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Dermatology Practical & Conceptual Oct 2021The differential diagnosis of lesions excised to exclude melanoma include a variety of benign and malignant melanocytic and non-melanocytic lesions.
INTRODUCTION
The differential diagnosis of lesions excised to exclude melanoma include a variety of benign and malignant melanocytic and non-melanocytic lesions.
OBJECTIVES
We examined the variability between pathologists in diagnosing non-melanocytic lesions.
METHODS
As part of a larger study prospectively examining the diagnosis of lesions excised to exclude melanoma in 198 patients at a primary care skin cancer clinic in Newcastle, Australia, we compared diagnosis made by 5 experienced dermatopathologists, of 44 non-melanocytic lesions in 44 patients aged 22-90.
RESULTS
Forty-four lesions (out of 217 in total) were non-melanocytic. Among the 5 pathologists who examined each case there was marked variability in the terminology used to diagnose each case. The most common variability was found between seborrheic keratosis, large cell acanthoma, solar lentigo, and lichenoid keratosis. The diagnosis made by the majority of the pathologists was deemed to be the reference diagnosis. Versus majority diagnosis, 4% of benign lesions were considered malignant, and 7% of malignant diagnoses were considered as benign.
CONCLUSIONS
The different terminology adopted and lack of consensus in the diagnosis of these non-melanocytic lesions in this setting suggests that training AI systems using gold standards may be problematic. We propose a new management classification scheme called MOLEM (Management of Lesions Excised to exclude Melanoma) which expands the previously described MPATH-dx to include non-melanocytic lesions.
PubMed: 35024222
DOI: 10.5826/dpc.1104a94 -
Journal Der Deutschen Dermatologischen... Feb 2024Tumor of follicular infundibulum (TFI) has been described as a neoplasm - isolated and multiple - and in association with other lesions. Its histopathologic definition... (Review)
Review
BACKGROUND AND OBJECTIVES
Tumor of follicular infundibulum (TFI) has been described as a neoplasm - isolated and multiple - and in association with other lesions. Its histopathologic definition is controversial.
PATIENTS AND METHODS
We present a histopathologically analyzed series of 28 patients with TFI features. This has been supplemented by a search in MEDLINE on the literature on this subject. The corresponding figures given in these articles have been discussed and analyzed.
RESULTS
Patients comprised 16 women and twelve men. TFI features were seen in five patients with nevus sebaceous, two trichofolliculomas, one dilated pore Winer, eight viral warts, one dermatofibroma, six seborrheic keratoses, three actinic keratoses, one invasive squamous cell carcinoma, and one basal cell carcinoma in association with a squamous cell carcinoma/actinic keratosis. After study of the literature especially of solitary cases of TFI, we interpret such cases mostly as variants of seborrheic keratoses with variable degree of infundibular, isthmic and/or sebaceous differentiation with or without regression.
CONCLUSIONS
We regard TFI as an epithelial growth pattern which may occur in hamartomatous, inflammatory, infectious, reactive, or neoplastic conditions, in most solitary forms likely best classified within the histopathological spectrum of seborrheic keratoses.
Topics: Male; Humans; Female; Keratosis, Seborrheic; Skin Neoplasms; Hair Diseases; Carcinoma, Squamous Cell; Acanthoma; Pituitary Gland; Follicular Cyst; Neoplasms, Basal Cell
PubMed: 38332423
DOI: 10.1111/ddg.15296 -
The American Journal of Dermatopathology Sep 2021Cutaneous clear cell proliferations encompass a heterogenous group of several primary cutaneous neoplasms and metastatic tumors with different histogenesis. Many of...
Cutaneous clear cell proliferations encompass a heterogenous group of several primary cutaneous neoplasms and metastatic tumors with different histogenesis. Many of these clear cell proliferations may seem strikingly similar under the microscope resulting in challenging diagnosis. In many of these clear cell lesions, the reason for the clear or pale appearance of proliferating cells is unknown, whereas in other ones, this clear cell appearance is due to intracytoplasmic accumulation of glycogen, mucin, or lipid. Artifacts of tissue processing and degenerative phenomenon may also be responsible for the clear cell appearance of proliferating cells. Awareness of the histopathologic findings as well as histochemical and immunohistochemical techniques are crucial to the accurate diagnosis. This review details the histopathologic features of clear cell cutaneous proliferations, classifying them according their type of differentiation and paying special attention to the histopathologic differential diagnosis among them.
Topics: Acanthoma; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Epidermis; Granular Cell Tumor; Hair Follicle; Hemangiosarcoma; Histiocytoma, Benign Fibrous; Humans; Immunohistochemistry; Keratosis, Seborrheic; Liposarcoma; Melanoma; Neurofibroma; Perivascular Epithelioid Cell Neoplasms; Sebaceous Gland Neoplasms; Skin Neoplasms; Sweat Gland Neoplasms; Xanthomatosis
PubMed: 34411018
DOI: 10.1097/DAD.0000000000001881 -
The American Journal of Dermatopathology Oct 2022Porokeratoma is a rare type of epidermal acanthoma, of which 22 cases have been published in the literature. It is characterized by the presence of multiple cornoid... (Review)
Review
Porokeratoma is a rare type of epidermal acanthoma, of which 22 cases have been published in the literature. It is characterized by the presence of multiple cornoid lamellae embedded within a single verrucous or keratotic nodule. Despite this histologic feature being shared with porokeratosis, the etiopathogenesis of porokeratoma and its relationship with porokeratosis remain unclear. We report a new case of porokeratoma involving hair follicles, a finding that has been reported in only one of the previously published cases. Analogous to follicular porokeratosis, a form of porokeratosis involving hair follicles, we have termed this lesion "follicular porokeratoma." A review of all 23 published cases (including the present case) is also provided.
Topics: Acanthoma; Epidermis; Hair Follicle; Humans; Porokeratosis; Skin Neoplasms
PubMed: 35925572
DOI: 10.1097/DAD.0000000000002271 -
Dermatopathology (Basel, Switzerland) Feb 2023Post-pemphigus acanthomas have been rarely discussed in the literature. A prior case series identified 47 cases of pemphigus vulgaris and 5 cases of pemphigus foliaceus,...
Post-pemphigus acanthomas have been rarely discussed in the literature. A prior case series identified 47 cases of pemphigus vulgaris and 5 cases of pemphigus foliaceus, out of which 13 developed acanthomata as a part of the healing process. Additionally, a case report by Ohashi et al. reported similar recalcitrant lesions on the trunk of a patient with pemphigus foliaceus being treated with prednisolone, IVIG, plasma exchange, and cyclosporine. Some view post-pemphigus acanthomas as variants of hypertrophic pemphigus vulgaris, being difficult to diagnose when they present as only single lesions, with a clinical differential of an inflamed seborrheic keratosis or squamous cell carcinoma. Here, we present a case of a 52-year-old female with a history of pemphigus vulgaris and four months of only topical therapy (fluocinonide 0.05%) who presented with a painful, hyperkeratotic plaque on the right mid-back that was found to be a post-pemphigus acanthoma.
PubMed: 36810570
DOI: 10.3390/dermatopathology10010012 -
The American Journal of Dermatopathology May 2024Onychocytic matricoma (OCM) is a benign neoplasm of the nail matrix. Only 18 cases of this tumor have been reported in the literature to date. We retrospectively...
Onychocytic matricoma (OCM) is a benign neoplasm of the nail matrix. Only 18 cases of this tumor have been reported in the literature to date. We retrospectively analyzed the clinical features of 14 patients with OCM. The most common clinical feature was longitudinal xanthopachyonychia (n = 9), followed by longitudinal leukopachyonychia (=3) and longitudinal pachymelanonychia (n = 2). The most common clinical findings identified following dermoscopy and analysis at high magnification of classical photographs were free-edge thickening of the nail plate without pitting (n = 14), longitudinal ridging (n = 7), round white clods (n = 7), white dots (n = 7), and filiform hemorrhages (n = 7), followed by oval and linear white clods (n = 5), fuzzy lateral border (n = 5), and red-purple blood clods (n = 3). Nail clipping histopathology showed a thickened nail plate with multiple, small, round-to-oval spaces. The tumor expressed immunopositivity for LEF-1. Dermoscopy of the nail plate and nail clipping histology provides useful information with regards to the differential diagnosis with subungual squamous cell carcinoma and nail melanoma. Ex vivo-in vivo correlation facilitates a better dermoscopic assessment of this unique underrecognized disease. However, the differential diagnosis between OCM and onychocytic carcinoma requires biopsy of the tumor. LEF-1 as an onychogenic marker can be used to resolve the differential diagnosis between OCM and subungual longitudinal acanthoma/seborrheic keratosis.
Topics: Humans; Skin Neoplasms; Retrospective Studies; Nail Diseases; Acanthoma; Nails, Malformed; Carcinoma, Squamous Cell; Diagnosis, Differential; Dermoscopy
PubMed: 38513115
DOI: 10.1097/DAD.0000000000002674 -
The Journal of Dermatological Treatment Aug 2022Clear cell acanthoma (CCA) is a rare, benign epidermal lesion of clear glycogen-containing keratinocytes. The exact etiology is unknown. Although CCA usually appear as...
Clear cell acanthoma (CCA) is a rare, benign epidermal lesion of clear glycogen-containing keratinocytes. The exact etiology is unknown. Although CCA usually appear as solitary lesions, cases of multiple CCAs have also been described. The rare eruptive CCA variant describes cases with more than 30 lesions.Current therapeutic evidence for the management of multiple CCAs is limited. CO2 laser remains the most widely used laser in clinical practice. However, literature describing its effectiveness on CCA is sparse, and previous reports have described its use for a maximum of three lesions. To our knowledge, this is the first report of successful CO2 laser treatment of the multiple eruptive CCA variant with an excellent cosmetic outcome.Our case adds to the evidence that CO2 laser is an effective treatment for this condition. Particularly in those patients with refractory or multiple eruptive CCAs, or for those who may not tolerate repeated courses of cryotherapy, or who are concerned about scarring and cosmetic outcome.
Topics: Acanthoma; Carbon Dioxide; Exanthema; Humans; Laser Therapy; Lasers, Gas; Skin Neoplasms
PubMed: 35238268
DOI: 10.1080/09546634.2022.2049587 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Dec 2020The patient, a 70-year-old woman, presented with a mass in the right nasal cavity accompanied by recurrent nosebleeds for 3 months. Physical examination revealed a mass...
The patient, a 70-year-old woman, presented with a mass in the right nasal cavity accompanied by recurrent nosebleeds for 3 months. Physical examination revealed a mass in the right nasal vestibule, with a diameter of about 1.5 cm. The surface of the mass was not smooth and nasal CT showed a mass in the right nasal vestibule, which could be surgically removed. Immunohistochemical results of the tumor showed CKpan(3+), CK5/6(3+), p40(3+), p53(+), CD10(-), AR(-), Bcl-2(-), ki-67(+20%). Pathological diagnosis was acantholytic dyskeratotic acanthoma. This disease is rare and easy to be misdiagnosed, so it is necessary to pay attention to identification.
Topics: Acanthoma; Aged; Epistaxis; Female; Humans; Immunohistochemistry; Nasal Cavity; Nose Neoplasms; Skin Neoplasms
PubMed: 33254352
DOI: 10.13201/j.issn.2096-7993.2020.12.019 -
Anais Brasileiros de Dermatologia 2021
Topics: Acanthoma; Dermoscopy; Humans; Skin Neoplasms
PubMed: 34006397
DOI: 10.1016/j.abd.2020.06.027 -
International Journal of Gynecological... Jan 2021
Topics: Acanthoma; Adult; Aged; Female; Genitalia; Humans; Hyperkeratosis, Epidermolytic; Male; Middle Aged; Retrospective Studies; Skin Neoplasms
PubMed: 33290356
DOI: 10.1097/PGP.0000000000000672