This article reviews the current state and future directions of digital dermatopathology, highlighting the role of whole-slide imaging (WSI) and artificial intelligence (AI). WSI can improve diagnostic accuracy, facilitate remote consultation, and enhance trainee education through virtual slide platforms. AI tools, particularly deep learning and convolutional neural networks, aid in diagnosis, triage, and prognostication, with accuracy often comparable to expert pathologists. Challenges remain, including high implementation costs, variability in image quality, and consequently, biases in algorithm learning. Continued real-world validation, cost analysis, and physician involvement are essential for integration into clinical practice.

BACKGROUND:Condyloma lata is a manifestation of secondary syphilis that is underrecognized histopathologically, reported to mimic other entities, including squamous cell carcinoma. OBJECTIVE:To describe characteristic clinical and histopathologic features of condyloma lata. METHOD:A retrospective review was conducted of cases with histopathologic diagnoses of syphilis from January 2010 to February 12, 2025. The histopathologic findings were categorized as condyloma lata or other manifestations of secondary syphilis. RESULT:Of 28 syphilis cases, 12 patients (15 specimens) were diagnosed with condyloma lata. The average age was 36.8 years (range: 21-52), with an equal sex distribution. Twelve of 15 lesions were anogenital, and 3 were extragenital. Syphilis was included in the clinical diagnosis in only 50% of cases, and one oral lesion was initially misdiagnosed as squamous cell carcinoma. In 25% (3/12) of the cases, the patient had other cutaneous manifestations of secondary syphilis. All condyloma lata lesions showed a consistent constellation of findings such as follows: eroded dome-shaped or verrucous plaque with bulbous, jagged, and/or irregular pseudoepitheliomatous hyperplasia, a dense or lichenoid lymphoplasmacytic infiltrate, prominent neutrophilic exocytosis associated with small spongiotic vesicles, and numerous spirochetes concentrated in the lower third of the epidermis. The remaining 16 patients (19 specimens) with noncondyloma lata secondary syphilis demonstrated considerable histopathologic variability. LIMITATION:Retrospective design with a small sample size. CONCLUSION:Condyloma lata exhibits consistent, reliable, reproducible histopathologic features. Recognition of these features can prevent misdiagnosis, particularly at extragenital sites, where syphilis may be clinically unsuspected.

Langerhans cell histiocytosis (LCH) is a rare malignancy marked by clonal proliferation of Langerhans cells, with BRAF V600E mutations identified in over 50% of the cases. BRAF inhibitors (BRAFi), such as dabrafenib, have shown efficacy in treating BRAF V600E-mutant LCH. However, BRAFi therapy is associated with cutaneous adverse effects, including the development of new melanocytic nevi, verrucae, and keratinocyte carcinoma (KC). This case report describes a 78-year-old woman with BRAF V600E-mutant LCH who developed multiple dermatologic side effects following dabrafenib salvage therapy. Seven weeks into treatment, the patient presented with eruptive palmoplantar nevi, verrucae, and a basal cell carcinoma (BCC). Biopsies revealed endophytic verruca vulgaris and acral junctional melanocytic nevus. A previous history of KC and photodamage likely contributed to the development of BCC. Additionally, the patient experienced arthralgias and Dupuytren’s contracture, consistent with known BRAFi side effects. While the cutaneous manifestations observed here have been documented in BRAF V600E-mutant melanoma, this case is unique in its presentation in LCH patients. This report emphasizes the need for routine dermatologic monitoring and awareness of potential skin malignancies and other side effects in adults undergoing BRAFi therapy for LCH.

Infantile hemangiomas (IH) are the most common benign tumors of infancy and progress through recognized stages of evolution including early proliferation, plateau, and involution. Ulceration is a common complication of IHs typically observed during the early proliferative stage characterized by rapid growth. In rare cases, ulceration is the primary clinical manifestation of IHs. We present the case of a newborn with an IH manifesting as an aggressive, early-onset ulcerative lesion on the lower extremity associated with transient thrombocytopenia and coagulation abnormalities.

A 68-year-old woman with a history of seizures on cenobamate presented with an itchy rash all over her body. The rash started about one month prior to her presentation to the dermatology clinic. The rash was initially treated with topical triamcinolone with improvement at one-month follow-up. However, four months later the rash flared and there was concern that cenobamate was the cause. Biopsy was performed showing vacuolar interface dermatitis with atrophy, suggestive of subacute lupus erythematosus. Blood work revealed positive antinuclear antibody, anti-ribonucleoprotein antibody, Sjogren Anti-SS-A and positive histone antibody. Given the worsening rash, positive labs, and cenobamate as the only changed drug several months before initial onset, she was diagnosed with drug-induced subacute cutaneous lupus erythematous and her cenobamate was discontinued. To the best of your knowledge, this is the first reported case of a medication in the carbamate family leading to drug induced subacute cutaneous lupus erythematosus.

Diffuse large B-cell lymphoma (DLBCL) is the most common and aggressive subtype of non-Hodgkin lymphoma. The overall risk of developing DLBCL is increased in patients with other lymphomas, such as mycosis fungoides (MF). In this report, we present an 81-year-old female with early-stage MF who simultaneously progressed to tumor stage, large-cell transformed (LCT) MF and developed a primary DLBCL in a lymph node (LN). She presented with a tumor on her leg and new lymphadenopathy in her right axilla. Skin biopsy of the tumor revealed infiltration of large atypical CD3+, CD4+, and CD30+ cells, and a smaller portion of CD8+ cells in the dermis, consistent with LCT MF. Biopsy of the axillary LN revealed diffuse sheets of CD20+, BCL-2+, c-MYC+, and CD10- cells, highly suggestive of double expressor DLBCL. High-throughput sequencing revealed monoclonal T cells in the skin tumor and a monoclonal B-cell population in the LN. The above findings led to simultaneous diagnoses of LCT MF and nodal double expressor DLBCL. Our case demonstrates the importance of performing a full pathological workup in cutaneous T-cell lymphoma patients presenting with lymphadenopathy.