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Practical Dermoscopy
A Shiny Nodule on the Forehead of a Man
Nódulo brillante en la frente de un adulto
J.F. Mir-Bonafé
Autor para correspondencia
jmirb@santpau.cat

Corresponding author.
, J. Dalmau, E. Rozas-Muñoz
Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 45-year-old man with no disease history of interest consulted with a tumor on his forehead&#44; right on the hairline&#44; that had first appeared 4 months previously&#46; The tumor took the form of a firm&#44; erythematous&#44; orange-colored&#44; shiny nodule that measured 8<span class="elsevierStyleHsp" style=""></span>mm and was completely asymptomatic&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Description</span><p id="par0010" class="elsevierStylePara elsevierViewall">We performed polarized light contact and noncontact dermoscopy&#46; The first examination revealed an intense general erythematous-pink tone mainly at the periphery&#44; with abundant vascularization comprising both homogeneous erythematous areas and irregular linear vessels&#46; The central area had a notable erythematous pale gray tone with homogeneous yellowish-white areas and less visible vascularization&#46; In the contact study&#44; the lesion took on a duller&#44; milky-red tone with almost no vascularization&#46; In the interior of the lesion&#44; we could see very clear opposing delimited yellowish-white areas&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The lesion was removed&#44; and histopathology revealed pilomatricoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Pilomatricoma is a benign adnexal neoplasm of the dermis or subcutaneous cellular tissue derived from immature cells in the hair matrix&#46; While the tumor usually appears before age 20 years&#44; a second peak in incidence is observed at around the sixth decade&#46; Clinically&#44; it presents as a solitary papule or nodule on the head&#44; neck&#44; or upper limbs and is commonly found in transition areas between hairy skin and hairless skin&#46; It may present in a wide variety of colors&#44; ranging from flesh&#44; erythematous&#44; and violaceous to highly pigmented lesions&#46; However&#44; the main characteristic of pilomatricoma is its hard consistency&#44; the result of frequent secondary calcification &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figures 1-4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Given that pilomatricoma is a benign tumor that is also very frequent in children&#44; it is interesting to make the diagnosis based on noninvasive tests&#46; Recent data indicate that while not specific&#44; dermoscopy findings can help us to establish a suspected diagnosis&#46; The most frequent dermoscopy findings are vascular structures&#46; Also very common are homogeneous red areas&#44; irregular linear vessels&#44; and hairpin vessels&#44; which are indicative of major vascular proliferation in the dermis&#46; However&#44; the most relevant findings are undoubtedly irregular whitish structures &#40;including white projections&#41; that are usually noticeable because of their very clearly defined shape and intense color&#46; In histological terms&#44; these structures correspond to areas of calcification&#44; which are so typical of this tumor&#46; Ulceration or bluish-gray structures can also be observed in a lower percentage of cases&#46; In conclusion&#44; the combination of a prominent vascular pattern with homogeneous reddish areas and irregular linear vessels with intense whitish-gray structures should point us toward a diagnosis of pilomatricoma&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of Interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mir-Bonaf&#233; JF&#44; Dalmau J&#44; Rozas-Mu&#241;oz E&#46; N&#243;dulo brillante en la frente de un adulto&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;681&#8211;682&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Firm&#44; shiny&#44; and well-delimited erythematous-pink nodule measuring 8<span class="elsevierStyleHsp" style=""></span>mm in diameter&#46;</p>"
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                      "titulo" => "Dermoscopic findings of pilomatricomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Zaballos"
                            1 => "A&#46; Llambrich"
                            2 => "S&#46; Puig"
                            3 => "J&#46; Malvehy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000148248"
                      "Revista" => array:6 [
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                        "link" => array:1 [
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                            "web" => "Medline"
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            1 => array:3 [
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                  "contribucion" => array:1 [
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                      "titulo" => "Three different dermoscopic view of three new cases with&#160;pilomatrixoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Ayhan"
                            1 => "O&#46; Ertugay"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0974-7753.136753"
                      "Revista" => array:6 [
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                        "link" => array:1 [
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                            "web" => "Medline"
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            ]
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              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rapidly growing blue-red nodule of the cheek of a 4-year-ol boy&#46; Pilomatricoma"
                      "autores" => array:1 [
                        0 => array:2 [
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                          "autores" => array:6 [
                            0 => "C&#46;R&#46; Wolff"
                            1 => "F&#46; Brehmer"
                            2 => "A&#46; Lockmann"
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