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
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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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 4 | 6 | 10 |
| 2024 Octubre | 92 | 60 | 152 |
| 2024 Septiembre | 86 | 36 | 122 |
| 2024 Agosto | 100 | 70 | 170 |
| 2024 Julio | 79 | 45 | 124 |
| 2024 Junio | 63 | 60 | 123 |
| 2024 Mayo | 86 | 48 | 134 |
| 2024 Abril | 80 | 23 | 103 |
| 2024 Marzo | 91 | 40 | 131 |
| 2024 Febrero | 75 | 33 | 108 |
| 2024 Enero | 65 | 37 | 102 |
| 2023 Diciembre | 67 | 15 | 82 |
| 2023 Noviembre | 66 | 34 | 100 |
| 2023 Octubre | 71 | 22 | 93 |
| 2023 Septiembre | 87 | 25 | 112 |
| 2023 Agosto | 65 | 17 | 82 |
| 2023 Julio | 65 | 33 | 98 |
| 2023 Junio | 47 | 24 | 71 |
| 2023 Mayo | 44 | 33 | 77 |
| 2023 Abril | 42 | 17 | 59 |
| 2023 Marzo | 57 | 15 | 72 |
| 2023 Febrero | 46 | 19 | 65 |
| 2023 Enero | 51 | 27 | 78 |
| 2022 Diciembre | 43 | 30 | 73 |
| 2022 Noviembre | 28 | 20 | 48 |
| 2022 Octubre | 26 | 17 | 43 |
| 2022 Septiembre | 38 | 34 | 72 |
| 2022 Agosto | 27 | 33 | 60 |
| 2022 Julio | 36 | 35 | 71 |
| 2022 Junio | 19 | 18 | 37 |
| 2022 Mayo | 52 | 38 | 90 |
| 2022 Abril | 41 | 24 | 65 |
| 2022 Marzo | 61 | 43 | 104 |
| 2022 Febrero | 35 | 19 | 54 |
| 2022 Enero | 60 | 31 | 91 |
| 2021 Diciembre | 33 | 39 | 72 |
| 2021 Noviembre | 45 | 37 | 82 |
| 2021 Octubre | 35 | 42 | 77 |
| 2021 Septiembre | 33 | 38 | 71 |
| 2021 Agosto | 32 | 26 | 58 |
| 2021 Julio | 26 | 25 | 51 |
| 2021 Junio | 30 | 28 | 58 |
| 2021 Mayo | 33 | 38 | 71 |
| 2021 Abril | 70 | 24 | 94 |
| 2021 Marzo | 48 | 18 | 66 |
| 2021 Febrero | 51 | 27 | 78 |
| 2021 Enero | 35 | 13 | 48 |
| 2020 Diciembre | 27 | 11 | 38 |
| 2020 Noviembre | 41 | 24 | 65 |
| 2020 Octubre | 31 | 15 | 46 |
| 2020 Septiembre | 28 | 7 | 35 |
| 2020 Agosto | 26 | 14 | 40 |
| 2020 Julio | 21 | 16 | 37 |
| 2020 Junio | 40 | 31 | 71 |
| 2020 Mayo | 28 | 15 | 43 |
| 2020 Abril | 24 | 18 | 42 |
| 2020 Marzo | 32 | 17 | 49 |
| 2020 Febrero | 3 | 0 | 3 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Junio | 2 | 0 | 2 |
| 2019 Abril | 4 | 1 | 5 |
| 2019 Marzo | 2 | 3 | 5 |
| 2019 Enero | 1 | 0 | 1 |
| 2018 Diciembre | 1 | 0 | 1 |
| 2018 Noviembre | 11 | 0 | 11 |
| 2018 Octubre | 61 | 0 | 61 |
| 2018 Septiembre | 6 | 0 | 6 |
| 2018 Febrero | 18 | 4 | 22 |
| 2018 Enero | 26 | 5 | 31 |
| 2017 Diciembre | 41 | 10 | 51 |
| 2017 Noviembre | 23 | 6 | 29 |
| 2017 Octubre | 25 | 5 | 30 |
| 2017 Septiembre | 24 | 10 | 34 |
| 2017 Agosto | 20 | 4 | 24 |
| 2017 Julio | 25 | 6 | 31 |
| 2017 Junio | 29 | 7 | 36 |
| 2017 Mayo | 30 | 5 | 35 |
| 2017 Abril | 32 | 2 | 34 |
| 2017 Marzo | 10 | 4 | 14 |
| 2017 Febrero | 11 | 6 | 17 |
| 2017 Enero | 10 | 4 | 14 |
| 2016 Diciembre | 18 | 11 | 29 |
| 2016 Noviembre | 27 | 8 | 35 |
| 2016 Octubre | 23 | 19 | 42 |
| 2016 Agosto | 1 | 0 | 1 |
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