Introduction: Integrated counseling and testing (ICTC) for HIV is a cost-effective intervention in preventing the spread of HIV transmission and is an integral part of HIV prevention program, which provides an opportunity to learn and accept the HIV status in a comfortable, convenient, and confidential manner. Material and Methods: A retrospective study of 3600 attendees visiting the ICTC centre from April 2010 to April 2011was undertaken. The study included 3600 attendees who came either voluntarily or referred by various department of this institute. Dominant reason for visiting ICTC was the history/presence of high risk behavior (HRB). Results: 60% indulged in heterosexual route; other HRB including men having sex with men or MSM were 5% and injecting drug users or IDU) were 15%. There were more positive among males, 21-40 years of age group, those living singly, unmarried, divorcee, widow(er) and separated. Similarly positives were more amongst illiterates, less educated and those engaged in unskilled and semi skilled jobs. Adolescent students (>14 years) accounted for one-fifth of the total positives. Direct walk in clients were more positive compared to those referred by doctors. Overall sero positivity was 4.8%; high in males, 21-40 years age, unmarried and divorcee etc. Conclusions: Sero prevalence decreased with improvement in education and also with improvement in job nature. It was also high in those living alone compared to those staying with their family.

Hayder et al [1] described a well-conducted clinical trial comparing topical erythromycin-Zinc acetate complex lotion against topical erythromycin get in treating patients with acne vulgaris of mild to moderate severity. This study bears several limitations, such as its being single-blinded, a predetermined recruitment period not clearly delineated, the response rate and completion rate unclear, and the randomisation process, if any, not being explicit. However, the authors courageously admitted some of these limitations.

Introduction: In Mauritius, studies on skin problem are limited to adults only and no reports are available on skin health of infants and toddlers. The aim of this study is to determine the prevalence of skin problem among infants and toddlers and to investigate whether there is an association between socioeconomic status and education level of parents on skin problem of infants and toddlers. Material and Methods: Survey data was collected from 500 parents that have children between the age of 1 month till 5 years. A questionnaire was distributed to elicit information on family history, socioeconomic and education details of parents, hygiene level and level of awareness of parents on skin problems and data was analysed using SPSS. Results: Skin problems were mostly nappy rashes, eczema and skin rashes. Itching has been noted to be the most prevalent among infants and toddlers with a prevalence of 22%. Socioeconomic status and education level of parents have an effect on prevalence of skin problem. A high percentage of parents possess good knowledge on hygiene, risks factors and concern towards the skin health of the child. Conclusions: There is a high prevalence of skin problem noted among infants and toddlers. Children having parents with low socioeconomic status and low education level have a higher incidence of skin problem. The majority of parents show high concern on skin health of their children.

Introduction: The etiopathogenesis of acne vulgaris is multifactorial, and its therapy is prolonged course that might be not accepted by many patients. Most recently TCA 35% one session peeling gave complete clearance and full remission for active acne vulgaris. Lactic acid has been used effectively as therapeutic topical agents for many skin diseases. Aim: To evaluate the efficacy and safety of chemical peeling using 88% lactic acid solution in the treatment of active acne vulgaris. Material and Methods: This clinical, interventional, therapeutic study was done at the Department of Dermatology, Baghdad Teaching Hospital, during the period from October 2012 to October 2013. Twenty five patients with active acne vulgaris were included, 15 (60%) females and 10 (40%) males and their ages ranged from 16-36 (21.5000± 5.46279) years. Fifteen patients were associated with acne scars. Three chemical peels using 88% lactic acid solution was carried out two weeks apart for patients with active acne vulgaris with or without scarring. Scoring for active acne vulgaris and acne scar was done for each case before and after operation to evaluate the severity of acne and the degree of scar before and after treatment. All patients were with Fitzpatrick’s skin types III and IV. Patients were followed up every two weeks during period of therapy and monthly for 3 months after stopping the treatment. Results: Twenty five patients with active acne vulgaris were treated with 3 sessions of lactic acid, fifteen patients had associated acne scar. Scoring for active acne vulgaris including papules and pustules showed highly statistically significant reduction after 2 weeks of therapy (p=0.0001), after 4 weeks (p=0.0001)and after 6 weeks (p=0.0001), with percent reduction 87.2% for papules and 94% for pustules after end of sessions while after 3 months follow up the reduction rate for papules 93.8% and p-value (p=0.001) and for pustules 97.6% and (p=0.0001). While the scarring reduction was moderate in 3 (20%) patients, marked in 3 (20%) patients and excellent in 9 (60%) patients with statistically significant reduction (p=0.002). All patients had full satisfaction about the results of peeling. Post inflammatory hyperpigmentation was observed few weeks after peeling but follow up for 3 months showed complete clearance of pigmentation with lightening and tightening of skin. Conclusions: Chemical peeling using 88% lactic acid is an effective mode of therapy for active acne vulgaris and acne scar in patient with dark complexion.

Introduction: The incidence of skin cancer is increasing at an alarming rate. Non melanoma skin cancer (NMSC) is the most common cancer affecting white individuals. Skin Cancer registration in Northern Africa is still limited and, until now, there have been no population-based data available for Libya. We perform the first epidemiological analysis of non melanoma skin cancer (NMSC) in Tripoli/ Libya during 5years period between 2006-2010. Aim: To discuss current epidemiologic data concerning incidence and demographic variation. To compare our findings with those of published reports from other regions. Material and Methods: All histopathologically proven cases of (NMSC) reported during the years 2006 through 2010 were retrieved and reviewed. 70% of the data were electronically stored. Information regarding tumor type, age, gender, and anatomical location were collected. Results: A total of 579 cases of (NMSC) were diagnosed between the years 2006 and 2010. Basal cell carcinoma (BCC) was the commonest type, representing 76.9% of all skin cancers. Males were more frequently affected than female. Conclusions: We concluded that (NMSC) in Tripoli/Libya is not uncommon problem. Ascertainment of NMSC should improve since the advent and use of electronic pathology data. Ongoing increases in age-adjusted incidence, combined with ageing of the population, will have major implications for the clinical workload associated with (NMSC) for the foreseeable future.

Introduction: Psoriasis is one of the most common chronic inflammatory diseases, affecting about 3.5% of the population. Despite psoriasis carries a high risk of morbidity, few epidemiological studies provide estimates on the prevalence of psoriasis in children. Aim: The objective of this study is to report the frequency of children and adolescents diagnosed with psoriasis at Instituto Dermatologico y Cirugía de Piel “Dr. Huberto Bogaert Díaz” (IDCP-DHBD) between March 2007 and March 2012. Material and Methods: Examination were done on 76 children and adolescents with psoriasis confirmed by histopathological examinations at the IDCP DHBD in the Dominican Republic between March 2007 and March 2012. The data was retrospectively reviewed to assess age, gender, clinical localization, treatment modalities and delay in diagnosis. Results: The frequency of children and adolescents with psoriasis among dermatological patients was 0.96 cases for every 10,000 patients seen in the Institute. There were 43 (56.6%) girls and 37 (43.4%) boys. The mean age of onset was 14 years. Children from 0-2 years, were the least affected with 3% of the cases. The most frequent site of onset were the trunk (28.8%) and the scalp (27.4%). 67% of the patients had 2 or more sites involved. The mean delay in diagnosis was 6 months. Topical therapy was the treatment of choice in all the patients except one. Conclusions: Even though psoriasis may cause a profound impact on the quality of life of children and adolescents the epidemiological data in the countries of Central America and the Caribbean is scarce.

Amongst the principal targets the New Organic Cosmetic (and peculiarly the modern “Juice Beauty Care” based on the use of juices from fruits and polychrome herbs) heralds, there is the fact that it is advisable that the extraction must be done “naturally” from all vegetables, randomly collected and these vegetables may contain degraded chlorophyll and its derivative phylloeritrin, that is a very important photosensitizing agent, since the ripening of most fruits and some vegetables is characterized by rapid decrease of chlorophyll levels coupled with rapid increase of pigments. This involves the presence of extreme severe photosensitising agents in natural cosmetics belonging to the category of the “make up and decorative” ones, as eye-shadows, foundations, pencils, fards aux paupiers, coloured creams and pastes. Aims of my study is to determine how much the presence of these photosensitising agents in Organic cosmetics may damage human skin, when covered by natural maquillage products and then exposed to sun. For this purpose I have recruited 20 women in a government prison that decided voluntarily to undergo my experiments, based on the simple application of natural make up cosmetics before to have their out of cell time, during summer days at noon. Final evaluations of photosensitization have been carried out along with the clinical scoring scale drawn up by the International Contact Dermatitis Research Group (ICDRG).

Introduction: Topical antibiotics are the main step in the treatment of mild to moderate acne vulgaris. Erythromycin is one of the effective topical therapies for this disease. Zinc sulfate 5% solution was reported to be effective in treatment of acne vulgaris and rosacea. Aim: To compare the effectiveness and side effects of topical erythromycin in combination with zinc and erythromycin alone in treatment of mild to moderate acne vulgaris. Material and Methods: This single, blind, therapeutic, comparative study was done in the Department of Dermatology – Baghdad Teaching Hospital, Baghdad, Iraq; from May 2012 – August 2013.Scoring of acne was carried out and the patients were examined every two weeks for 10 weeks of treatment. One month after stopping drugs, patients were evaluated for drug complications and disease recurrence. Eighty patients fulfilling enrollment criteria were included in this study. Patients were divided into two groups: Group A (40 patients) treated twice daily with topical erythromycin-zinc complex lotion and Group B (40 patients) treated twice daily with topical 2% erythromycin gel. Results: Both topical erythromycin-zinc lotion and erythromycin gel were statistically an effective therapy starting after 6 weeks treatment and up to 4 weeks after stopping treatment. Erythromycin-zinc lotion was more effective and act earlier than erythromycin gel starting from 4 weeks of therapy till the end of treatment (after 10 week) and even after 4 weeks after stopping the treatment (p value <0.0001). Conclusions: Erythromycin-zinc complex lotion was an effective and well tolerated topical therapy for mild to moderate inflammatory acne vulgaris and was more effective than erythromycin gel alone.

Aim: To evaluate the number of lesions of psoriasis and to find risk factors for multiple lesions. Material and Methods: 1,236 patients (male 54.13%, female 45.87%) with psoriasis were seen over a period of 8 years in an Outpatient Clinic. Patients filled out questionnaires containing age at onset, number of lesions and location at the beginning of the disease, gender, type and localization of psoriasis at the time of clinical examination, psoriasis family history, previous treatment, comorbidities, and social status. Results: The number of psoriasis lesions correlates with: onset age of psoriasis (F=8.902, p=0.0029); age at the moment of clinical examination (F=8.902, p=0.0029); residence in rural area (χ2=8.589, p=0.00338, 95%CI); alcohol intake (χ2=16.47, p=0.00005, 95%CI); smoking (χ2=8.408, p=0.00373, 95%CI); occupation: workers/pupils/students (χ2=14.11, p=0.0069, 95%CI). Conclusions: There is a correlation between number of psoriatic lesions and some factors. Multiple lesions were observed in older patients, smokers and drinkers, coming from rural area and social active (workers and pupils/students). No correlation was statistically proved between number of lesions and gender, comorbidities and family history of psoriasis.

Introduction: The nail fold video capillaroscopy allows the study of micro vascular abnormalities in autoimmune rheumatic diseases. Aim: Report a case of Raynaud’s phenomenon, in which images of video capillaroscopy correlate with disease course. Case Report: Patient with Raynaud’s phenomenon that after ten years of evolution develops pulmonary hypertension. The progression of micro vascular disease in the nail fold and lip mucosa was studied. Discussion: Scleroderma pattern progresses in successive controls were observed in studies of video capillaroscopy. Pro-angiogenic and anti-angiogenic factors may trigger the formation of micro vascular changes during systemic scleroderma. The same can be correlated with lung involvement. Conclusion: Images of video capillaroscopy collaborate with the diagnosis and prognosis in the spectrum of Systemic Scleroderma..

Gorlin syndrome or basal cell nevus syndrome (BCNS) is a rare autosomal dominant disorder. The condition appears to have complete penetrance and variable expressivity, which makes clinilcal presentation among families variable. All known BCNS carry mutations in PATCHED gene. A 65 years old male patient presented with complaints of characteristic skin lesions on his face, back, palms since early adulthood. The lesions were pigmented nodules with characteristic border. The histopathology showed characteristic features suggestive of Basal Cell Carcinoma (BCC). This case was atypical due to appearance of lesions quite later in life.

Kikuchi Fujimoto disease (KFD) was first described in Japan in 1972 almost simultaneously by Kikuchi and Fujimoto. It is a rare, self-limiting, benign form of histiocytic necrotizing lymphadenitis, which can be mistaken for tuberculosis, lymphoma or systemic lupus erythematosus. Although the pathogenesis of KFD is not fully understood, infectious and autoimmune etiologies have been proposed. It generally presents as cervical lymphadenopathy with associated systemic signs and symptoms. Definitive diagnosis requires histopathological examination of the affected lymph nodes. There are only few cases described in the literature, as far as we are aware we report the first case of KFD in the Dominican Republic.

There is a high mortality rate in Stevens Johnson Syndrome (SJS) and it ranges between 5%-15%. At present, there is no definite consensus regarding treatment in SJS although the effectiveness of intravenous immunoglobulin’s (IVIg) and immunosuppressive like cyclosporine have generated new hopes in the lives of these patients. But the options of combination therapy of steroids, IVIg and Placentrex gel have not been fully exercised in SJS. Henceforth, we report a case of Nimesulide induced SJS; managed successfully with a combined approach without any recurrence during a 12 months follow-up.

There is paucity in world literature regarding the simultaneous occurrence of Becker’s nevus and ipsilateral acanthosis nigricans in the same individual. There is only case reported previously in world literature. We speculate that our case may further strengthen the view of probable, more than a chance, association of these two entities and suggest need for further exploration of the role of androgen receptors in such cases.

Introduction: A clinical “halo nevus” is a benign melanocytic-neoplasm, often exhibiting spontaneous involution. A characteristic clinical feature is depigmentation of the surrounding skin, and a centripetal progression of the tumor regression phenomenon. Case Report: An 18 year old male consulted the dermatologist for changes in color of an asymptomatic mole. Materials and Methods: A clinical evaluation was performed, and skin biopsies were obtained for hematoxylin and eosin (H&E) review, and for immunohistochemical (IHC) studies including CD3, CD4, CD8, CD20, CD68, CD99, myeloid/histiocyte antigen, S-100, PNL2 and SOX-10. Results: A neoplastic process was identified on H&E examination, located along the dermal/epidermal junction and within the dermis. The neoplasm was composed of nests, cords and strands of benign melanocytes, with infiltrating lymphocytes. IHC staining demonstrated a strong pattern of positivity with all of the IHC antibodies within, infiltrating and surrounding the primary neoplastic process. In addition, evidence of the primary tumor immune response was noted around surrounding blood vessels and hair follicles, and on adjacent epidermal melanocytes. Conclusions: In the present study, we demonstrate by histopathologic and immunologic evidence that lymphocytes are primarily responsible for halo nevus tumor regression. Moreover, the immune response involves not only CD8 positive T lymphocytes, but a larger spectrum of B and T lineage lymphocytes. Thus, the immunologic foundations of halo nevus regression are likely of greater complexity than previously determined.

Exogenous ochronosis is an infrequent dermatosis characterized by dark blue hyperpigmentation. It may be caused largely by hydroquinone, a fenolic compound which is used in the treatment of melasma and other skin hyperpigmentation. The exact etiopathology is still not understood and the results of various treatments offered are unsatisfactory. We present a case of exogenous ochronosis which resembled melasma but clinicopathologic evaluation led to the correct diagnosis. We also emphasize the need to restrict the indiscriminate use of hydroquinone containing compounds without medical prescription.

Lymphomatoid papulosis (LyP) is an indolent form of primary cutaneous T-cell lymphoma, currently classified together with primary cutaneous anaplastic large T-cell lymphoma within the spectrum of CD30-positive lymphoproliferative disorders. It is characterized by presenting as a clinically benign but histopathological malignant disease. Clinical features consist in recurrent waxing and waning red papules. Histopathologically, there are 4 variants recognized, Type A or Hystiocitic type, being the most frecuent of all, Type B or Mycosis fungoides-like, Type C or Anaplastic large-cell lymphoma-like and Type D, the most recently described and uncommon variant with features similar to Cutaneous Aggressive CD8-Positive Cytotoxic T-Cell Lymphoma. We present a case of a 22-year-old female with multiple papules and nodules in trunk and limbs that after histopathological and immunochemical examination was compatible with Type D LyP. It is important to report this case, as a perfect example of an uncommon variant of LyP, with emphasis in its typical clinical, histopathological and inmunohistochemical findings and review of the literature.

Photoexposed area involvement in acute febrile neutrophilic dermatosis is uncommon and has rarely been described in literature. We report a case of photodistributed Sweets syndrome in a middle aged lady who responded to symptomatic treatment with NSAID and systemic antibiotic. Sweets syndrome is an uncommon inflammatory disorder characterized by the abrupt appearance of painful, oedematous and erythematous papules and plaques or nodules on the skin. Fever and leukocytosis frequently accompany cutaneous lesions. Our patient presented with fever and abrupt onset of painful erythematous plaques over exposed parts of the body.

Xeroderma pigmentosum (XP) is a rare autosomal recessive disorder characterized by photosensitivity, cutaneous pigmentary changes, premature skin ageing, and the development of various cutaneous and internal malignancies at an early age. We present this case of a 10 year-old girl in a developing country like India, with significant corneal scarring and multiple cutaneous skin lesions in sun-exposed areas. Developmental delay had been present since 3 months of age, with these clinical features it was consistent with Xeroderma Pigmentosum. We highlight the difficulties encountered due to the lack of diagnostic and treatment modalities for this child, and offer a brief review of XP, including emerging treatments.

Introduction: Pyoderma gangrenosum (PG) represents a lesion with an elusive etiology associated with Crohn’s and/or arthritic diseases. A genuine associated vasculitis has not been proven; however, dilation of the dermal blood vessels the presence of neutrophilic and/or lymphocytic infiltrates in selected biopsies suggests that vessels are likely play a role in the pathogenesis of PG. Materials and Methods: A patient presented with a necrotic pustule or furuncle, evolving into a large necrotic ulcer with violaceous borders and surrounding erythema. A skin biopsy for hematoxylin and eosin (H&E) review and immunohistochemistry (IHC) stains was obtained. A second biopsy for direct immunofluorescence (DIF) was also taken. Results: H&E review demonstrated an ulcerated epidermis; within the ulcer base were numerous neutrophils, lymphocytes, histiocytes and fibrin. No vasculitis was present. DIF revealed strong deposits of FITC conjugated fibrinogen around superficial and the deep dermal vessels. FITC conjugated Complement/C1q and albumin conjugated were also seen between dermal extracellular matrix fibers. IHC showed that the dermal vessels (venules, arterioles and lymphatics) displayed dilation, and a loss of normal endothelial markers including von Willebrand factor and D2-40/podoplanin. Conclusions: Our case of PG shows that there seems to be an alteration of several skin structures, including dermal vessels. An alteration of the vascular fibrin-fibrinogen balance was also detected, causing some autoreactivity to fibrinogen and an immune response involving neutrophils and T lymphocytes. Our findings suggest that the etiology of PG is more complex than previously thought.

Even tiny despicable skin signs may eventually unveil systemic illnesses enabling a prompt start of medication and better prognosis. Here, we present a case of a 28-year-old female patient who came to the office complaining of a „minor irritation” on the left eyebrow that was a discrete and asymptomatic 5mm infiltrated apple jelly coloured papule that had started 6 months earlier. Biopsy of a second similar lesion discovered on left forearm showed granulomatous features of sarcoidosis. Under subsequent systemic investigation, the presence of sarcoidosis in other organs was found to be positive as stage II pulmonary sarcoidosis, and also with reticulo-endothelial involvement manifested by enlarged mediastinal lymph nodes. This case highlights the skin as a mirror to internal multisystemic disease and also the importance of investigating even small and discrete lesions with care and in depth.

Darkly discolored, cariously destroyed teeth were „normal” 18 months previously. Methamphetamine, plus the lack of oral hygiene and craving for sweet foods and drinks, can destroy teeth in adults more rapidly than any other process.

The interesting article touches the unfamiliar for most of doctors problem: the existence of skin lymphoproliferative disease which is malignant in histopathology but mild in course: lymphomatoid papulosis (LyP) It presents with papules in the skin of the trunk and the extremities. Those papules can appear scaly and typically develop superficial, central necrosis. They also tend to heal spontaneously (most often in 3-12 weeks).

Introduction: Fibroepithelial polyps are a type of mesenchymal lesion that typically occurs in women of reproductive age. These lesions can be polypoid or pedunculated and are usually solitary. They are typically asymptomatic and do not grow larger than 5 cm in diameter. However, there are few reported cases of giant fibroepithelial polyps of the vulva. In these cases, tumors cause usually symptoms including bleeding, discharge and general discomfort (with sensation of a mass). Case Report: Here we report a painful giant fibro epithelial polyp on the left labia majora in a 47-year-old Tunisian nulliparous woman. The mass was pedunculated, firm, 10cm in diameter. It was excised and the histological examination confirmed the diagnosis of fibro epithelial polyp with myxoid stroma and abcesses. Conclusion: The current case is characterized by huge fibro epithelial polyp of the vulva, rare disorder which may cause symptoms resulting from its size. Abcesses can be added to the main complications of these tumors such as bleeding, discharge and superficial ulceration.

Background: Multicentric reticulohistiocytosis (MRH) is a rare histiocytic proliferative disorder involving skin, mucosa and joints. Diagnosis is confirmed by histopathological examination. Case Report: A 45 year old patient presented with non-pruritic papules over the body and multiple joint pains. Histopathologically, the lesion was composed of oncocytic macrophages and multinucleate giant cells with abundant, eosinophilic and granular cytoplasm with ground glass appearance. Immunohistochemical expression for CD-68 and S-100 was seen . Conclusion: We describe a case of MRH along with brief review of literature with unusual immunohistochemical expression of S-100 protein which is reported negative in majority of previously presented cases, however CD68 positivity confirmed the non-langerhans cell origin.

A 45 years old man who had sustained a burn injury to his right hand 20 years ago come to our dermatology clinic with complaint of a rapidly growing fungating mass in burn scar from 4 months ago (Fig. 1). A biopsy of the mass revealed invasive squamous cell carcinoma consistent with Marjolin Ulcer (Fig. 2). The patinet underwent wide local excision and placement of a split thickness skin graft.No evidence of tumor was identified in the sentinel lymph nodes.

Erythema ab igne is now more commonly related to heating pads, water bottles, infrared lamps and laptop computer use with skin contact. Heat damages superficial skin vessels leading to vasodilatation and leakage of blood and deposition of hemosiderin that presents in a net form. Any surface of the body is susceptible but mostly lower limbs, lower back and abdomen areas are affected.

Pyoderma gangrenosum (PG) is a disease characterized by refractory, sterile, deep ulcers, predominantly in the extremities, occasionally in association with several systemic diseases. We herein describe three cases of PG, which were triggered by iatrogenic or surgical procedures in patients with acute myeloid leukemia, Takayasu’s arteritis (TA), and ulcerative colitis, respectively.

Mycosis fungoides (MF) is a neoplastic disease of the lymphoreticular system with substrate of T lymphocyte hyperplasia and multifactorial etiology. Usual onset is around age 50, with skin lesions, and in advanced stages affects the internal organs. Mycosis fungoides has specific histological feature: polymorphous infiltrate located in the papillary dermis which ends abruptly in the middle dermis.

A 29-year-old woman came to our outpatient clinic with a several-month history of itchy red lesions over her trunk. There was no family history and past history of any other diseases or medication. Dermatological examination revealed annular and oval-shaped plaques up to several cm’s in size, one of which was polycyclic in configuration, on back of the patient (Fig. 1). It was also noticed that lesions had erythematous indurated bordes with paler central areas (Fig. 1).

Gingival enlargement is common among patients and can be caused by a variety of etiological factors. The most common reason is poor oral hygiene and high bacterial load that leads to gingival inflammation and enlargement. Other implicated factors include systemic drugs, such as Phenytoin, Nifedipine, Verapamil and Cyclosporine. Some enlargements could be associated with other conditions such as puberty, pregnancy or diabetes or be a symptom of a systemic disease (leukemia, Wegener’s granulomatosis or sarcoidosis) [1].

Eponyms are used almost daily in the clinical practice of dermatology. And yet, information about the person behind the eponyms is difficult to find. Indeed, who is? What is this person’s nationality? Is this person alive or dead? How can one find the paper in which this person first described the disease? Eponyms are used to describe not only disease, but also clinical signs, surgical procedures, staining techniques, pharmacological formulations, and even pieces of equipment. In this article we present the symptoms starting with (N) and other. The symptoms and their synonyms, and those who have described this symptom or phenomenon.

A 93-year -old Caucasian female presented with a 2-month history of a single frontal scalp nodule. The lesion was non-tender however had grown rapidly and was eroded with intermittent bleeding. There were no other skin lesions, lymphadenopathy, or hepatosplenomegaly. Past medical history was significant for breast cancer and review of systems was unremarkable. Physical exam revealed a 10cm x12cm exophytic, fungating, and malodorous tumor of the right frontal scalp (Fig. 1). A biopsy was performed and revealed a dense diffuse CD30+ atypical lymphoid infiltrate, ulceration, and inflammation.