Practical Dermoscopy
Collision Tumors
Aquí hay «baso» encerrado
P. Zaballos-Diego
Hospital de Sant Pau i Santa Tecla de Tarragona, Tarragona, Spain
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Mujer de 67 años que presenta, desde hace años, un nódulo indurado rosado de 7<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm localizado en el brazo izquierdo. Signo del ojal positivo. Diagnóstico clínico: dermatofibroma. B. Varón de 75 años con múltiples queratosis seborreicas en la espalda que presenta una pápula queratósica de 1<span class="elsevierStyleHsp" style=""></span>cm diferente al resto (centro de la imagen). Diagnóstico clínico: queratosis seborreica inflamada</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Zaballos-Diego" "autores" => array:1 [ 0 => array:2 [ "nombre" => "P." 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Nuestra experiencia en 4 pacientes. Informe preliminar" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 752 "Ancho" => 1001 "Tamanyo" => 134403 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical images of one of the patients (patient number 4 in the Table). This patient had a history of generalized subacute eczema resistant to all treatments mentioned in the text. A, Before treatment with ustekinumab. B, After 3 injections of the drug.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.C. Fernández-Antón Martínez, F. Alfageme Roldán, C. Ciudad Blanco, R. 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Despite the absence of the tarsus, it was possible to preserve part of the palpebral conjunctiva, the medial canthus, and the lacrimal apparatus.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.M. Otero Rivas, H.A. Cocunubo Blanco, B. González Sixto, M.Á. Rodríguez Prieto" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.M." "apellidos" => "Otero Rivas" ] 1 => array:2 [ "nombre" => "H.A." "apellidos" => "Cocunubo Blanco" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "González Sixto" ] 3 => array:2 [ "nombre" => "M.Á." "apellidos" => "Rodríguez Prieto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731013004274" "doi" => "10.1016/j.ad.2013.11.005" "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/S0001731013004274?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014000493?idApp=UINPBA000044" "url" => "/15782190/0000010500000003/v1_201404030048/S1578219014000493/v1_201404030048/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Practical Dermoscopy</span>" "titulo" => "Collision Tumors" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "310" "paginaFinal" => "311" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "P. Zaballos-Diego" "autores" => array:1 [ 0 => array:3 [ "nombre" => "P." "apellidos" => "Zaballos-Diego" "email" => array:1 [ 0 => "pzaballos@aedv.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital de Sant Pau i Santa Tecla de Tarragona, Tarragona, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aquí hay «baso» encerrado" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 697 "Ancho" => 1900 "Tamanyo" => 222518 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Comment</span><p id="par0005" class="elsevierStylePara elsevierViewall">The dermoscopy image of the first case shows a lesion that can be divided into 2 parts (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). On the right side we can see a pattern formed of a central white patch surrounded by a fine pigmented reticulum. This pattern has been reported in 35% to 80% of dermatofibromas and is considered to be the characteristic dermoscopic pattern of such lesions.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, on the left side of the image we see a completely different pattern. There are small telangiectasias of short and twisted vessels (kinked vessels) on an erythematous background, and a large arborizing or branching telangiectasia, a structure characteristic of basal cell carcinoma.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The dermoscopic diagnosis was a collision tumor (dermatofibroma-basal cell carcinoma) and this was confirmed after excision of the lesion.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The dermoscopy image of the second case (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) shows fissures and crests, with a few crypts at the periphery of the lesion; these structures are characteristic of seborrheic keratosis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However, in the central and lower areas we can see telangiectasias, some of which have an arborizing morphology, ovoid blue-gray areas, and numerous blue-gray globules. These structures are characteristic of basal cell carcinoma.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The dermoscopic diagnosis was a collision tumor (seborrheic keratosis-basal cell carcinoma) and this was confirmed after excision of the lesion.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The collision of skin tumors is a relatively rare phenomenon (Boyd and Rapini<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> found only 69 cases in the 40.000 biopsies they reviewed) and can be difficult to suspect in practice. Diagnostic error is particularly important when the collision tumor is formed of a combination of a malignant and a benign tumor and the benign lesion is clinically more evident, as occurred in both cases presented. By revealing epidermal and dermal structures invisible to the naked eye, dermoscopy has been shown to be very useful in the diagnosis of these lesions, and collision tumors that would normally escape clinical detection can now be diagnosed using this technique (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>, A and B).<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Comment" ] 1 => 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: Zaballos-Diego P. Aquí hay «baso» encerrado. Actas Dermosifiliogr. 2014. 105:310–311.</p>" ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 697 "Ancho" => 1900 "Tamanyo" => 222518 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 691 "Ancho" => 1900 "Tamanyo" => 299227 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. An indurated pink nodule of 7<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm that had been present for years on the left arm of a 67-year-old woman. Positive buttonhole sign. The clinical diagnosis was dermatofibroma. B. Multiple seborrheic keratoses on the back of a 75-year-old man. One of the keratotic papules (center of the photograph), measuring 1<span class="elsevierStyleHsp" style=""></span>cm in diameter, was different from the other lesions. The clinical diagnosis was inflamed seborrheic keratosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopy of dermatofibromas: A prospective morphological study of 412 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Zaballos" 1 => "S. Puig" 2 => "A. Llambrich" 3 => "J. 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Puig" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Australas J Dermatol" "fecha" => "2013" "volumen" => "54" "paginaInicial" => "12" "paginaFinal" => "20" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010500000003/v1_201404030048/S157821901400050X/v1_201404030048/en/main.assets" "Apartado" => array:4 [ "identificador" => "19289" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Practical Dermoscopy" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010500000003/v1_201404030048/S157821901400050X/v1_201404030048/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901400050X?idApp=UINPBA000044" ]
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| 2022 Agosto | 26 | 36 | 62 |
| 2022 Julio | 31 | 28 | 59 |
| 2022 Junio | 37 | 35 | 72 |
| 2022 Mayo | 42 | 33 | 75 |
| 2022 Abril | 71 | 41 | 112 |
| 2022 Marzo | 88 | 55 | 143 |
| 2022 Febrero | 51 | 36 | 87 |
| 2022 Enero | 55 | 35 | 90 |
| 2021 Diciembre | 37 | 37 | 74 |
| 2021 Noviembre | 41 | 58 | 99 |
| 2021 Octubre | 43 | 48 | 91 |
| 2021 Septiembre | 48 | 34 | 82 |
| 2021 Agosto | 47 | 36 | 83 |
| 2021 Julio | 82 | 53 | 135 |
| 2021 Junio | 36 | 34 | 70 |
| 2021 Mayo | 52 | 39 | 91 |
| 2021 Abril | 114 | 80 | 194 |
| 2021 Marzo | 63 | 23 | 86 |
| 2021 Febrero | 41 | 24 | 65 |
| 2021 Enero | 27 | 20 | 47 |
| 2020 Diciembre | 37 | 9 | 46 |
| 2020 Noviembre | 20 | 16 | 36 |
| 2020 Octubre | 24 | 9 | 33 |
| 2020 Septiembre | 39 | 13 | 52 |
| 2020 Agosto | 20 | 14 | 34 |
| 2020 Julio | 29 | 12 | 41 |
| 2020 Junio | 22 | 18 | 40 |
| 2020 Mayo | 21 | 10 | 31 |
| 2020 Abril | 30 | 11 | 41 |
| 2020 Marzo | 32 | 16 | 48 |
| 2020 Febrero | 7 | 0 | 7 |
| 2020 Enero | 2 | 2 | 4 |
| 2019 Diciembre | 8 | 2 | 10 |
| 2019 Noviembre | 5 | 2 | 7 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 4 | 3 | 7 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 7 | 6 | 13 |
| 2019 Junio | 4 | 5 | 9 |
| 2019 Mayo | 6 | 10 | 16 |
| 2019 Abril | 2 | 1 | 3 |
| 2019 Marzo | 0 | 3 | 3 |
| 2019 Febrero | 6 | 0 | 6 |
| 2019 Enero | 1 | 0 | 1 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Marzo | 4 | 8 | 12 |
| 2018 Febrero | 44 | 5 | 49 |
| 2018 Enero | 47 | 4 | 51 |
| 2017 Diciembre | 68 | 11 | 79 |
| 2017 Noviembre | 36 | 10 | 46 |
| 2017 Octubre | 43 | 10 | 53 |
| 2017 Septiembre | 49 | 4 | 53 |
| 2017 Agosto | 44 | 19 | 63 |
| 2017 Julio | 45 | 11 | 56 |
| 2017 Junio | 48 | 22 | 70 |
| 2017 Mayo | 45 | 7 | 52 |
| 2017 Abril | 44 | 7 | 51 |
| 2017 Marzo | 24 | 39 | 63 |
| 2017 Febrero | 33 | 12 | 45 |
| 2017 Enero | 24 | 12 | 36 |
| 2016 Diciembre | 35 | 11 | 46 |
| 2016 Noviembre | 58 | 11 | 69 |
| 2016 Octubre | 66 | 23 | 89 |
| 2016 Septiembre | 110 | 14 | 124 |
| 2016 Agosto | 49 | 13 | 62 |
| 2016 Julio | 40 | 9 | 49 |
| 2016 Junio | 10 | 3 | 13 |
| 2016 Mayo | 8 | 12 | 20 |
| 2016 Abril | 3 | 1 | 4 |
| 2016 Marzo | 11 | 3 | 14 |
| 2016 Febrero | 9 | 4 | 13 |
| 2016 Enero | 11 | 3 | 14 |
| 2015 Diciembre | 5 | 4 | 9 |
| 2015 Noviembre | 9 | 8 | 17 |
| 2015 Octubre | 9 | 2 | 11 |
| 2015 Septiembre | 6 | 0 | 6 |
| 2015 Agosto | 9 | 3 | 12 |
| 2015 Julio | 30 | 5 | 35 |
| 2015 Junio | 26 | 3 | 29 |
| 2015 Mayo | 42 | 7 | 49 |
| 2015 Abril | 28 | 5 | 33 |
| 2015 Marzo | 21 | 7 | 28 |
| 2015 Febrero | 20 | 3 | 23 |
| 2015 Enero | 23 | 2 | 25 |
| 2014 Diciembre | 24 | 6 | 30 |
| 2014 Noviembre | 19 | 8 | 27 |
| 2014 Octubre | 32 | 5 | 37 |
| 2014 Septiembre | 20 | 5 | 25 |
| 2014 Agosto | 14 | 6 | 20 |
| 2014 Julio | 17 | 5 | 22 |
| 2014 Junio | 25 | 4 | 29 |
| 2014 Mayo | 20 | 5 | 25 |
| 2014 Abril | 18 | 7 | 25 |
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