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Epidermotropic secondary extramammary Paget's disease of the glans penis from retrograde lymphatic dissemination by transitional cell carcinoma of the bladder

mented in FHI. Reported changes include hyperpigmentation of the epidermis, and hair follicle and/or eccrine gland hyperplasia. While the mechanisms underlying these changes in our case are unknown, epidermal hyperplasia is a characteristic feature for dermatofibroma, and may be accompanied by follicular and sebaceous hyperplasia. Epithelial–mesenchyme interaction mediated by epidermal growth factor receptor, ectopic hedgehog signaling and/or b-catenin have been implicated in these changes. In the present case, inductive elements released from hamartomatous mesenchymal tissues may have contributed to the proliferation of epidermal and adnexal tissues. Alternatively, FHI may represent a cutaneous organoid hamartoma rather than a hamartoma of only mesenchymal origin, as suggested in a previous report. In a recent study, eccrine changes were frequently seen in FHI; thus, epidermal and adnexal changes may be important components and clues to the histological diagnosis of FHI in superficial partial biopsies. Eishi TAKAHASHI, Hiroo YOKOZEKI, Takahiro SATOH Department of Dermatology, National Defense Medical College, Saitama, and Department of Dermatology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan