Case and research letter
Dermoscopic Rainbow Pattern in Atypical Fibroxanthoma
Patrón dermatoscópico en arcoíris en fibroxantoma atípico
G. Pitarch
Sección de Dermatología, Hospital General de Castelló, Castelló, Spain
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Rosettes (indicated by a white circle in the lesion on the left; a larger number of rosettes are seen in the central area of the lesion on the right) are in evidence, along with irregularly shaped vessels and a clear rainbow pattern.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Pérez-Pérez, J. García-Gavín, F. Allegue, A. Zulaica" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Pérez-Pérez" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "García-Gavín" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Allegue" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Zulaica" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731013000835" "doi" => "10.1016/j.ad.2012.12.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013000835?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013002783?idApp=UINPBA000044" "url" => "/15782190/0000010500000001/v1_201401220123/S1578219013002783/v1_201401220123/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and research letter</span>" "titulo" => "Dermoscopic Rainbow Pattern in Atypical Fibroxanthoma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "97" "paginaFinal" => "99" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "G. Pitarch" "autores" => array:1 [ 0 => array:3 [ "nombre" => "G." "apellidos" => "Pitarch" "email" => array:1 [ 0 => "gerardpitarch@hotmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Sección de Dermatología, Hospital General de Castelló, Castelló, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Patrón dermatoscópico en arcoíris en fibroxantoma atípico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 922 "Ancho" => 900 "Tamanyo" => 109009 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tumor on the scalp and nearby actinic keratoses.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 73-year-old man with a history of non-insulin-dependent diabetes mellitus, arterial hypertension, abdominal aortic aneurysm, and hypercholesterolemia. He was referred to our department for evaluation of a tumor on the scalp that had appeared 6 weeks earlier. The tumor was pink with some reddish and violaceous areas, had a maximum diameter of 18<span class="elsevierStyleHsp" style=""></span>mm and distinct borders, was nonulcerated, and displayed mild scaling in the center (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Dermoscopic examination was performed with a polarized light contact dermoscope (DermLite Foto, 3Gen LLC) using ultrasound gel as the liquid interface. The dermoscopic images showed a round, symmetrical lesion with a reddish peripheral area from which atypical, irregularly distributed, out-of-focus blood vessels—mostly linear and unbranched—extended in a vaguely radial pattern (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Most of the tumor surface displayed rainbow-patterned areas, often arranged in parallel to the linear, irregular blood vessels. None of the criteria specific to melanocytic lesions were observed. Shiny whitish areas were observed between the rainbow-patterned structures, and scales were visible on the surface.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Complete surgical excision of the lesion was performed. Histologic examination revealed a nodular cell proliferation in the dermis comprising aberrant spindle-shaped cells, epithelioid cells, multinucleated giant cells, and abundant mitotic figures. Hemorrhagic zones were observed in some areas. Immunohistochemistry was positive for vimentin, CD68, and CD10 and negative for CD31, CD34, FVIII, S100, cytokeratins, epithelial membrane antigen, desmin, and smooth muscle actin. The proliferative index, measured using Ki-67, was between 10% and 20%. A diagnosis of atypical fibroxanthoma was established on the basis of the histopathologic findings.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Atypical fibroxanthoma is a rare low-grade tumor. It usually develops on chronically sun-damaged skin, especially on the head or neck of elderly patients.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Clinically, it presents as a single, rapidly growing nodule. Differential diagnosis should include basal cell carcinoma, squamous cell carcinoma, Merkel cell carcinoma, and melanoma. Lymph node metastases are rare and distant metastases are very rare.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Only 4 dermoscopic observations of this rare tumor have been described in the literature. An atypical vascular pattern with irregularly distributed polymorphic vessels—including linear, punctate, globular, tortuous, and arborizing vessels—was observed in 3 cases.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Whitish areas were observed in 2 of these patients and heterogeneous hyperpigmentation in the other. The remaining case was a collision tumor associated with a basal cell carcinoma, in which the atypical fibroxanthoma component appeared as a hemorrhagic, ulcerated lesion with small telangiectasias.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In our patient, the most striking dermoscopic finding was the rainbow pattern in the center of the tumor. Although the rainbow pattern was initially considered to be a characteristic feature of Kaposi sarcoma, it has since been observed in various conditions, including melanoma, stasis dermatitis, lichen planus, hemosiderotic dermatofibroma, and basal cell carcinoma.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4-7</span></a> The rainbow pattern is an optical phenomenon that can only be observed with a polarized light dermoscope (either contact or noncontact). It occurs when light in different states of polarization interacts with the structures of the lesion.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Bugatti et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> specified that a contact dermoscope was used in the 3 cases they reported but did not state whether or not the device used polarized light, without which the rainbow pattern cannot be observed.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The shiny white structures can take the form of shiny white streaks (also known as chrysalis structures), shiny white areas, or rosettes. These structures can be observed much more clearly with a polarized light dermoscope. The presence of shiny white structures has been described in various benign and malignant tumors—including melanoma, Spitz nevus, dermatofibroma, actinic keratosis, squamous cell carcinoma, and basal cell carcinoma—and is indicative of an increase in dermal collagen.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">All dermoscopic observations of atypical fibroxanthoma reported to date have described an atypical vascular pattern characterized by polymorphic vessels interspersed with whitish areas. This dermoscopic pattern is nonspecific and indicative of chaotic neoangiogenesis during growth. It is also seen in other tumors that are clinically similar to atypical fibroxanthoma, such as squamous cell carcinoma, Merkel cell carcinoma, and amelanotic melanoma.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Since the rainbow pattern is also found in a number of these tumors, this finding alone is not sufficient to establish a dermoscopic diagnosis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In summary, we present the first dermoscopic observation of the rainbow pattern in an atypical fibroxanthoma, thereby adding atypical fibroxanthoma to the list of entities that can present this finding. A vascular pattern characterized by polymorphic vessels is a constant finding in all reported cases of this tumor.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pitarch G. Patrón dermatoscópico en arcoíris en fibroxantoma atípico. Actas Dermosifiliogr. 2014;105:97–99.</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" => 922 "Ancho" => 900 "Tamanyo" => 109009 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tumor on the scalp and nearby actinic keratoses.</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" => 762 "Ancho" => 900 "Tamanyo" => 108026 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic image, obtained using a polarized light contact dermoscope, showing irregular blood vessels in the peripheral area and a rainbow pattern in the center.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fibroxantoma atípico. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 9 | 5 | 14 |
| 2024 Octubre | 125 | 68 | 193 |
| 2024 Septiembre | 105 | 42 | 147 |
| 2024 Agosto | 130 | 56 | 186 |
| 2024 Julio | 93 | 45 | 138 |
| 2024 Junio | 123 | 35 | 158 |
| 2024 Mayo | 96 | 27 | 123 |
| 2024 Abril | 85 | 32 | 117 |
| 2024 Marzo | 97 | 33 | 130 |
| 2024 Febrero | 94 | 40 | 134 |
| 2024 Enero | 79 | 30 | 109 |
| 2023 Diciembre | 77 | 21 | 98 |
| 2023 Noviembre | 77 | 37 | 114 |
| 2023 Octubre | 90 | 53 | 143 |
| 2023 Septiembre | 99 | 63 | 162 |
| 2023 Agosto | 55 | 68 | 123 |
| 2023 Julio | 114 | 60 | 174 |
| 2023 Junio | 98 | 35 | 133 |
| 2023 Mayo | 103 | 58 | 161 |
| 2023 Abril | 66 | 25 | 91 |
| 2023 Marzo | 63 | 32 | 95 |
| 2023 Febrero | 55 | 38 | 93 |
| 2023 Enero | 53 | 37 | 90 |
| 2022 Diciembre | 44 | 45 | 89 |
| 2022 Noviembre | 24 | 40 | 64 |
| 2022 Octubre | 27 | 37 | 64 |
| 2022 Septiembre | 27 | 57 | 84 |
| 2022 Agosto | 22 | 32 | 54 |
| 2022 Julio | 25 | 45 | 70 |
| 2022 Junio | 27 | 35 | 62 |
| 2022 Mayo | 79 | 51 | 130 |
| 2022 Abril | 66 | 47 | 113 |
| 2022 Marzo | 62 | 59 | 121 |
| 2022 Febrero | 61 | 39 | 100 |
| 2022 Enero | 51 | 54 | 105 |
| 2021 Diciembre | 57 | 48 | 105 |
| 2021 Noviembre | 43 | 52 | 95 |
| 2021 Octubre | 64 | 51 | 115 |
| 2021 Septiembre | 70 | 47 | 117 |
| 2021 Agosto | 49 | 37 | 86 |
| 2021 Julio | 54 | 45 | 99 |
| 2021 Junio | 63 | 44 | 107 |
| 2021 Mayo | 70 | 44 | 114 |
| 2021 Abril | 133 | 88 | 221 |
| 2021 Marzo | 95 | 34 | 129 |
| 2021 Febrero | 46 | 30 | 76 |
| 2021 Enero | 77 | 27 | 104 |
| 2020 Diciembre | 45 | 17 | 62 |
| 2020 Noviembre | 52 | 15 | 67 |
| 2020 Octubre | 41 | 22 | 63 |
| 2020 Septiembre | 53 | 20 | 73 |
| 2020 Agosto | 48 | 27 | 75 |
| 2020 Julio | 67 | 25 | 92 |
| 2020 Junio | 58 | 38 | 96 |
| 2020 Mayo | 91 | 24 | 115 |
| 2020 Abril | 49 | 24 | 73 |
| 2020 Marzo | 36 | 25 | 61 |
| 2020 Febrero | 6 | 4 | 10 |
| 2020 Enero | 0 | 6 | 6 |
| 2019 Diciembre | 7 | 5 | 12 |
| 2019 Noviembre | 5 | 2 | 7 |
| 2019 Octubre | 0 | 8 | 8 |
| 2019 Septiembre | 8 | 5 | 13 |
| 2019 Agosto | 2 | 4 | 6 |
| 2019 Julio | 5 | 16 | 21 |
| 2019 Junio | 4 | 5 | 9 |
| 2019 Mayo | 7 | 23 | 30 |
| 2019 Abril | 2 | 16 | 18 |
| 2019 Marzo | 2 | 4 | 6 |
| 2019 Febrero | 3 | 0 | 3 |
| 2018 Diciembre | 4 | 12 | 16 |
| 2018 Noviembre | 4 | 0 | 4 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Agosto | 0 | 6 | 6 |
| 2018 Julio | 0 | 13 | 13 |
| 2018 Junio | 0 | 9 | 9 |
| 2018 Mayo | 0 | 9 | 9 |
| 2018 Abril | 0 | 12 | 12 |
| 2018 Marzo | 4 | 1 | 5 |
| 2018 Febrero | 97 | 6 | 103 |
| 2018 Enero | 99 | 6 | 105 |
| 2017 Diciembre | 67 | 11 | 78 |
| 2017 Noviembre | 76 | 7 | 83 |
| 2017 Octubre | 80 | 6 | 86 |
| 2017 Septiembre | 59 | 12 | 71 |
| 2017 Agosto | 68 | 9 | 77 |
| 2017 Julio | 66 | 17 | 83 |
| 2017 Junio | 73 | 15 | 88 |
| 2017 Mayo | 75 | 21 | 96 |
| 2017 Abril | 62 | 31 | 93 |
| 2017 Marzo | 72 | 23 | 95 |
| 2017 Febrero | 54 | 14 | 68 |
| 2017 Enero | 42 | 20 | 62 |
| 2016 Diciembre | 59 | 18 | 77 |
| 2016 Noviembre | 83 | 17 | 100 |
| 2016 Octubre | 96 | 25 | 121 |
| 2016 Septiembre | 198 | 30 | 228 |
| 2016 Agosto | 97 | 17 | 114 |
| 2016 Julio | 54 | 6 | 60 |
| 2016 Junio | 9 | 12 | 21 |
| 2016 Mayo | 13 | 14 | 27 |
| 2016 Abril | 10 | 2 | 12 |
| 2016 Marzo | 7 | 4 | 11 |
| 2016 Febrero | 4 | 1 | 5 |
| 2016 Enero | 15 | 3 | 18 |
| 2015 Diciembre | 11 | 2 | 13 |
| 2015 Noviembre | 12 | 3 | 15 |
| 2015 Octubre | 11 | 1 | 12 |
| 2015 Septiembre | 8 | 4 | 12 |
| 2015 Agosto | 13 | 2 | 15 |
| 2015 Julio | 100 | 1 | 101 |
| 2015 Junio | 66 | 10 | 76 |
| 2015 Mayo | 65 | 20 | 85 |
| 2015 Abril | 47 | 11 | 58 |
| 2015 Marzo | 34 | 3 | 37 |
| 2015 Febrero | 43 | 6 | 49 |
| 2015 Enero | 27 | 8 | 35 |
| 2014 Diciembre | 32 | 6 | 38 |
| 2014 Noviembre | 34 | 3 | 37 |
| 2014 Octubre | 45 | 6 | 51 |
| 2014 Septiembre | 25 | 1 | 26 |
| 2014 Agosto | 37 | 3 | 40 |
| 2014 Julio | 26 | 11 | 37 |
| 2014 Junio | 28 | 8 | 36 |
| 2014 Mayo | 26 | 10 | 36 |
| 2014 Abril | 18 | 4 | 22 |
| 2014 Marzo | 14 | 9 | 23 |
| 2014 Febrero | 6 | 4 | 10 |
| 2014 Enero | 1 | 1 | 2 |
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