Focal acantholytic dyskeratosis of the oral mucosa

Oral Warty Dyskeratoma—A Systematic Review of the Literature

Objective: To systematically review the clinicopathological features of oral warty keratoma based on published literature. Materials and Methods: PubMed and Scopus databases were searched for reports of oral warty dyskeratoma. Of the 52 identified articles, only 25 articles (43 cases) satisfied the selection criteria (case report/series in the English language reporting clinicopathologically diagnosed oral warty dyskeratoma/oral focal acantholytic keratosis/oral isolated dyskeratosis follicularis in humans). Risk of bias was assessed using the Joanna Briggs institute critical appraisal checklist for case reports and case series. Results: Most cases had well-circumscribed, white, nodular verruco-papillary lesions with a central depressed/crater-like area. Alveolar ridges were the most frequent sites of occurrence and tobacco was the most commonly associated risk factor. Histopathologically, the most pathognomonic feature was the supra-basal clefting. The cleft had dyskeratotic acantholytic cells (corps ronds, and grains). Below the cleft were projections of the connective tissue villi lined by basal cells. The basal cells in a few cases exhibited hyperplasia in the form of budding into the stroma, but epithelial dysplasia was not reported. The surface epithelium had crypts filled with keratin debris. Conclusion: Oral warty dyskeratoma is a rare solitary self-limiting benign entity, which due to its clinical and histopathological resemblance and associated habit history could be misdiagnosed as leukoplakia or carcinoma. None of the assessed articles provided molecular data, which in turn could be the reason for the lack of insight into the etiopathogenesis of this enigmatic lesion.

Focal acantholytic dyskeratosis arising in an intraoral skin flap

A case is described of a patient with a myocutaneous pectoralis major flap who presented with an oral lesion of focal acantholytic dyskeratosis that was clinically suspicious of recurrent tumour.

Incidental focal acantholytic dyskeratosis

BACKGROUND

Focal acantholytic dyskeratosis is a distinctive histologic pattern characterized by (1) suprabasilar clefts around preserved papillae, (2) acantholytic and dyskeratotic cells at all levels of the epidermis, and (3) hyperkeratosis and parakeratosis. These histologic changes have been observed as an incidental finding in a variety of skin lesions.

OBJECTIVE

Our purpose was to identify the lesions associated with incidental focal acantholytic dyskeratosis.

METHODS

Eight specimens containing incidental focal acantholytic dyskeratosis were retrospectively evaluated, and the published literature describing lesions with incidental focal acantholytic dyskeratosis was reviewed.

RESULTS

The ages of the eight patients ranged from 29 to 53 years. Incidental focal acantholytic dyskeratosis was seen in nevi with architectural disorder (four lesions), scars (two lesions), a ruptured follicle (one lesion), and a seborrheic keratosis (one lesion). Incidental focal acantholytic dyskeratosis was either present in the "clinically normal-appearing" skin adjacent to the lesion (five lesions) or within the lesion (three lesions). Twenty-one additional cases of incidental focal acantholytic dyskeratosis have previously been reported.

CONCLUSION

Incidental focal acantholytic dyskeratosis has been described in benign and malignant epithelial lesions, fibrohistiocytic lesions, inflammatory lesions, melanocytic lesions, and miscellaneous lesions. This pathologic change was observed either within the actual lesion or in the immediately adjacent epithelium. The cause of this clinically benign, microscopically intriguing condition remains to be determined.

Oral focal acantholytic dyskeratosis

Focal acantholytic dyskeratosis (FAD) is an uncommon lesion of the oral mucosa with only 22 cases reported in the medical/dental literature. Fifteen additional cases of solitary oral FAD are presented. Of these cases, 4 occurred clinically as leukoplakia. Leukoplakia-associated lesions may be an addition to the current classification of solitary FAD.

Focal acantholytic dyskeratosis in condyloma acuminata

Focal acantholytic dyskeratosis (FAD) is considered an incidental histological finding of unknown etiology. It has been described in association with only few pathological conditions. To the best of our knowledge, we report the first case of focal acantholytic dyskeratosis occurring in condyloma acuminata.

Warty dyskeratoma of the oral mucosa

A case of oral warty dyskeratoma is presented and the literature is reviewed in brief. While warty dyskeratoma of the oral mucosa is rare, it appears to exhibit a variability of clinical appearance and to have a special predilection for keratinised mucosae exposed to friction and mechanical stress.

Focal acantholytic dyskeratosis and epidermolytic hyperkeratosis of the oral mucosa adjacent to squamous cell carcinoma

A 74-year-old woman presented with an ulcerating squamous cell carcinoma of the posterior mandibular gingiva. Biopsy of the mucosa directly anterior to the tumor revealed areas of both focal acantholytic dyskeratosis (FAD) and epidermolytic hyperkeratosis (EH). Rare solitary lesions of FAD have been described in the oral mucosa; this is the first report of FAD as an incidental finding. EH has only recently been reported in the mouth, and the concept is unknown in the oral pathology literature. Both FAD and EH may represent nonspecific reaction patterns of skin and oral mucosa to numerous stimuli, including carcinogens or adjacent neoplasms.