Practical Dermoscopy
Pigmented Tumor on the Scalp
Tumor pigmentado de cuero cabelludo
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Anatomic structure. Left, dorsal view. M: mouth. Formed by teeth (which cut into the epidermis like a circular saw) and a haustellum to suck the blood from the dermal vessels. The haustellum, in turn, contains 2 dorsal stylets (firmly positioned to form a conduit that empties into the pharynx), a medial stylet (containing a salivary canal), and a ventral stylet (that groups together the other stylets to form a fascicle). It also has distal teeth, which help penetrate the dermis. E: eye. 1: first leg (less robust than the other legs; fine terminal claw). D: digestive tube (seen against the light). Note the ingested blood. 2 and 3: second and third legs (more robust than the first leg; terminal claw similar to that seen in crabs, designed to grasp tightly to the hair of the host). Parts of the leg (c: coxa, tr: trochanter, f: femur, tb: tibia, tp: tibial projection; n: nail). D: dorsum showing some hair structures on the surface. <span class="elsevierStyleBold">*</span>: spiracle. <span class="elsevierStyleItalic">Phthirus pubis</span> usually has 2 pairs of thoracic spiracles and 6 pairs of abdominal spiracles that connect the respiratory system to the outside. T: tracheal system. S: marginal septae. G: genital plate. gp: gonopod. Both the genital plate and the 2 gonopods are found in female specimens.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Right image: ventral view. A: antenna (divided into 5 segments). Used to detect smell and moisture. St: sternite (segments constituting the ventral side).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Martin-Gorgojo, A. Comunión-Artieda, F.-J. Bru-Gorraiz" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Martin-Gorgojo" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Comunión-Artieda" ] 2 => array:2 [ "nombre" => "F.-J." 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B, Higher-magnification view. Note the dotted red lesions inside and outside the lesions with a fine collarette.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Ramos-Rodríguez, L.J. Del Pozo-Hernando, F. Mestre-Bauzá" "autores" => array:3 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Ramos-Rodríguez" ] 1 => array:2 [ "nombre" => "L.J." "apellidos" => "Del Pozo-Hernando" ] 2 => array:2 [ "nombre" => "F." 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Vidal, A.C. Innocenti, N. Marabini" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J.N." "apellidos" => "Vidal" "email" => array:1 [ 0 => "jorgelinanvidal@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A.C." "apellidos" => "Innocenti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "N." "apellidos" => "Marabini" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Español de Mendoza, Mendoza, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Mendoza, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Luis Lagomaggiore, Mendoza, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumor pigmentado de cuero cabelludo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 708 "Ancho" => 755 "Tamanyo" => 214763 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Photograph of lesion on the frontoparietal area of the scalp.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 27-year-old woman with no remarkable medical history presented with an asymptomatic tumor of several years’ duration on the scalp. Physical examination revealed a firm, skin-colored, pedunculated lesion with a diameter of approximately 2 cm.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comment</span><p id="par0010" class="elsevierStylePara elsevierViewall">Evaluation of the lesion with polarized light dermoscopy showed a polymorphous vascular pattern with hairpin, dotted, glomerular, and arborizing vessels with elliptical endings, white areas around the vessels, and blue-gray peripheral pigmentation. The histopathologic features were consistent with pigmented eccrine poroma (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1, 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Eccrine poroma is a benign adnexal tumor derived from acrosyringeal cells. Onset is most common between the fourth and sixth decades of life and the tumor shows no predilection for sex.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> It usually occurs on the hands and feet, but has been reported in other areas, although scalp lesions are rare.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Clinically, it presents as a firm nodule, papule, or plaque.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5,6</span></a> Pigmented and nonpigmented variants exist, although the latter are less common.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Eccrine poroma exhibits a wide variety of dermoscopic patterns frequently suggestive of other common skin tumors.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> One of these patterns is the polymorphous vascular pattern, which consists of different types of vessels, including cherry blossom vessels. These are arborizing vessels with elliptical or semi-elliptical endings and they were a key diagnostic finding in our patient.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> Other characteristic dermoscopic findings are structureless yellowish areas, milky red globules, interlacing white areas around vessels, and blue-gray globules in pigmented lesions.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Histologic findings include nests or cords of basaloid cells connected to the epidermis<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,6</span></a> as well as differentiation towards poroid cells, characterized by the formation of small ductal lumina.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,6</span></a> Melanocytes and melanin are observed in pigmented variants.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The differential diagnosis includes benign lesions such as pyogenic granuloma, seborrheic keratosis, and angiofibromas, and malignant lesions, such as squamous cell carcinoma, basal cell carcinoma, and melanoma.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5,6</span></a> Although the definitive diagnosis of eccrine poroma is histopathologic, dermoscopic features, while not pathognomonic, can help establish a tentative diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Although eccrine poroma is benign, the treatment of choice is surgery, as there have been reports of transformation to eccrine porocarcinoma.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Report" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Comment" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of Interest" ] 3 => 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: Vidal JN, Innocenti AC, Marabini N. Tumor pigmentado de cuero cabelludo. Actas Dermosifiliogr. 2021;112:903–904.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 708 "Ancho" => 755 "Tamanyo" => 214763 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Photograph of lesion on the frontoparietal area of the scalp.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 578 "Ancho" => 755 "Tamanyo" => 99339 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic appearance of the lesion (polarized light dermoscopy).</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" => "Pigmented eccrine poroma: dermoscopic and confocal features" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. 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| año/Mes | Html | Total | |
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