Case and Research Letter
Large Asymmetric Pigmented Nodule in a 27-Year-Old Female
Nódulo pigmentado asimétrico de gran tamaño en una mujer de 27 años
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Osório, A. Margarida Barros, O. Ferreira, F. Azevedo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Osório" "email" => array:1 [ 0 => "filipaosorio@gmail.com" ] "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" => "A." "apellidos" => "Margarida Barros" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "O." "apellidos" => "Ferreira" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "F." "apellidos" => "Azevedo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Dermatology and Venereology, Centro Hospitalar de São João EPE, Porto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculty of Medicine of University of Porto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nódulo pigmentado asimétrico de gran tamaño en una mujer de 27 años" ] ] "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" => 1216 "Ancho" => 900 "Tamanyo" => 142434 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic picture (20×): central dark hyperpigmented area with a predominant globular pattern (thick arrow), an eccentric thickened pigment network (thin arrow) and a blue-whitish-veil (*), surrounded by a rim of thin regular pigment network (**).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 27-year-old female presented with an asymptomatic nodule on the left thigh. She reported a smaller pigmented lesion since birth, with significant growth in the last 5 years. The patient had no personal or family history of skin cancer. She was otherwise healthy and had no systemic symptoms. She was doing oral contraception and no other medications.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a smooth nodular dome-shaped lesion measuring 1<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm, with central hyperpigmented and peripheral erythematous areas, located on the medium third of the anterior left thigh (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There was no regional lymphadenopathy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Dermoscopically there was a central dark hyperpigmented area surrounded by a rim of thin regular pigment network (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In the central area we observed a predominant globular pattern, an eccentric thickened pigment network and a blue-whitish-veil.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Excision was performed. Histological examination revealed a compound (predominantly intradermal) melanocytic nevus with congenital-like growth pattern and a dermatofibroma, with no signs of malignancy (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Nevus cells involved deep dermal appendages and neurovascular structures and they became progressively smaller in deeper portions of the lesion suggesting maturation and benignity. Intermingled with melanocytes, there was a proliferation of spindle fibro-histiocytic cells characteristic of dermatofibroma.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Collision tumors result from the combination of two or more benign and/or malignant neoplasms in a single lesion.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> As it is unknown whether the association is a random event or whether there is, in fact, a pathogenic relationship in the development of two distinctive neoplasms together, some authors propose the designation of compound tumor instead of collision tumor because the last one suggests the association is incidental.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Collision tumors are not rare. Boyd and Rapini performed a retrospective evaluation of approximately 40,000 cutaneous biopsies, yielding 69 collision tumors.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Cascajo and colleagues found 54 collision tumors of malignant cutaneous neoplasms associated with seborrheic keratoses in 85,000 biopsies.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The most common combinations found by Boyd and Rapini included basal cell carcinoma and nevus (14), basal cell carcinoma and seborrheic keratosis (8), nevus and seborrheic keratosis (14), actinic keratosis and nevus (7), and basal cell carcinoma and neurofibroma (4).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Another commonly described association is that of melanocytic nevus with desmoplastic trichoepithelioma.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Our patient had a compound tumor of congenital nevus and dermatofibroma. As far as we know, this is the first reported case of such a combination.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Furthermore this tumor clinically and dermoscopically mimicked malignant melanoma. Although in some cases dermoscopy can help with collision tumor diagnosis,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> this was not the case. In fact, according to Giorgi and colleagues cutaneous collision tumors are extremely difficult to diagnose preoperatively, even with the help of dermoscopy, in particular when one of the lesions is melanocytic.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The presence of a pigment network, the pathognomonic sign of the melanocytic lesion, allows dermatologists to use dermoscopic algorithms, which in this case ended up in the wrong preoperative diagnosis of a malignant lesion.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 766 "Ancho" => 900 "Tamanyo" => 117085 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Asymmetric pigmented nodule (1<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm) on the left anterior thigh.</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" => 1216 "Ancho" => 900 "Tamanyo" => 142434 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic picture (20×): central dark hyperpigmented area with a predominant globular pattern (thick arrow), an eccentric thickened pigment network (thin arrow) and a blue-whitish-veil (*), surrounded by a rim of thin regular pigment network (**).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 676 "Ancho" => 900 "Tamanyo" => 230736 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histological picture (H&E, 4×): collision tumor of congenital nevus and dermatofibroma.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Collision of malignant melanoma (lentigo maligna type) with squamous cell carcinoma in solar-damaged skin of the face" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "V. 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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" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopy is useful for the recognition of benign–malignant compound tumours" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Zaballos" 1 => "A. Llambrich" 2 => "S. Puig" 3 => "J. Malvehy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2005.06717.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2005" "volumen" => "153" "paginaInicial" => "653" "paginaFinal" => "656" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16120160" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous collision tumour (melanocytic naevus, basal cell carcinoma, seborrheic keratosis): a clinical, dermoscopic and pathological case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "V. Giorgi" 1 => "D. Massi" 2 => "S. Sestini" 3 => "B. Alfaioli" 4 => "G. Carelli" 5 => "P. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 9 | 6 | 15 |
| 2024 Octubre | 39 | 42 | 81 |
| 2024 Septiembre | 30 | 26 | 56 |
| 2024 Agosto | 56 | 70 | 126 |
| 2024 Julio | 65 | 37 | 102 |
| 2024 Junio | 70 | 40 | 110 |
| 2024 Mayo | 39 | 32 | 71 |
| 2024 Abril | 55 | 29 | 84 |
| 2024 Marzo | 59 | 30 | 89 |
| 2024 Febrero | 53 | 33 | 86 |
| 2024 Enero | 47 | 29 | 76 |
| 2023 Diciembre | 39 | 11 | 50 |
| 2023 Noviembre | 43 | 27 | 70 |
| 2023 Octubre | 47 | 11 | 58 |
| 2023 Septiembre | 49 | 30 | 79 |
| 2023 Agosto | 35 | 20 | 55 |
| 2023 Julio | 76 | 34 | 110 |
| 2023 Junio | 51 | 24 | 75 |
| 2023 Mayo | 38 | 11 | 49 |
| 2023 Abril | 31 | 17 | 48 |
| 2023 Marzo | 40 | 21 | 61 |
| 2023 Febrero | 53 | 16 | 69 |
| 2023 Enero | 39 | 33 | 72 |
| 2022 Diciembre | 54 | 29 | 83 |
| 2022 Noviembre | 48 | 29 | 77 |
| 2022 Octubre | 51 | 41 | 92 |
| 2022 Septiembre | 41 | 46 | 87 |
| 2022 Agosto | 57 | 45 | 102 |
| 2022 Julio | 43 | 45 | 88 |
| 2022 Junio | 35 | 35 | 70 |
| 2022 Mayo | 35 | 43 | 78 |
| 2022 Abril | 42 | 36 | 78 |
| 2022 Marzo | 39 | 49 | 88 |
| 2022 Febrero | 37 | 35 | 72 |
| 2022 Enero | 38 | 36 | 74 |
| 2021 Diciembre | 38 | 35 | 73 |
| 2021 Noviembre | 36 | 43 | 79 |
| 2021 Octubre | 38 | 64 | 102 |
| 2021 Septiembre | 28 | 42 | 70 |
| 2021 Agosto | 30 | 31 | 61 |
| 2021 Julio | 26 | 38 | 64 |
| 2021 Junio | 36 | 45 | 81 |
| 2021 Mayo | 33 | 39 | 72 |
| 2021 Abril | 75 | 62 | 137 |
| 2021 Marzo | 62 | 31 | 93 |
| 2021 Febrero | 58 | 25 | 83 |
| 2021 Enero | 41 | 23 | 64 |
| 2020 Diciembre | 43 | 14 | 57 |
| 2020 Noviembre | 24 | 21 | 45 |
| 2020 Octubre | 29 | 9 | 38 |
| 2020 Septiembre | 30 | 15 | 45 |
| 2020 Agosto | 22 | 18 | 40 |
| 2020 Julio | 31 | 9 | 40 |
| 2020 Junio | 28 | 20 | 48 |
| 2020 Mayo | 22 | 14 | 36 |
| 2020 Abril | 21 | 18 | 39 |
| 2020 Marzo | 15 | 19 | 34 |
| 2020 Febrero | 6 | 7 | 13 |
| 2020 Enero | 4 | 7 | 11 |
| 2019 Diciembre | 4 | 2 | 6 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 5 | 1 | 6 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 2 | 6 |
| 2019 Junio | 4 | 12 | 16 |
| 2019 Mayo | 6 | 9 | 15 |
| 2019 Abril | 2 | 6 | 8 |
| 2019 Marzo | 0 | 12 | 12 |
| 2019 Febrero | 4 | 1 | 5 |
| 2019 Enero | 2 | 1 | 3 |
| 2018 Diciembre | 2 | 2 | 4 |
| 2018 Noviembre | 2 | 3 | 5 |
| 2018 Octubre | 1 | 1 | 2 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Julio | 0 | 1 | 1 |
| 2018 Marzo | 3 | 2 | 5 |
| 2018 Febrero | 36 | 5 | 41 |
| 2018 Enero | 42 | 5 | 47 |
| 2017 Diciembre | 47 | 10 | 57 |
| 2017 Noviembre | 37 | 7 | 44 |
| 2017 Octubre | 37 | 4 | 41 |
| 2017 Septiembre | 45 | 6 | 51 |
| 2017 Agosto | 56 | 10 | 66 |
| 2017 Julio | 39 | 4 | 43 |
| 2017 Junio | 53 | 9 | 62 |
| 2017 Mayo | 32 | 4 | 36 |
| 2017 Abril | 21 | 6 | 27 |
| 2017 Marzo | 20 | 24 | 44 |
| 2017 Febrero | 28 | 4 | 32 |
| 2017 Enero | 19 | 5 | 24 |
| 2016 Diciembre | 38 | 8 | 46 |
| 2016 Noviembre | 43 | 10 | 53 |
| 2016 Octubre | 49 | 25 | 74 |
| 2016 Septiembre | 92 | 10 | 102 |
| 2016 Agosto | 20 | 6 | 26 |
| 2016 Julio | 21 | 6 | 27 |
| 2016 Junio | 6 | 0 | 6 |
| 2016 Mayo | 4 | 7 | 11 |
| 2016 Abril | 9 | 0 | 9 |
| 2016 Marzo | 7 | 0 | 7 |
| 2016 Febrero | 12 | 11 | 23 |
| 2016 Enero | 7 | 43 | 50 |
| 2015 Diciembre | 8 | 21 | 29 |
| 2015 Noviembre | 11 | 17 | 28 |
| 2015 Octubre | 8 | 11 | 19 |
| 2015 Septiembre | 6 | 8 | 14 |
| 2015 Agosto | 12 | 6 | 18 |
| 2015 Julio | 61 | 4 | 65 |
| 2015 Junio | 62 | 9 | 71 |
| 2015 Mayo | 109 | 23 | 132 |
| 2015 Abril | 80 | 8 | 88 |
| 2015 Marzo | 47 | 4 | 51 |
| 2015 Febrero | 35 | 2 | 37 |
| 2015 Enero | 38 | 0 | 38 |
| 2014 Diciembre | 34 | 0 | 34 |
| 2014 Noviembre | 26 | 0 | 26 |
| 2014 Octubre | 44 | 0 | 44 |
| 2014 Septiembre | 38 | 0 | 38 |
| 2014 Agosto | 32 | 0 | 32 |
| 2014 Julio | 25 | 0 | 25 |
| 2014 Junio | 45 | 0 | 45 |
| 2014 Mayo | 44 | 0 | 44 |
| 2014 Abril | 36 | 0 | 36 |
| 2014 Marzo | 60 | 14 | 74 |
| 2014 Febrero | 58 | 5 | 63 |
| 2014 Enero | 60 | 5 | 65 |
| 2013 Diciembre | 73 | 10 | 83 |
| 2013 Noviembre | 44 | 5 | 49 |
| 2013 Octubre | 59 | 11 | 70 |
| 2013 Septiembre | 43 | 8 | 51 |
| 2013 Agosto | 41 | 6 | 47 |
| 2013 Julio | 51 | 18 | 69 |
| 2013 Junio | 46 | 5 | 51 |
| 2013 Mayo | 49 | 4 | 53 |
| 2013 Abril | 47 | 27 | 74 |
| 2013 Marzo | 36 | 23 | 59 |
| 2013 Febrero | 2 | 3 | 5 |
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