Dermoscopic features of nonpigmented eccrine poromas in association with their histopathological features

Diagnostic features of a non-pigmented eccrine poroma with a collarette: Histopathological and dermoscopic correlation

This is a case that emphasized the need for detailed observation of the entire lesion in dermoscopic examination. Novel dermoscopic findings within a collarette.

The transition between a poroma and a porocarcinoma evidenced by the dermoscopy

Eccrine porocarcinoma (EPC) is a rare malignant skin tumor. The dermoscopy of invasive EPC reveals focal presence of whitish-pink, structureless areas surrounded by pinkish-white halos. In an eccrine poroma (EP), such areas present diffuse distribution in the "frog- eggs" pattern. We reported an EPC in situ that presents a transitional dermoscopy pattern between EP and invasive EPC. We found a diffuse distribution; whitish-pink, structureless areas surrounded by pinkish-white halos; a central exulceration and a polymorphic vascular pattern.

Dermoscopy of Adnexal Tumors

Cutaneous adnexal tumors include lesions with apocrine, eccrine, follicular, sebaceous, and mixed differentiation. Most are benign and sporadic, although malignant forms are occasionally observed and some cases develop in the setting of inherited syndromes. These tumors often cause immense diagnostic difficulty. Dermoscopy is a noninvasive technique that has greatly improved the diagnostic accuracy of different skin lesions, including these tumors. We provide a review of the literature on the dermoscopic structures and patterns associated with adnexal tumors. Most patterns associated with this kind of tumor are nonspecific and are observed in other nonadnexal tumors, especially in basal cell carcinomas.

Dermoscopic features and patterns of poromas: a multicentre observational case-control study conducted by the International Dermoscopy Society

BACKGROUND

Poromas are benign cutaneous sweat gland tumours that are challenging to identify. The dermoscopic features of poromas are not well characterized.

OBJECTIVE

To determine the clinical-dermoscopic features of poromas.

METHODS

Cross-sectional, observational study of 113 poromas and 106 matched control lesions from 16 contributors and eight countries. Blinded reviewers evaluated the clinical and dermoscopic features present in each clinical and dermoscopic image.

RESULTS

Poromas were most commonly non-pigmented (85.8%), papules (35.4%) and located on non-acral sites (65.5%). In multivariate analysis, dermoscopic features associated with poroma included white interlacing areas around vessels (OR: 7.9, 95% CI: 1.9-32.5, P = 0.004), yellow structureless areas (OR: 2.5, 95% CI: 1.1-6.0, P = 0.04), milky-red globules (OR: 3.9, 95% CI: 1.4-11.1, P = 0.01) and poorly visualized vessels (OR: 33.3, 95% CI: 1.9-586.5, P = 0.02). The presence of branched vessels with rounded endings was positively associated with poromas but did not reach statistical significance (OR: 2.4, 95% CI: 0.8-6.5, P = 0.10). The presence of any of these five features was associated with a sensitivity and specificity of 62.8% and 82.0%, respectively.

CONCLUSION

We identified dermoscopic features that are specific to the diagnosis of poroma. Overall, however, the prevalence of these features was low. Significant clinical and dermoscopic variability is a hallmark of these uncommon tumours, which are most prevalent on non-acral sites.

Dermoscopic features of endocrine mucin-producing sweat gland carcinoma

Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is very rare, with only 61 cases reported to date. EMPSGC is considered to be a low-grade carcinoma of sweat gland origin. Dermoscopic findings of EMPSGC have not been previously reported. We report the first case of a man with EMPSGC, featuring dermoscopic findings. Dermoscopic examinations of the present EMPSGC lesion revealed tumor cell proliferation that appeared as pink ovoid nests and elongated epidermis that resembled a whitish-pink network. Another characteristic finding of the present lesion was the large red/blue globules in pink ovoid nests in the tumor. Those reflected lacunae containing secretory fluid with red blood cells. We think that the large red/blue globules in pink ovoid nests in our case could be a characteristic dermoscopic finding specific to EMPSGC. We dermatologists encounter many "pink nodules" at out-patient clinics. The present dermoscopic findings may be useful for the differential diagnosis of EMPSGC.

Accuracy of dermatoscopy for the diagnosis of nonpigmented cancers of the skin

BACKGROUND

Nonpigmented skin cancer is common, and diagnosis with the unaided eye is error prone.

OBJECTIVE

To investigate whether dermatoscopy improves the diagnostic accuracy for nonpigmented (amelanotic) cutaneous neoplasms.

METHODS

We collected a sample of 2072 benign and malignant neoplastic lesions and inflammatory conditions and presented close-up images taken with and without dermatoscopy to 95 examiners with different levels of experience.

RESULTS

The area under the curve was significantly higher with than without dermatoscopy (0.68 vs 0.64, P < .001). Among 51 possible diagnoses, the correct diagnosis was selected in 33.1% of cases with and 26.4% of cases without dermatoscopy (P < .001). For experts, the frequencies of correct specific diagnoses of a malignant lesion improved from 40.2% without to 51.3% with dermatoscopy. For all malignant neoplasms combined, the frequencies of appropriate management strategies increased from 78.1% without to 82.5% with dermatoscopy.

LIMITATIONS

The study deviated from a real-life clinical setting and was potentially affected by verification and selection bias.

CONCLUSIONS

Dermatoscopy improves the diagnosis and management of nonpigmented skin cancer and should be used as an adjunct to examination with the unaided eye.

Standardization of terminology in dermoscopy/dermatoscopy: Results of the third consensus conference of the International Society of Dermoscopy

BACKGROUND

Evolving dermoscopic terminology motivated us to initiate a new consensus.

OBJECTIVE

We sought to establish a dictionary of standardized terms.

METHODS

We reviewed the medical literature, conducted a survey, and convened a discussion among experts.

RESULTS

Two competitive terminologies exist, a more metaphoric terminology that includes numerous terms and a descriptive terminology based on 5 basic terms. In a survey among members of the International Society of Dermoscopy (IDS) 23.5% (n = 201) participants preferentially use descriptive terminology, 20.1% (n = 172) use metaphoric terminology, and 484 (56.5%) use both. More participants who had been initially trained by metaphoric terminology prefer using descriptive terminology than vice versa (9.7% vs 2.6%, P < .001). Most new terms that were published since the last consensus conference in 2003 were unknown to the majority of the participants. There was uniform consensus that both terminologies are suitable, that metaphoric terms need definitions, that synonyms should be avoided, and that the creation of new metaphoric terms should be discouraged. The expert panel proposed a dictionary of standardized terms taking account of metaphoric and descriptive terms.

LIMITATIONS

A consensus seeks a workable compromise but does not guarantee its implementation.

CONCLUSION

The new consensus provides a revised framework of standardized terms to enhance the consistent use of dermoscopic terminology.

Periungual eccrine poroma

BACKGROUND

Eccrine poroma is a rare, benign skin appendage tumor originating from the intraepidermal portion of the eccrine sweat duct, which typically occurs on the sides and soles of the feet. Nonetheless, eccrine poroma may be found in any skin area bearing sweat glands.

OBJECTIVE

Herein we report a case of an eccrine poroma in an unusual location, the surgical management of the condition, and follow-up processes.

Pink lesions

Dermoscopy (dermatoscopy or surface microscopy) is an ancillary dermatologic tool that in experienced hands can improve the accuracy of diagnosis of a variety of benign and malignant pigmented skin tumors. The early and more accurate diagnosis of nonpigmented, or pink, tumors can also be assisted by dermoscopy. This review focuses on the dermoscopic diagnosis of pink lesions, with emphasis on blood vessel morphology and pattern. A 3-step algorithm is presented, which facilitates the timely and more accurate diagnosis of pink tumors and subsequently guides the management for such lesions.

Dermoscopy of non-pigmented eccrine poromas: study of Mexican cases

Background:

Eccrine poroma is a benign neoplasm that can mimick a malignant neoplasm dermoscopically. The characteristic vascular pattern of this tumor has not been established.

Objective:

To evaluate dermoscopic features of non-pigmented eccrine poroma in Mexican patients.

Method:

We retrospectively studied histologically proven cases of eccrine poroma from three Mexican hospitals analyzed by four dermoscopists.

Results:

Thirteen cases were studied. A polymorphous vascular pattern was found in most cases. Four presented with irregular linear and branched vessels with semi-elliptical, or semicircular endings (“chalice-form” and “cherry-blossoms” vessels). Structureless pink-white areas were the most common other dermoscopic finding.

Conclusions:

“Chalice-form” and “cherry-blossom” vessels have not been reported in other benign or malignant neoplasms and can be a useful clue to the diagnosis of non-pigmented eccrine poroma. Due to the variability of dermoscopic patterns of eccrine poroma further studies are required to establish the specificity of our findings.