1/11. Multiple scrotal epidermolytic acanthomas; secondary to trauma? Epidermolytic hyperkeratosis (EH) is an abnormality of epidermal maturation, most commonly due to mutations in keratins 1 and 10, which may be a congenital or an acquired defect. The term epidermolytic acanthoma was applied to a solitary discrete epidermal proliferation characterized by EH. Subsequently there have been several reports of disseminated epidermolytic acanthomas. We report a rare case of multiple epidermolytic acanthomas localized to the scrotum. With the aetiology of epidermolytic acanthoma unknown, trauma has been postulated as a possible cause. Our patient repetitively scratched his scrotum for 5 years and we believe that this action triggered his multiple scrotal epidermolytic acanthomas. ( info) |
2/11. Subcutaneous nodules on the face: acantholytic in-transit cutaneous metastasis. BACKGROUND: Although skin is the biggest organ of the body, cutaneous or subcutaneous metastasis from internal malignancies or primary skin cancers is very uncommon. OBJECTIVE: In this report, we present two cases of in-transit cutaneous metastasis in acantholytic pattern from a skin tumor on the face. methods: Both patients presented with the subcutaneous nodule and had history of multiple squamous cell carcinomas on the face. The epidermis was intact above the nodule. Computed tomography scan was performed, and subcutaneous located cystic lesions were seen. RESULTS: Nodules were excised and reported as acantholytic squamous cell carcinoma. There was no recurrence or distant metastasis. There were no early or late complications. CONCLUSIONS: These nodules were in-transit metastasis of the previous multiple squamous cell carcinomas of the face. Although patients with squamous cell carcinomas presenting as subcutaneous nodules of the head were presented in the literature, to our knowledge, this is the first report to present in-transit metastasis of acantholytic squamous cell carcinoma. ( info) |
3/11. Pigmented lesions of the oral cavity: review, differential diagnosis, and case presentations. Pigmented lesions are commonly found in the mouth. Such lesions represent a variety of clinical entities, ranging from physiologic changes to manifestations of systemic illnesses and malignant neoplasms. Evaluation of a patient presenting with a pigmented lesion should include a full medical and dental history, extraoral and intraoral examinations and, in some cases, biopsy and laboratory investigations. In this paper, an algorithm is proposed for the assessment of pigmented lesions of the oral cavity, and 3 patients with such lesions are described. ( info) |
4/11. Oral melanoacanthosis (melanoachantoma): report of a case and review of the literature. Oral melanoacanthosis (MA) is a rare pigmented mucosal lesion that is considered the counterpart of cutaneous melanoacanthoma. Microscopically the superficial epithelium shows mild to moderate acanthosis, spongiosis and prominent dendritic melanin producing melanocytes, which are present throughout the spinous keratinocytes. Reported cases show predilection for black females and the most common locations in decreasing frequency are buccal mucosa, lip, palate and gingiva. Although its pathogenesis remains uncertain, its clinical behavior is suggestive of a reactive origin. The clinical appearance of oral MA is non diagnostic and therefore biopsy is mandatory to differentiate from other melanocytic lesions, including melanoma. ( info) |
5/11. Multiple disseminated large-cell acanthomas of the skin associated with human papillomavirus type 6. Cutaneous acanthomas encompass many clinically distinct types. We describe a patient with multiple nodules on the skin of the upper limbs which were histologically diagnosed as large-cell acanthomas. Further analysis revealed, surprisingly, the presence of human papillomavirus (HPV) type 6 within these lesions. HPV type 6 should therefore be considered an important cofactor in the pathogenesis of large-cell acanthomas. ( info) |
6/11. Multiple spreading epidermolytic acanthomas of the genital and perigenital skin. Epidermolytic acanthoma is an uncommon benign tumour mainly characterized histologically by a prominent epidermolytic degeneration of the keratinocytes of the upper layers of the stratum spinosum and of the stratum granulosum. The absence of desmosome involvement allows to differentiate this condition from others such as acantholytic acanthoma. We report the first case, to our knowledge, of a 54-year-old male patient exhibiting disseminated scrotal, gluteal, inguinal and perineal epidermolytic acanthomas. ( info) |
7/11. Clear cell acanthoma successfully treated with a carbon dioxide laser. BACKGROUND: The treatment of choice for clear cell acanthoma (CCA) is excision. Resolution after cryotherapy has also been reported but requires three to four courses of treatment. OBJECTIVE: To demonstrate three CCA lesions in two patients successfully treated with a carbon dioxide (CO2) laser. methods: Under local anesthesia, these lesions were vaporized by using a CO2 laser in the Silktouch mode with a spot size of 5 mm and a fluence of 20 J/cm2. Two to six passes, as needed, were delivered until the tumor was completely removed. RESULTS: pain was minimal or nonexistent during and after the operation. No postoperative edema was noted. The wounds healed satisfactorily without scarring. No sign of recurrence was found following operation. CONCLUSION: The CO2 laser has the advantages of requiring only one course, precise tumor removal, a relatively bloodless surgical field, a short operation time, and less or no postoperative pain and edema. Postoperative wound care is convenient and easy with hydrocolloid and alginate dressings. The patient's quality of life is less adversely affected. The CO2 laser may be appropriate for multiple CCAs, giant CCA, CCA overlying or near joints, CCA refractory to cryotherapy, patients on anticoagulants, and those who cannot tolerate pain from cryotherapy, especially children and the elderly. ( info) |
8/11. Oral melanoacanthoma: a case report, a review of the literature, and a new treatment option. OBJECTIVES: Oral melanoacanthoma is a rare condition that presents as a pigmented, painful lesion, most commonly on the buccal mucosa. argon plasma coagulation is a new treatment option for benign oral lesions and is hypothesized to be efficacious for this rare mucosal disorder. methods: Treatment of a case and a review of the English-language literature were performed. RESULTS: One patient received a diagnosis of oral melanoacanthoma, and argon plasma coagulation treatment resulted in ablation of the lesion with excellent mucosal healing. A review of the literature demonstrated that this lesion is most commonly associated with black (90.9%), adult female (69.7%) patients and is most commonly located on the buccal mucosa (64.7%). CONCLUSIONS: Oral melanoacanthoma is a rare, benign mucosal lesion that may require surgical intervention for symptomatic relief. argon plasma coagulation is a relatively safe and effective means of treating this lesion. argon plasma coagulation treatment may be expanded to include other benign, superficial lesions of the oral mucosa. ( info) |
9/11. Porocarcinoma arising in pigmented hidroacanthoma simplex. Hidroacanthoma simplex (HAS) is a rare benign tumor that is also known as intraepidermal poroma. While there have been a few reports of HAS with malignant transformation (porocarcinoma), we report an unusual case of porocarcinoma, arising in a pigmented HAS, the latter also showing secondary amyloid deposits. An 80-year-old Japanese man presented with a cutaneous tumor on his left buttock, which had first been noticed in his childhood. The tumor consisted of flat pigmented plaque and a depigmented papule with erosion. Histologic analysis revealed many pigmented and well-defined nests within the epidermis of the flat pigmented portion. The nests were composed of cuboidal to oval and occasionally elongated, bland, basaloid cells with numerous melanin granules. In addition, there were infrequently ductal structures and small clusters of sebocytes, and abundant amyloid deposits in the upper dermis. These findings were consistent with pigmented HAS with amyloid deposition. In the depigmented portion, markedly atypical cells with occasional ductal structures and intracytoplasmic lumina extended throughout the entire thickness of the epidermis, with minimal invasion of the dermis. We considered this portion of the tumor to be a porocarcinoma. Since the two portions of the tumor were continuous, we made a final diagnosis of porocarcinoma arising in pre-existing pigmented HAS with amyloid deposition. ( info) |
10/11. Melanoacanthoma simulating pigmented spitz nevus: an unusual dermoscopy pitfall. BACKGROUND: The starburst pattern is the dermoscopic hallmark of pigmented Spitz nevus, although it has been rarely observed in melanoma as well. OBJECTIVE: To describe a case of melanoacanthoma simulating pigmented Spitz nevus. MATERIAL AND methods: Clinical, dermoscopic, and histopathologic examinations were performed for the occurrence of a 4-mm pigmented skin lesion on the hip of a 38-year-old Caucasian woman. RESULTS: dermoscopy examination of the lesion disclosed a stereotypical starburst pattern characterized by pigmented streaks symmetrically distributed at the periphery. A preoperative diagnosis of pigmented Spitz nevus was made, and the lesion was excised. However, subsequent histopathologic examination revealed a melanoacanthoma. CONCLUSION: The starburst pattern, although diagnostic for pigmented Spitz nevus, can be rarely observed in other benign or malignant pigmented skin lesions. Accordingly, all lesions in adults exhibiting a starburst pattern or other spitzoid features should be excised for histopathologic evaluation. ( info) |