Case and Research Letters
Evaluation of Collision Tumors by Confocal Microscopy
Tumores de colisión valorados por microscopía confocal
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Se señala, en recuadros negros, áreas con tapones córneos. B) Imagen de microscopía confocal de 3,5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3,5<span class="elsevierStyleHsp" style=""></span>mm. Patrón anillado en unión dermoepidérmica (flecha roja) y cordones policíclicos (flecha amarilla), y estructuras brillantes en anillo que simulan capas de cebollas (flecha verde). C) Obsérvese un nevus melanocítico juntural en transición con una queratosis seborreica, con su característico patrón reticulado.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Ascanio Armada, R. Gamo Villegas, A. Pampin Franco, F. Pinedo Moraleda" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Ascanio Armada" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Gamo Villegas" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Pampin Franco" ] 3 => array:2 [ "nombre" => "F." 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A, Gray scale (longitudinal axis, right thumb, ulnar border) shows a hypoechoic tumor (asterisk, between<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>signs) with lower echogenicity centrally (o). Observe remodeling of the underlying bone surface (arrow). B, Color Doppler of the nail (longitudinal axis, right thumb, ulnar border) showing hypervascularity (in color) at the periphery of the tumor (asterisk).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Le-Bert, D. Soto, V. Vial, R. Bentjerodt, X. Wortsman" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Le-Bert" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Soto" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Vial" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Bentjerodt" ] 4 => array:2 [ "nombre" => "X." 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Ascanio Armada, R. Gamo Villegas, A. Pampin Franco, F. Pinedo Moraleda" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Ascanio Armada" "email" => array:2 [ 0 => "luciaascanioarmada@gmail.com" 1 => "mlascanio@fhalcorcon.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "R." "apellidos" => "Gamo Villegas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Pampin Franco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "F." "apellidos" => "Pinedo Moraleda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumores de colisión valorados por microscopía confocal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1372 "Ancho" => 1600 "Tamanyo" => 420833 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A Dermoscopy image. Homogeneous globular network with asymmetric globules peripherally (red arrow). Milia-like cysts and comedo-like openings (in square). B, Confocal microscopy image of 5.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mm. The yellow square outlines the area with the bright annular structures and the hyperreflective round structures with a smooth outline (green arrow); on the right, at higher power, the ring pattern is visible at the dermoepidermal junction, with an area of crest fusion (arrow). C, The histologic image shows the presence in the same area of a compound melanocytic nevus and a seborrheic keratosis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Collision tumors are common in daily clinical practice, but diagnosis can be difficult. Dermoscopy and confocal microscopy are 2 noninvasive techniques that are very helpful in this type of lesion. We describe 2 cases in which the dermoscopic suspicion of a collision tumor was confirmed by confocal microscopy.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case 1</span><p id="par0010" class="elsevierStylePara elsevierViewall">A woman aged 51 years presented a macular lesion on her abdomen; she was uncertain how long the lesion had been present. Dermoscopy revealed a network pattern. In addition, there were several small round areas with comedo-like openings on dermoscopy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Confocal microscopy showed a cobblestone pattern of the epidermis and a ring pattern at the dermoepidermal junction. Several areas with bright (hyperreflective) annular structures (with an onion skin appearance) and polycyclic cords were also visible (Fig.<span class="elsevierStyleHsp" style=""></span>1B). Histology revealed a collision tumor between a junctional melanocytic nevus and a seborrheic keratosis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case 2</span><p id="par0020" class="elsevierStylePara elsevierViewall">This patient was a 49-year-old man with a history of superficial spreading melanoma excised in 2011. Follow-up using digital dermoscopy revealed growth of a pigmented lesion on his back. The lesion was a pigmented macule measuring 0.6<span class="elsevierStyleHsp" style=""></span>cm in diameter. Dermoscopy revealed a homogeneous globular network pattern with asymmetric globules peripherally. An area of the lesion presented milia-like cysts and comedo-like openings (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">A honeycomb pattern was observed in the epidermis and ring-like structures at the dermoepidermal junction, with occasional areas of crest fusion. In addition, a ring of bright (hyperreflective) structures (comedo-like openings on dermoscopy) and hyperreflective round intraepithelial structures with a smooth outline (milia-like cysts on dermoscopy) were observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Histology revealed collision between a compound melanocytic nevus with distorted architecture but no atypia, and a seborrheic keratosis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C).</p><p id="par0035" class="elsevierStylePara elsevierViewall">The term collision tumor is used to refer to the presence of 2 or more different tumors in a single lesion.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> Clinical diagnosis can be difficult (particularly when the collision is between a malignant and a benign tumor), and dermoscopy and confocal microscopy are very useful diagnostic tools. When the collision is between 2 benign tumors, very good concordance is achieved between dermoscopy, confocal microscopy, and histology.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> However, in the cases presented, although both lesions appeared benign on confocal microscopy, they were excised for histologic confirmation of the suspected diagnosis.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The association of seborrheic keratosis with melanocytic nevus is not uncommon. In a retrospective study published by Boyd and Rapini,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> 40<span class="elsevierStyleHsp" style=""></span>000 skin biopsies were analyzed and 69 collision tumors were found, 14 of which involved a nevus and a seborrheic keratosis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In case of doubt, confocal microscopy, a noninvasive imaging technique, helps to improve the evaluation of melanocytic lesions, as it permits in vivo evaluation of microscopic structures.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> Moscarella et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> described 24 cases of collision tumors and reported an excellent correlation between the histologic images and those obtained on confocal microscopy.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 2" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of Interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-05-31" "fechaAceptado" => "2015-12-07" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Armada LA, Villegas RG, Franco AP, Moraleda FP. Evaluation of Collision Tumors by Confocal Microscopy. Actas Dermosifiliogr. 2016;107:440–442.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 787 "Ancho" => 1600 "Tamanyo" => 251439 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A Dermoscopy image. The black squares outline areas with comedo-like openings. B, Confocal microscopy image of 3.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3.5<span class="elsevierStyleHsp" style=""></span>mm. Ring pattern at the dermoepidermal junction (red arrow), polycyclic cords (yellow arrow), and bright annular structures with an onion-skin appearance (green arrow). C, A junctional melanocytic nevus in transition with a seborrheic keratosis, with its characteristic network pattern.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1372 "Ancho" => 1600 "Tamanyo" => 420833 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A Dermoscopy image. Homogeneous globular network with asymmetric globules peripherally (red arrow). Milia-like cysts and comedo-like openings (in square). B, Confocal microscopy image of 5.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mm. The yellow square outlines the area with the bright annular structures and the hyperreflective round structures with a smooth outline (green arrow); on the right, at higher power, the ring pattern is visible at the dermoepidermal junction, with an area of crest fusion (arrow). C, The histologic image shows the presence in the same area of a compound melanocytic nevus and a seborrheic keratosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous collision tumors. An analysis of 69 cases and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.S. Boyd" 1 => "R.P. Rapini" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "1994" "volumen" => "16" "paginaInicial" => "253" "paginaFinal" => "257" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7943631" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of reflectance confocal microscopy as an aid in the diagnosis of collision tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Moscarella" 1 => "H. Rabinovitz" 2 => "M.C. Oliviero" 3 => "L. Brown" 4 => "C. Longo" 5 => "I. Zalaudek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000351771" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2013" "volumen" => "227" "paginaInicial" => "109" "paginaFinal" => "117" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24080548" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Correlation among dermoscopy, confocal reflectance microscopy, and histologic features of melanoma and basal cell carcinoma collision tumor" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Salerni" 1 => "L. Lovatto" 2 => "C. Carrera" 3 => "J. Palou" 4 => "L. Alos" 5 => "J.A. Puig-Butille" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.2010.01871.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "275" "paginaFinal" => "279" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21281387" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000005/v2_201703310310/S1578219016300348/v2_201703310310/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010700000005/v2_201703310310/S1578219016300348/v2_201703310310/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016300348?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 9 | 14 |
| 2024 October | 72 | 32 | 104 |
| 2024 September | 79 | 21 | 100 |
| 2024 August | 91 | 59 | 150 |
| 2024 July | 79 | 22 | 101 |
| 2024 June | 74 | 36 | 110 |
| 2024 May | 66 | 33 | 99 |
| 2024 April | 59 | 31 | 90 |
| 2024 March | 66 | 24 | 90 |
| 2024 February | 54 | 27 | 81 |
| 2024 January | 47 | 32 | 79 |
| 2023 December | 56 | 27 | 83 |
| 2023 November | 52 | 43 | 95 |
| 2023 October | 57 | 37 | 94 |
| 2023 September | 53 | 40 | 93 |
| 2023 August | 54 | 19 | 73 |
| 2023 July | 47 | 35 | 82 |
| 2023 June | 61 | 27 | 88 |
| 2023 May | 41 | 21 | 62 |
| 2023 April | 37 | 20 | 57 |
| 2023 March | 40 | 17 | 57 |
| 2023 February | 43 | 28 | 71 |
| 2023 January | 36 | 25 | 61 |
| 2022 December | 48 | 34 | 82 |
| 2022 November | 27 | 26 | 53 |
| 2022 October | 17 | 20 | 37 |
| 2022 September | 29 | 29 | 58 |
| 2022 August | 24 | 27 | 51 |
| 2022 July | 23 | 30 | 53 |
| 2022 June | 30 | 23 | 53 |
| 2022 May | 42 | 33 | 75 |
| 2022 April | 40 | 35 | 75 |
| 2022 March | 36 | 38 | 74 |
| 2022 February | 28 | 26 | 54 |
| 2022 January | 31 | 23 | 54 |
| 2021 December | 33 | 25 | 58 |
| 2021 November | 31 | 35 | 66 |
| 2021 October | 30 | 50 | 80 |
| 2021 September | 32 | 41 | 73 |
| 2021 August | 23 | 27 | 50 |
| 2021 July | 33 | 27 | 60 |
| 2021 June | 34 | 16 | 50 |
| 2021 May | 35 | 46 | 81 |
| 2021 April | 70 | 28 | 98 |
| 2021 March | 87 | 24 | 111 |
| 2021 February | 63 | 22 | 85 |
| 2021 January | 24 | 15 | 39 |
| 2020 December | 13 | 6 | 19 |
| 2020 November | 26 | 20 | 46 |
| 2020 October | 24 | 6 | 30 |
| 2020 September | 36 | 16 | 52 |
| 2020 August | 25 | 14 | 39 |
| 2020 July | 28 | 18 | 46 |
| 2020 June | 32 | 28 | 60 |
| 2020 May | 26 | 18 | 44 |
| 2020 April | 30 | 14 | 44 |
| 2020 March | 37 | 17 | 54 |
| 2020 February | 5 | 1 | 6 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 10 | 0 | 10 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 6 | 0 | 6 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 7 | 1 | 8 |
| 2019 April | 2 | 0 | 2 |
| 2019 March | 2 | 3 | 5 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 3 | 0 | 3 |
| 2018 November | 1 | 0 | 1 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 5 | 0 | 5 |
| 2018 February | 42 | 4 | 46 |
| 2018 January | 27 | 1 | 28 |
| 2017 December | 60 | 9 | 69 |
| 2017 November | 24 | 4 | 28 |
| 2017 October | 25 | 3 | 28 |
| 2017 September | 19 | 7 | 26 |
| 2017 August | 22 | 3 | 25 |
| 2017 July | 20 | 8 | 28 |
| 2017 June | 24 | 8 | 32 |
| 2017 May | 19 | 6 | 25 |
| 2017 April | 26 | 6 | 32 |
| 2017 March | 18 | 9 | 27 |
| 2017 February | 12 | 4 | 16 |
| 2017 January | 10 | 1 | 11 |
| 2016 December | 19 | 11 | 30 |
| 2016 November | 20 | 18 | 38 |
| 2016 October | 20 | 14 | 34 |
| 2016 May | 0 | 1 | 1 |
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