherapy, particularly cytarabine. We report a 73-year-old woman with acute myelogenous leukemia who developed rapidly expansive neutrophilic eccrine hidradenitis mimicking facial cellulitis only after a course of cytarabine was followed by granulocyte-colony stimulating factor. Prompt diagnosis is imperative to prevent prolonged antimicrobial therapy
— id: 71204, year: 2007, vol: 56, page: 693, stat: Journal Article,

Fabry disease: an atypical presentation
Choudhury, Sourab; Meehan, Shane; Shin, Helen T
2005 Jul-Aug;22(4):334-337, Pediatric dermatology
Fabry disease is a rare X-linked recessive lysosomal storage disease. Patients typically have angiokeratomas distributed between the umbilicus and knees, painful crises of the hands and feet, and renal, ophthalmologic, and cardiac abnormalities. An 11-year-old boy presented with a 6-year history of widespread petechial-like lesions and painful crises of the hands and feet. On physical examination, he had numerous erythematous, nonblanching pinpoint macules and rare papules with an overlying crust. These lesions were widely distributed on his trunk, palms, and soles, while sparing the area between the umbilicus and knees. Histologic evaluation of one of these lesions found several dilated, blood-filled vessels in the upper dermis beneath a thinned epidermis. The patient also had markedly decreased alpha galactosidase A levels. Although the distribution of the angiokeratomas was atypical, the clinical and histologic findings were consistent with a diagnosis of Fabry disease
— id: 94717, year: 2005, vol: 22, page: 334, stat: Journal Article,

Improved identification of potentially dangerous pigmented skin lesions by computerized image analysis
Jamora, Maria Jasmin; Wainwright, Brent D; Meehan, Shane A; Bystryn, Jean-Claude
2003 Feb;139(2):195-198, Archives of dermatology
BACKGROUND: Melanoma is completely curable if resected early. Unfortunately, early melanoma can be difficult to differentiate from other pigmented lesions. Computerized image analysis instruments have now been developed to assist in determining whether a pigmented lesion is potentially dangerous and requires biopsy. To evaluate whether one such instrument can improve the management of pigmented lesions, we obtained biopsy specimens from 52 pigmented lesions that appeared clinically benign to an experienced dermatologist but were suspicious by image analysis. OBSERVATION: Histologically, 9 (17%) of the lesions that were removed based solely on computer recommendation were potentially dangerous and should have been removed. These included 1 malignant melanoma in situ and 8 dysplastic nevi with moderate to severe cytologic atypia. CONCLUSION: The results of the present study indicate that computerized image analysis can improve the evaluation of pigmented skin lesions by identifying clinically unsuspicious, but potentially dangerous, lesions that might have otherwise have been neglected
— id: 39300, year: 2003, vol: 139, page: 195, stat: Journal Article,

Capecitabine induced cutaneous hyperpigmentation: report of a case
Pui, John C; Meehan, Shane; Moskovits, Tibor
2002 Sep;1(2):202-205, Journal of drugs in dermatology : JDD
We report an unusual case of cutaneous and mucosal hyperpigmentation in a thirty-six year old African American woman who was receiving capecitabine chemotherapy for Stage IV breast carcinoma. Possible etiologies for the hyperpigmentation are discussed. To our knowledge, this is the first reported case of capecitabine associated cutaneous hyperpigmentation
— id: 39157, year: 2002, vol: 1, page: 202, stat: Journal Article,

Extensive Riga-Fede disease of the lip and tongue
Zaenglein, Andrea L; Chang, Mary Wu; Meehan, Shane A; Axelrod, Felicia B; Orlow, Seth J
2002 Sep;47(3):445-447, Journal of the American Academy of Dermatology
Riga-Fede disease presents in early infancy and is characterized by firm, verrucous plaques arising on the oral mucosal surfaces. These histologically benign lesions occur as a result of repetitive trauma of the oral mucosal surfaces by the teeth. Early recognition of this entity is important, because it may be the presenting sign of an underlying neurologic disorder. We report the case of a 10-month-old boy with extensive Riga-Fede disease involving the lip and tongue that prompted a diagnosis of congenital autonomic dysfunction with universal pain loss
— id: 34782, year: 2002, vol: 47, page: 445, stat: Journal Article,

Congenital granular cell tumors localized to the arm
Zaenglein AL; Meehan SA; Orlow SJ
2001 May-Jun;18(3):234-237, Pediatric dermatology
We report an instance of congenital granular cell tumors localized to the arm of a female infant. While granular cell tumors are well described during infancy as congenital epulis of the oral cavity, this case is unusual in both its location and histologic characteristics. The lesions, located around the antecubital fossa, were comprised of CD34-positive, S-100-negative granular cells. In addition, there were numerous eccrine glands in the upper dermis. The salient features of the case are discussed and reviewed in the context of the literature pertaining to this unusual entity
— id: 21152, year: 2001, vol: 18, page: 234, stat: Journal Article,

Clear cell myomelanocytic tumor of the falciform ligament/ligamentum teres: a novel member of the perivascular epithelioid clear cell family of tumors with a predilection for children and young adults
Folpe AL; Goodman ZD; Ishak KG; Paulino AF; Taboada EM; Meehan SA; Weiss SW
2000 Sep;24(9):1239-1246, American journal of surgical pathology
The perivascular epithelioid cell family of tumors (PEComas), defined by their co-expression of melanocytic and muscle markers, includes angiomyolipoma, lymphangioleiomyoma, and clear cell 'sugar' tumors of the lung, pancreas, and uterus. We present seven cases of a unique and previously unrecognized tumor of children and young adults, which represents a new addition to the PEComa group of tumors. Culled from three institutions over a 50-year period, all cases occurred in or immediately adjacent to the ligamentum teres and falciform ligament. Six patients were female and one male; their ages ranged from 3 to 21 years (median, 11 yrs). Tumor sizes ranged from 5 to 20 cm (median, 8 cm). All cases consisted of clear to faintly eosinophilic spindled cells arranged in fascicular and nested patterns. The cells had small but distinct nucleoli and low mitotic activity. Immunohistochemically, all cases were positive with antibodies to gp100 protein (HMB-45) and negative for S-100 protein. In three of the seven cases studied immunohistochemically, the tumors expressed smooth muscle actin, melan-A, microphthalmia transcription factor (MiTF), and myosin, but not desmin. No expression of the TSC2 gene product, tuberin, was seen in three cases. One case studied cytogenetically disclosed a t(3;10). Follow-up data, available in six of seven cases (median duration, 18 mos), showed five patients to be free of disease and one to have a radiographically presumed lung metastasis. We think these tumors comprise a new entity for which we propose the term 'clear cell myomelanocytic tumor of the falciform ligament/ligamentum teres.' The differential diagnosis of these tumors includes clear cell sarcoma of tendons and aponeuroses, leiomyosarcoma, and angiomyolipoma
— id: 24339, year: 2000, vol: 24, page: 1239, stat: Journal Article,

Basal cell carcinoma with tumor epithelial and stromal giant cells: a variant of pleomorphic basal cell carcinoma
Meehan SA; Egbert BM; Rouse RV
1999 Oct;21(5):473-478, American journal of dermatopathology
A case of basal cell carcinoma with giant cells of the central epithelial and surrounding stromal components is presented. The lesion was an 8-mm dome-shaped papule on the ear of a 66-year-old man. The giant cells of the epithelial component shared the immunophenotype of the more typical cells of the basal cell carcinoma (keratin, smooth muscle actin, and bcl-2 positive), whereas the stromal giant cells were positive only for bcl-2. This case represents a peculiar variant of pleomorphic basal cell carcinoma, the significance of which is unknown
— id: 24340, year: 1999, vol: 21, page: 473, stat: Journal Article,

Dermatofibrosarcoma protuberans of the oral cavity
Meehan SA; Napoli JA; Perry AE
1999 Nov;41(5 Pt 2):863-866, Journal of the American Academy of Dermatology
Dermatofibrosarcoma protuberans (DFSP) is a low grade, malignant spindle cell tumor with an infiltrative growth pattern and a high rate of local recurrence. This tumor's cell of origin is controversial. DFSP usually presents in adult life and is most frequently located on the trunk and proximal extremities. Although 10% to 15% of cases involve the head and neck, this tumor has not been previously described in the oral cavity
— id: 24341, year: 1999, vol: 41, page: 863, stat: Journal Article,

Cutaneous Langerhans cell histiocytosis of the genitalia in the elderly: a report of three cases
Meehan SA; Smoller BR
1998 Aug;25(7):370-374, Journal of cutaneous pathology
Langerhans cell histiocytosis (LCH) is a disease with a broad spectrum of clinical presentations. All of the variants have in common the proliferation of cells which are morphologically, biochemically, and immunophenotypically indistinguishable from Langerhans cells. A retrospective study of three elderly patients revealed the unique presentation of cutaneous Langerhans cell histiocytosis limited to the genitalia. These cases produced a diagnostic challenge because of their unusual clinical presentation and their morphological similarity to certain other entities, including extramammary Paget's disease and malignant melanoma, which may also show S-100-positive atypical cells. All three cases showed infiltrates of histiocytic-appearing cells with folded nuclei and moderate amounts of cytoplasm which involved the epidermis, dermis, or both. Immunoperoxidase studies using antibody to S-100, CD1a and CD68 in each case showed positive staining
— id: 24342, year: 1998, vol: 25, page: 370, stat: Journal Article,

Spitz's nevi with halo reaction: a histopathologic study of 17 cases
Harvell JD; Meehan SA; LeBoit PE
1997 Nov;24(10):611-619, Journal of cutaneous pathology
Halo reactions to melanocytic nevi are a well-recognized phenomenon. In contrast, halo reactions to Spitz's nevi have been reported only infrequently. Halo reactions may cause misdiagnosis of an otherwise benign nevus as melanoma because inflammatory cells sometimes obscure the architectural features of the underlying nevus, and may induce cytologic atypia. For Spitz's nevus where the distinction between malignancy and benignancy is already challenging, halo reactions compound the problem. We describe 17 examples of Spitz's nevus with halo reaction, and compare their immunohistochemical features with those of 'ordinary' halo nevi. Only 2 of 17 lesions demonstrated clinically apparent halos. Clinical follow-up was available for 12 of 17 cases. None of the 12 has persisted at the biopsy site or metastasized after an average 3.6-year follow-up period. Junctional, compound, intradermal, and combined types of Spitz's nevi were represented. All were characterized by symmetrical lymphocytic infiltrates which permeated the full thickness of the nevus, including junctional nests. Combined Spitz's nevi constituted more than one-half of examples in this series (9/17 cases). The combined Spitz's nevus included a combination of Spitz's nevus with either an ordinary (common, banal) nevus or a superficial congenital type nevus. In these combined Spitz's nevi, the lymphocytic response was often directed exclusively to the Spitz's nevic component. Important distinguishing features from malignant melanoma arising in a pre-existing nevus included symmetry and lateral circumscription of the spitzoid component, no large expansile-appearing aggregates of melanocytes, a decrease in size of nests with increasing dermal depth, a lack of mitotic figures among melanocytes at the base, and a symmetrical and diffusely permeative lymphocytic response. Although the combined Spitz's nevus with halo reaction sometimes appeared asymmetrical at scanning magnification, each component of the combination was symmetrical, when examined independently. Probably because of reactive atypia, nuclear maturation with progressive descent into the dermis was sometimes absent. There were no obvious differences in immunohistochemical staining patterns among 4 Spitz's nevi with halo reaction, 5 regressing melanomas, and 5 benign halo nevi when stained with antibodies to S100, HMB-45, OPD4, CD8, TIA-1, CD1a, CD68, and Ki-67
— id: 24343, year: 1997, vol: 24, page: 611, stat: Journal Article,

An immunohistochemical analysis of radiation fibroblasts
Meehan SA; LeBoit PE
1997 May;24(5):309-313, Journal of cutaneous pathology
A commonly recognized feature of chronic radiation dermatitis is the presence of mesenchymal cells with large atypical nuclei known as radiation fibroblasts. Little is known about their lineage or potential for neoplastic transformation. To investigate these properties, we examined 16 biopsy specimens in which radiation fibroblasts were present with antisera to mesenchymal determinants (FXIIIa, CD34, HHF-35), a proliferation marker (Ki-67), and a tumor-suppressor protein that is overexpressed in many cancers (p53). Radiation fibroblasts were largely negative for the markers of lineage that we employed - only 2 of 16 specimens showed strong expression of FXIIIa, with weak expression in another case. Scattered radiation fibroblasts expressed CD34 in one case. HHF-35 (muscle specific actin) stained small, dendritic cells in the superficial dermis, but not radiation fibroblasts. P53 was not detected within radiation fibroblasts in any of our cases, but was overexpressed by endothelial cells in 2 cases. Ki-67 stained rare endothelial and interstitial cells but not radiation fibroblasts. Radiation fibroblasts are immunophenotypically distinct from dermal dendrocytes and myofibroblasts. They appear to be non-cycling cells, and do not express high levels of p53 despite their marked nuclear atypia. Their phenotype argues against their possible role as progenitors of atypical fibroxanthoma (AFX) and dermatofibrosarcoma protuberans (DFSP) which are associated with ionizing radiation-induced skin damage
— id: 24344, year: 1997, vol: 24, page: 309, stat: Journal Article,