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Benign Nonmelanocytic Skin Tumors
Published in Aimilios Lallas, Zoe Apalla, Elizabeth Lazaridou, Dimitrios Ioannides, Theodosia Gkentsidi, Christina Fotiadou, Theocharis-Nektarios Kirtsios, Eirini Kyrmanidou, Konstantinos Lallas, Chryssoula Papageorgiou, Dermatoscopy A–Z, 2019
Aimilios Lallas, Zoe Apalla, Elizabeth Lazaridou, Dimitrios Ioannides, Theodosia Gkentsidi, Christina Fotiadou, Theocharis-Nektarios Kirtsios, Eirini Kyrmanidou, Konstantinos Lallas, Chryssoula Papageorgiou
Clear cell acanthoma (CCA) is a benign tumor with a not fully elucidated pathogenesis. Although it was considered a benign epidermal tumor, recent evidence rather suggests that it is a reactive inflammatory dermatosis. Clinically, it appears as a red-purple nodule (Figure 4.40) more often on the lower extremities. Differential diagnosis includes benign and malignant skin tumors as well as inflammatory skin diseases. Dermatoscopically, it is characterized by the presence of dotted and sometimes glomerular vessels arranged linearly like strings of pearls. This unique dermoscopic pattern is almost pathognomonic and allows a straightforward diagnosis (Figure 4.41).
Benign and Malignant Conditions of the Skin
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Murtaza Khan, Agustin Martin-Clavijo
Diffuse oral mucosal melanosis is often physiological in dark skinned individuals but may arise as a result of smoking, medication or following inflammation. The differential diagnosis of focal melanotic lesions includes benign melanotic macules, melano-acanthoma, melanocytic naevi and melanoma. Benign melanotic macules are synonymous with lentigines and are described above. A melano-acanthoma is a benign lesion that often rapidly increases in size and usually resolves without treatment or following biopsy. Melanocytic naevi in the oral cavity are usually acquired rather than congenital and have a smooth surface. They do not transform to melanoma but a biopsy should be performed for new lesions. Mucosal melanoma is rare and can arise in the nose, sinuses or mouth. Within the mouth the palate is the commonest site of involvement and thus all pigmented lesions in this area should be regarded with suspicion.
Histopathology
Published in Dimitris Rigopoulos, Alexander C. Katoulis, Hyperpigmentation, 2017
Seborrheic keratosis is a very common pigmented acanthoma that occurs in the adult population. The lesions commonly occur on the trunk, in the big folds, and on sun-exposed surfaces of the face and extremities, but they spare palms and soles. The clinical appearance and histopathology can be variable in regard to the amount of hyperkeratosis and acanthosis, but all lesions show at least some acanthosis and at least hyperpigmentation of basal keratinocytes.27,28 Usually, basaloid, as well as squamoid, differentiation of keratinocytes is seen, but the proportion of both varies in the different types of seborrheic keratosis. Melanocytes are present, but regularly distributed and with no formation of nests. On sun-damaged skin, seborrheic keratosis commonly presents with reticulated acanthosis (so-called adenoid seborrheic keratosis), and it is commonly seen in continuity with solar lentigo. Just as solar lentigo, seborrheic keratosis may undergo regression in the form of lichen planus–like keratosis.
Diagnosis and treatment of low-risk superficial basal cell carcinoma in a single visit
Published in Journal of Dermatological Treatment, 2022
Georgette A. Hattier, Robert F. Duffy, Mitchell J. Finkelstein, Sarah M. Beggs, Jason B. Lee
Of the 151 histologically confirmed sBCCs, 144 were clinically diagnosed as sBCC or BCC unmodified, resulting in a diagnostic sensitivity of 95%. The 7 (5%) clinically misdiagnosed specimens were initially thought to be squamous cell carcinoma in situ (SCCIS), squamous cell carcinoma (SCC), hypertrophic solar keratosis, dermatofibroma (DF), and interface dermatitis. After reviewing all biopsies from the provider (JBL) over the 5-year period, there were 112 clinically diagnosed sBCC that were SB&C in a single appointment. Of the 112 cases, 103 were histologically confirmed as a BCC, albeit not all were the superficial subtype, resulting in a diagnostic specificity of 92.0%. The 9 specimens unnecessarily treated were an acantholytic dyskeratotic acanthoma, DF, seborrheic keratosis, granulomatous dermatitis (n = 2), and lichen-planus-like-keratosis (LPLK) (n = 4).
Multiple eruptive clear cell acanthomas successfully treated with CO2 laser ablation
Published in Journal of Dermatological Treatment, 2022
Claire Drumm, Kok Ngan, Juliano Crema, Nitin Khirwadkar, Charlotte Defty, Karen Eustace
A 63-year old man presented to the Dermatology clinic with multiple, pruritic, erythematous lesions on the lower limbs and abdomen, which had increased in size and number over 20 years. On examination there were 30 erythematous papules with a peripheral scaling collarette, measuring between 2 and 10 mm (Figure 1(a)). Dotted vessels were observed on dermoscopic examination. Histological examination of a punch biopsy revealed pale staining keratinocytes and psoriasiform epidermal hyperplasia with parakeratosis. A clear demarcation of the acanthoma from the normal epidermis was evident. Periodic-acid–Schiff (PAS) staining revealed the presence of glycogen in pale epidermal cells. The findings were consistent with a diagnosis of multiple eruptive clear cell acanthomas. Given the number and extent of the lesions, surgical excision would prove challenging. Two courses of liquid nitrogen cryotherapy were performed on the lesions. The treatment was poorly tolerated by the patient and did not result in clinical resolution. The patient was then trialed on topical 5-fluorouracil cream daily for 6 weeks with limited effect. He was then considered a candidate for CO2 laser therapy due to the refractory nature of his lesions. The patient underwent a single ablative CO2 laser treatment of all lesions using ultra-pulse setting (2 mm spot size, 125mj and 10 Hz). Lesions were injected with a small amount of lidocaine 1% prior to treatment. The procedure was tolerated well with no reported pain or discomfort following treatment. At 6 weeks follow up complete resolution was observed. No recurrence was noted at 1-year and 3-year follow up (Figure 1(b)).