Cases for Diagnosis
Pigmented Vascular Tumor in Skin Not Exposed to Sunlight
Lesión tumoral pigmentada y vascular en piel no fotoexpuesta
C. Guebenlian
, J. Magliano, C. Agorio
Corresponding author
Cátedra de Dermatología Médico Quirúrgica, Hospital de Clínicas «Dr. Manuel Quintela», Universidad de la República, Montevideo, Uruguay
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"apellidos" => "Agorio" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Cátedra de Dermatología Médico Quirúrgica, Hospital de Clínicas «Dr. Manuel Quintela», Universidad de la República, Montevideo, Uruguay" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesión tumoral pigmentada y vascular en piel no fotoexpuesta" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 500 "Ancho" => 669 "Tamanyo" => 131313 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×40.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 68-year-old hypertensive woman consulted about an asymptomatic lesion of 1 year's duration at her annual checkup. Her last check up had been 2 years earlier, and there had been no remarkable findings.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">The physical examination revealed a slightly indurated tumor measuring 2<span class="elsevierStyleHsp" style=""></span>cm on the left buttock. The lesion had 2 components: a pink erythematous component with a vascular appearance and a white-yellowish scale-crust, and a second component with brown pigmentation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Dermoscopic examination showed polymorphous (dotted and hairpin) vessels surrounded by a whitish halo in the vascularized component and brown pigment with peripheral projections that did not radiate from the center of the lesion or form a specific dermoscopic pattern in the pigmented component (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). An excisional biopsy was performed to check for melanoma and pigmented basal cell carcinoma (BCC).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histologic examination showed hyperkeratosis with parakeratosis, fibrin, and foci of melanin pigment on the surface. There were thick, well-delimited ridges in the Malpighian layer, with no invasion of the underlying dermis. Differentiated keratinocytes, anisocytosis, anisokaryosis, and large hyperchromatic nuclei were observed throughout this layer. There were also horn pearls and hyperpigmentation of keratinocytes without associated melanocytic hyperplasia in the pigmented component. Additional findings included a moderate band-like lymphohistiocytic infiltrate with abundant melanophages in the underlying dermis, under the lesional epithelium (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Pigmented squamous cell carcinoma in situ in a component of a lesion.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">We widened the tumor margins and found no residual tumor in the specimen analyzed. In 2 years of follow-up, there have been no signs of recurrence or new lesions.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comments</span><p id="par0035" class="elsevierStylePara elsevierViewall">SSC is the second most common malignant skin tumor, but the pigmented variant of this tumor is rare, accounting for just 7% to 25% of all SCCs.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Pigmented SCC typically presents as pigmented papules or plaques in sun-exposed areas of the head and neck in elderly individuals.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Our case is interesting not just because the lesion was pigmented, but also because it involved a patient under 70 years of age and was located in a part of the body that had not been damaged by the sun.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Dermoscopic features of pigmented SCC include a scaling surface, diffuse or homogeneous blue pigmentation and/or irregularly distributed granular structures; the vessels are often not visible because of the pigment.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Vascular structures can be highly polymorphous, with irregular hairpin vessels, dotted and/or irregular linear vessels, and spiral vessels, surrounded on occasions by a whitish halo. Chung et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> recently published a case of SCC in situ with, as in our case, pigmented projections in peripheral sectors that did not converge geometrically towards the center of the lesion. The authors proposed that this finding suggests a possible nonmelanocytic origin, and together with the scaling, a probable diagnosis of SCC. The presence of whitish perivascular halos suggests a high degree of differentiation,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> which was observed in our case.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The pathophysiology of pigmented SCC is uncertain, and it is thought that the tumor cells might produce cytokines and growth factors that favor melanocytic proliferation and colonization. Another possibility is that the tumor originates from stem cells.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Histology shows typical features of conventional SCC in addition to pigment in the cytoplasm of the keratinocytes or throughout the tumor in the form of dispersed nonneoplastic dendritic melanocytes and melanophages in the surrounding stroma.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The differential diagnosis should include pigmented actinic keratosis, pigmented Bowen disease, seborrheic keratosis, pigmented basal cell carcinoma, melanoma, and other adnexal tumors (trichoblastoma and pilomatricoma).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">As there have been few reports of pigmented SCC, little is known about the biologic behavior of this tumor. While pigmentation does not have any prognostic value, it can prompt early consultation.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In conclusion, although an atypical pigmented lesion in an area of the body protected from the sun may typically suggest melanoma, pigmented BCC, or seborrheic keratosis, the presence of scaling, nongeometric pigmented projections, and a whitish perivascular halo should raise suspicion of BCC.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comments" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Guebenlian C, Magliano J, Agorio C. Lesión tumoral pigmentada y vascular en piel no fotoexpuesta. Actas Dermosifiliogr. 2016;107:421–422.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 668 "Ancho" => 501 "Tamanyo" => 80274 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 467 "Ancho" => 350 "Tamanyo" => 61491 ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 500 "Ancho" => 669 "Tamanyo" => 131313 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×40.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carcinoma espinocelular cutáneo pigmentado: descripción de dos casos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 13 | 22 |
| 2024 October | 92 | 60 | 152 |
| 2024 September | 86 | 36 | 122 |
| 2024 August | 100 | 70 | 170 |
| 2024 July | 79 | 45 | 124 |
| 2024 June | 63 | 60 | 123 |
| 2024 May | 86 | 48 | 134 |
| 2024 April | 80 | 23 | 103 |
| 2024 March | 91 | 40 | 131 |
| 2024 February | 75 | 33 | 108 |
| 2024 January | 65 | 37 | 102 |
| 2023 December | 67 | 15 | 82 |
| 2023 November | 66 | 34 | 100 |
| 2023 October | 71 | 22 | 93 |
| 2023 September | 87 | 25 | 112 |
| 2023 August | 65 | 17 | 82 |
| 2023 July | 65 | 33 | 98 |
| 2023 June | 47 | 24 | 71 |
| 2023 May | 44 | 33 | 77 |
| 2023 April | 42 | 17 | 59 |
| 2023 March | 57 | 15 | 72 |
| 2023 February | 46 | 19 | 65 |
| 2023 January | 51 | 27 | 78 |
| 2022 December | 43 | 30 | 73 |
| 2022 November | 28 | 20 | 48 |
| 2022 October | 26 | 17 | 43 |
| 2022 September | 38 | 34 | 72 |
| 2022 August | 27 | 33 | 60 |
| 2022 July | 36 | 35 | 71 |
| 2022 June | 19 | 18 | 37 |
| 2022 May | 52 | 38 | 90 |
| 2022 April | 41 | 24 | 65 |
| 2022 March | 61 | 43 | 104 |
| 2022 February | 35 | 19 | 54 |
| 2022 January | 60 | 31 | 91 |
| 2021 December | 33 | 39 | 72 |
| 2021 November | 45 | 37 | 82 |
| 2021 October | 35 | 42 | 77 |
| 2021 September | 33 | 38 | 71 |
| 2021 August | 32 | 26 | 58 |
| 2021 July | 26 | 25 | 51 |
| 2021 June | 30 | 28 | 58 |
| 2021 May | 33 | 38 | 71 |
| 2021 April | 70 | 24 | 94 |
| 2021 March | 48 | 18 | 66 |
| 2021 February | 51 | 27 | 78 |
| 2021 January | 35 | 13 | 48 |
| 2020 December | 27 | 11 | 38 |
| 2020 November | 41 | 24 | 65 |
| 2020 October | 31 | 15 | 46 |
| 2020 September | 28 | 7 | 35 |
| 2020 August | 26 | 14 | 40 |
| 2020 July | 21 | 16 | 37 |
| 2020 June | 40 | 31 | 71 |
| 2020 May | 28 | 15 | 43 |
| 2020 April | 24 | 18 | 42 |
| 2020 March | 32 | 17 | 49 |
| 2020 February | 3 | 0 | 3 |
| 2019 December | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 June | 2 | 0 | 2 |
| 2019 April | 4 | 1 | 5 |
| 2019 March | 2 | 3 | 5 |
| 2019 January | 1 | 0 | 1 |
| 2018 December | 1 | 0 | 1 |
| 2018 November | 11 | 0 | 11 |
| 2018 October | 61 | 0 | 61 |
| 2018 September | 6 | 0 | 6 |
| 2018 February | 18 | 4 | 22 |
| 2018 January | 26 | 5 | 31 |
| 2017 December | 41 | 10 | 51 |
| 2017 November | 23 | 6 | 29 |
| 2017 October | 25 | 5 | 30 |
| 2017 September | 24 | 10 | 34 |
| 2017 August | 20 | 4 | 24 |
| 2017 July | 25 | 6 | 31 |
| 2017 June | 29 | 7 | 36 |
| 2017 May | 30 | 5 | 35 |
| 2017 April | 32 | 2 | 34 |
| 2017 March | 10 | 4 | 14 |
| 2017 February | 11 | 6 | 17 |
| 2017 January | 10 | 4 | 14 |
| 2016 December | 18 | 11 | 29 |
| 2016 November | 27 | 8 | 35 |
| 2016 October | 23 | 19 | 42 |
| 2016 August | 1 | 0 | 1 |
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