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Correspondence
3 Seitz CS, Rose C, Br€ ocker EB, et al. Intertriginous urticaria pigmentosa. Dermatology 2005; 210: 77–79. 4 Li CY. Diagnosis of mastocytosis: value of cytochemistry and immunohistochemistry. Leuk Res 2001; 25: 537–541.
5 Dunst KM, Huemer GM, Zelger BG, et al. A new variant of mastocytosis: report of three cases clinicopathologically mimicking histiocytic and vasculitic disorders. Br J Dermatol 2005; 153: 642–646.
Biopsy-proven pigmented poroma with no vascular structure in dermoscopy
and comedo-like openings (25%). Kuo and Ohara described two cases of pigmented poromas with dermoscopic features mimicking pigmented basal cell carcinoma, such as blue–gray ovoid nests, blue–gray dots, and arborizing vessels.6 Dermoscopic images in pigmented poroma may mimic pigmented basal cell carcinomas, seborrheic keratosis, or malignant melanoma. These suggested difficulties of diagnosis of poroma in dermoscopy.3–6 Recently, Shalom et al.1 retrospectively collected 19 biopsy-proven poromas and showed specific vascular
Poromas may clinically be misdiagnosed as malignant melanoma, basal cell carcinoma, squamous cell carcinoma, seborrheic keratosis, and vascular neoplasm. Dermoscopy for poroma may show a specific pattern of leaf and flower-like vessels and a suggestive pattern of interlacing white cords, giving the lesion a separating appearance,1,2 even though dermoscopic images in both non-pigmented and pigmented poromas may illustrate no significant difference from malignant melanoma and nonmelanoma skin tumors.3–6 Here, we report a case of biopsy-proven pigmented poroma with no vascular structure in dermoscopy. A 44-year-old Japanese woman visited us with an asymptomatic papule on the right thigh. The patient had noticed it five years earlier. Physical examination revealed an asymptomatic, elevated, and slightly variably pigmented papule 5 mm in size on the right thigh (Fig. 1a). We first considered the papule to be malignant melanoma. Dermoscopic images with immersion gels showed (i) dark brown roundish structures with black dots and lines (arrow) in a dark bluish structureless lesion (dotted arrow), and (ii) no vascular structure (Fig. 1b). An excisional biopsied specimen showed characteristic anastomosing cells emanating from the lower portion of the epidermis (Fig. 2a). High magnification revealed monotonous small cuboidal cells containing abundant melanin granules (Fig. 2b,c) and cuticular cells displaying duct-like structure (arrow) (Fig. 2d). We diagnosed the papule as pigmented poroma with histopathologic assessment. Poroma is a benign skin– appendage tumor derived from the eccrine or apocrine duct epithelium in the epidermis. It is an asymptomatic, pinkish or reddish, soft papule, plaque, or nodule with a surface ranging from smooth to verrucous, and ulcerated, and may be pigmented. It is usually present on the palmoplantar area but can be present on other anatomical sites. Ferrari et al.4 summarized dermoscopic structures in seven cases of non-pigmented poromas: (i) a white-topink halo surrounding the vessels; (ii) pink–white structureless areas; and (iii) vascular structures of glomerular and linear irregular vessels, hairpin vessels, and linear irregular vessels. Minagawa et al.3 summarized dermoscopic appearances in 12 cases of pigmented poromas: vascular structures (75%), globule-like structures (58%), International Journal of Dermatology 2014, 53, e332–e346
(a)
(b)
Figure 1 (a) Clinical appearance of an asymptomatic, elevated, and slightly variably pigmented papule 5 mm in size on the right thigh. (b) Dermoscopic images with immersion gels showed (i) dark brown roundish structures with black dots and lines (arrow) in a dark bluish structureless lesion (dotted arrow), and (ii) no vascular structure ª 2014 The International Society of Dermatology
Correspondence
(a)
(b)
(c)
(d)
Figure 2 (a) An excisional biopsied specimen showed characteristic anastomosing cells emanating from the lower portion of the epidermis (hematoxylin and eosin stain, 940). (b–d) High magnification revealed (b,c) monotonous small cuboidal cells containing abundant melanin granules and (d) cuticular cells displaying duct-like structure (arrow) (hematoxylin and eosin stain, 9 400)
features of leaf and flower-like vessels. In our case, we could not find any suggestive dermoscopic vascular images in dermoscopy. We retrospectively evaluated that the dark brown rounded structures in a dark bluish structureless lesion resembled the suggestive pattern of the interlacing pigmented cords, giving the lesion a separating appearance. Our case was a rare type of pigmented poroma with no vascular structure in dermoscopy, and it re-emphasized the importance of histopathologic examination in pigmented poroma. Naoki Oiso, MD, PhD Hiromasa Matsuda, MD Akira Kawada, MD, PhD Department of Dermatology Kinki University Faculty of Medicine Osaka-Sayama Japan E-mail: [email protected]
Communication on the dangers and abuse of skin lighteners in Africa
To the Editor: The 4th African Ethnic Skin and Hair Workshop took place at the Continental Hotel, Nairobi, Kenya, from November 8‐11, 2012. The workshop deliberated extenª 2014 The International Society of Dermatology
Financial disclosures: None. Conflicts of interest: None. References 1 Shalom A, Schein O, Landi C, et al. Dermoscopic findings in biopsy-proven poromas. Dermatol Surg 2012; 38: 1091–1096. 2 Aydingoz IE. New dermoscopic vascular patterns in a case of eccrine poroma. J Eur Acad Dermatol Venereol 2009; 23: 725–726. 3 Minagawa A, Koga H. Dermoscopy of pigmented poromas. Dermatology 2010; 221: 78–83. 4 Ferrari A, Buccini P, Silipo V, et al. Eccrine poroma: a clinical-dermoscopic study of seven cases. Acta Derm Venereol 2009; 89: 160–164. 5 Nicolino R, Zalaudek I, Ferrara G, et al. Dermoscopy of eccrine poroma. Dermatology 2007; 215: 160–163. 6 Kuo HW, Ohara K. Pigmented eccrine poroma: a report of two cases and study with dermatoscopy. Dermatol Surg 2003; 29: 1076–1079.
sively on various dermatoses that affect people of African descent. The previous workshop, held in Accra, Ghana, in 2010, saw the presentations of three scientific studies focusing on the issues of skin lighteners.1,2 The lectures were delivered by Dr. Ncoza Dlova from South Africa on International Journal of Dermatology 2014, 53, e332–e346
e335
Correspondence
3 Seitz CS, Rose C, Br€ ocker EB, et al. Intertriginous urticaria pigmentosa. Dermatology 2005; 210: 77–79. 4 Li CY. Diagnosis of mastocytosis: value of cytochemistry and immunohistochemistry. Leuk Res 2001; 25: 537–541.
5 Dunst KM, Huemer GM, Zelger BG, et al. A new variant of mastocytosis: report of three cases clinicopathologically mimicking histiocytic and vasculitic disorders. Br J Dermatol 2005; 153: 642–646.
Biopsy-proven pigmented poroma with no vascular structure in dermoscopy
and comedo-like openings (25%). Kuo and Ohara described two cases of pigmented poromas with dermoscopic features mimicking pigmented basal cell carcinoma, such as blue–gray ovoid nests, blue–gray dots, and arborizing vessels.6 Dermoscopic images in pigmented poroma may mimic pigmented basal cell carcinomas, seborrheic keratosis, or malignant melanoma. These suggested difficulties of diagnosis of poroma in dermoscopy.3–6 Recently, Shalom et al.1 retrospectively collected 19 biopsy-proven poromas and showed specific vascular
Poromas may clinically be misdiagnosed as malignant melanoma, basal cell carcinoma, squamous cell carcinoma, seborrheic keratosis, and vascular neoplasm. Dermoscopy for poroma may show a specific pattern of leaf and flower-like vessels and a suggestive pattern of interlacing white cords, giving the lesion a separating appearance,1,2 even though dermoscopic images in both non-pigmented and pigmented poromas may illustrate no significant difference from malignant melanoma and nonmelanoma skin tumors.3–6 Here, we report a case of biopsy-proven pigmented poroma with no vascular structure in dermoscopy. A 44-year-old Japanese woman visited us with an asymptomatic papule on the right thigh. The patient had noticed it five years earlier. Physical examination revealed an asymptomatic, elevated, and slightly variably pigmented papule 5 mm in size on the right thigh (Fig. 1a). We first considered the papule to be malignant melanoma. Dermoscopic images with immersion gels showed (i) dark brown roundish structures with black dots and lines (arrow) in a dark bluish structureless lesion (dotted arrow), and (ii) no vascular structure (Fig. 1b). An excisional biopsied specimen showed characteristic anastomosing cells emanating from the lower portion of the epidermis (Fig. 2a). High magnification revealed monotonous small cuboidal cells containing abundant melanin granules (Fig. 2b,c) and cuticular cells displaying duct-like structure (arrow) (Fig. 2d). We diagnosed the papule as pigmented poroma with histopathologic assessment. Poroma is a benign skin– appendage tumor derived from the eccrine or apocrine duct epithelium in the epidermis. It is an asymptomatic, pinkish or reddish, soft papule, plaque, or nodule with a surface ranging from smooth to verrucous, and ulcerated, and may be pigmented. It is usually present on the palmoplantar area but can be present on other anatomical sites. Ferrari et al.4 summarized dermoscopic structures in seven cases of non-pigmented poromas: (i) a white-topink halo surrounding the vessels; (ii) pink–white structureless areas; and (iii) vascular structures of glomerular and linear irregular vessels, hairpin vessels, and linear irregular vessels. Minagawa et al.3 summarized dermoscopic appearances in 12 cases of pigmented poromas: vascular structures (75%), globule-like structures (58%), International Journal of Dermatology 2014, 53, e332–e346
(a)
(b)
Figure 1 (a) Clinical appearance of an asymptomatic, elevated, and slightly variably pigmented papule 5 mm in size on the right thigh. (b) Dermoscopic images with immersion gels showed (i) dark brown roundish structures with black dots and lines (arrow) in a dark bluish structureless lesion (dotted arrow), and (ii) no vascular structure ª 2014 The International Society of Dermatology
Correspondence
(a)
(b)
(c)
(d)
Figure 2 (a) An excisional biopsied specimen showed characteristic anastomosing cells emanating from the lower portion of the epidermis (hematoxylin and eosin stain, 940). (b–d) High magnification revealed (b,c) monotonous small cuboidal cells containing abundant melanin granules and (d) cuticular cells displaying duct-like structure (arrow) (hematoxylin and eosin stain, 9 400)
features of leaf and flower-like vessels. In our case, we could not find any suggestive dermoscopic vascular images in dermoscopy. We retrospectively evaluated that the dark brown rounded structures in a dark bluish structureless lesion resembled the suggestive pattern of the interlacing pigmented cords, giving the lesion a separating appearance. Our case was a rare type of pigmented poroma with no vascular structure in dermoscopy, and it re-emphasized the importance of histopathologic examination in pigmented poroma. Naoki Oiso, MD, PhD Hiromasa Matsuda, MD Akira Kawada, MD, PhD Department of Dermatology Kinki University Faculty of Medicine Osaka-Sayama Japan E-mail: [email protected]
Communication on the dangers and abuse of skin lighteners in Africa
To the Editor: The 4th African Ethnic Skin and Hair Workshop took place at the Continental Hotel, Nairobi, Kenya, from November 8‐11, 2012. The workshop deliberated extenª 2014 The International Society of Dermatology
Financial disclosures: None. Conflicts of interest: None. References 1 Shalom A, Schein O, Landi C, et al. Dermoscopic findings in biopsy-proven poromas. Dermatol Surg 2012; 38: 1091–1096. 2 Aydingoz IE. New dermoscopic vascular patterns in a case of eccrine poroma. J Eur Acad Dermatol Venereol 2009; 23: 725–726. 3 Minagawa A, Koga H. Dermoscopy of pigmented poromas. Dermatology 2010; 221: 78–83. 4 Ferrari A, Buccini P, Silipo V, et al. Eccrine poroma: a clinical-dermoscopic study of seven cases. Acta Derm Venereol 2009; 89: 160–164. 5 Nicolino R, Zalaudek I, Ferrara G, et al. Dermoscopy of eccrine poroma. Dermatology 2007; 215: 160–163. 6 Kuo HW, Ohara K. Pigmented eccrine poroma: a report of two cases and study with dermatoscopy. Dermatol Surg 2003; 29: 1076–1079.
sively on various dermatoses that affect people of African descent. The previous workshop, held in Accra, Ghana, in 2010, saw the presentations of three scientific studies focusing on the issues of skin lighteners.1,2 The lectures were delivered by Dr. Ncoza Dlova from South Africa on International Journal of Dermatology 2014, 53, e332–e346
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