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Australasian Journal of Dermatology (2014) ••, ••–••
doi: 10.1111/ajd.12206
DERMOSCOPY
Dermoscopic features of clear cell acanthoma: five new cases and a review of existing published cases Georgina Lyons, Alex J Chamberlain and John W Kelly Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia
CASE REPORTS Case 1 INTRODUCTION Clear-cell acanthoma (CCA), or Degos acanthoma, is a rare clinical entity first described by Degos and colleagues in 1962.1 Traditionally thought to be a form of benign epidermal neoplasia,2 CCA has also been suggested to be a form of non-specific reactive dermatosis3,4 or localised psoriasis, in view of changes in the dermal microvasculature and immunohistochemical findings.3–6 On histopathology CCA is characterised by a well-demarcated area of psoriasiform epidermal hyperplasia with keratinocytes with palestaining cytoplasm. Mild spongiosis, exocytosis of neutrophils and thinning of the suprapapillary plates may also be evident.7 CCA typically arises on the lower extremities, with a peak age of incidence of 60 years and both sexes are equally affected.8 In most cases CCA presents as a solitary, slowgrowing pink, red or brown papule or nodule that is moist, well-circumscribed and typically 3 mm–2 cm in diameter. The surface may resemble a vascular lesion such as pyogenic granuloma. Occasionally patients present with multiple lesions.9 CCA is commonly mistaken for basal cell carcinoma, irritated seborrhoeic keratosis, squamous cell carcinoma, amelanotic melanoma or even psoriasis.8 Dermoscopic recognition of CCA may help to avoid unnecessary biopsies or surgical excision. There are few reports on the dermoscopic features of CCA and we endeavour here to review comprehensively the features of all dermoscopic images of CCA presented in the literature. We review these images and report five new cases of our own (a total of 20 cases) in order to delineate the key dermoscopic features of CCA.
A 64 year-old woman presented with a 5-year history of a red, scaly papule over the posterior aspect of her left ankle (Fig. 1a). The lesion bled intermittently, did not respond to topical corticosteroids or cryotherapy and was increasing in size. Dermoscopy revealed red dots, globules and glomeruloid structures, some of which were linear in arrangement, forming an incomplete vascular reticular pattern (Fig. 1b,c). A peripheral collarette of translucent scale was the only non-vascular feature of note.
Case 2 A 58 year-old man with a family history of non-melanoma skin cancer presented with a pruritic pink nodule on the left wrist of 6 weeks’ duration (Fig. 2a). On dermoscopy (Fig. 2b) red dots and globules were present, forming a vascular reticular pattern. Areas of haemorrhage and orange crusts were also evident.
Case 3 A 55 year-old man presented with a tender bleeding nodule over the left posterior ankle of 2 years’ duration (Fig. 3a). Dermoscopy revealed red pin-point dots and globules, some of which were arranged in a linear formation (Fig. 3b).
Case 4 A 48 year-old woman with a family history of melanoma presented with a pink nodule on her right thigh (Fig. 4a). On dermoscopy, linear and serpiginous arrangements of red dots, globules and glomeruloid structures covered the entire lesion, with translucent scaling around the periphery (Fig. 4b).
Case 5 Correspondence: Dr Georgina Lyons, Royal Children’s Hospital, 50 Flemington Road, Parkville Vic. 3052, Australia. Email: [email protected] Georgina Lyons, MBBS(Hons). Alex J Chamberlain, FACD. John W Kelly, FACD. Conflict of interest: none Submitted 2 April 2014; accepted 8 June 2014. © 2014 The Australasian College of Dermatologists
A 75-year-old woman presented with a 1-year duration of a scaly pink papule on the lateral aspect of her right knee Abbreviation: CCA
clear-cell acanthoma
2
G Lyons et al.
B
A
Figure 1 (a) Macroscopic image; (b–c) dermoscopic images of the lesion with red pin-point and globular dots, some arranged in a linear or ‘string-of-pearls’ formation (long arrows) and a border of translucent scale (short arrows).
C
Table 1
Studies presenting dermoscopic images of clear-cell acanthoma (CCA)
Study
Year
Dermoscopic images of CCA (n)
Patient: sex, age
Location
Blum et al.15 Bugatti et al.5
2001 2003
1 4
Zalaudek et al.14 Lacarrubba et al.16 Akin et al.10 Ardigo et al.13
2003 2003 2008 2009
1 3 1 3
Tanaka et al.11 Köse et al.12 Lyons et al.
2010 2010 2014
1 1 5
Male, 45 Female, 47 Female, 63 Male, 45 Male, 69 Not stated Male, 69 (multiple CCAs in same patient) Male, 65 Female, 78 Male, 61 Male, 68 Female, 85 Male, 64 Female, 64 Male, 58 Male, 55 Female, 48 Female, 75
Upper leg Calf Leg Lower leg Leg Not stated Legs Posterior leg Shoulder Thigh Chest Lower leg Calf Posterior ankle Wrist Posterior ankle Thigh Lateral knee
Total = 20
(Fig. 5a). Dermoscopy revealed a vascular reticular pattern composed of red dots and globules (Fig. 5b).
METHODS A consultant dermatologist (AJC) reviewed the 15 dermoscopic cases of CCA (Table 1) presented in the © 2014 The Australasian College of Dermatologists
literature,5,10–16 in addition to the five new cases reported here. Each of the cases had been confirmed as CCA on histopathology. The dermoscopic features of these 20 lesions are summarised in Table 2. Dermoscopic descriptions in the literature of CCA without accompanying images were not included, as the features of these dermoscopic images could not be assessed.
Dermoscopy of clear cell acanthoma Table 2
Frequency of dermoscopic criteria in clear cell acanthoma (CCA)
Pin-point red dots Globular red dots Glomeruloid structures Linear, serpiginous or ‘string-of-pearls’ formation Pale pink background Vascular reticular pattern Complete Partial Collarette of translucent scales Orange crusts Haemorrhagic areas Crystalline structures (NB: only five CCAs assessed were examined using polarised dermoscopy)
CCA (n = 20)
Percentage
20 20 11 20 18
100 100 55 100 90
12 8 8 3 7 3
60 40 40 15 35 60 of CCAs visualised with polarised dermoscopy
A
A
B
B
Figure 3
Figure 2
3
(a) Macroscopic image; (b) dermoscopic image.
RESULTS Irregularly spaced, pin-point red dots and globular red dots were observed in all 20 cases, with at least some of these
(a) Macroscopic image; (b) dermoscopic image.
dots arranged in a linear or serpiginous formation (Fig. 6). These linear formations tended to coalesce to form a vascular reticular pattern, covering whole (complete pattern) or part (incomplete pattern) of the lesion. In addition, glomeruloid vessels were observed in over half of the CCA images (at low magnification). It would appear that these © 2014 The Australasian College of Dermatologists
4
G Lyons et al.
A A
B Figure 4
(a) Macroscopic image; (b) dermoscopic image.
glomeruloid vessels are better appreciated at higher magnifications;16 however examination of lesions under high magnification (>10×) may be impractical in a clinical setting. In some images the vascular patterning was less prominent centrally, perhaps due to compression artefact. This could be minimised by the use of non-contact polarised dermoscopy, which also enables the visualisation of crystalline structures (seen in 60% of the lesions examined using polarised dermoscopy). Other non-vascular structures observed included a collarette of translucent scale around the periphery of the lesion (40%), haemorrhagic areas (35%) and orange crusts (15%). The background upon which the red dots were set was typically pale pink (90%); however in some cases, such as in that of Akin and colleagues (2008), the patient had more heavily pigmented skin and the background colour was crimson or brown.10
DISCUSSION Dermoscopy is a non-invasive, in vivo technique that relies on bright light-emitting diode illumination and magnifica© 2014 The Australasian College of Dermatologists
B Figure 5
(a) Macroscopic image; (b) dermoscopic image.
tion (usually ×10) of skin lesions, exposing subsurface colours and structures that are not ordinarily visible to the naked eye. On dermoscopy CCA has a unique appearance, characterised by red dots, globules and, in some cases, glomeruloid vessels, at least some of which are arranged in linear or serpiginous patterns. These linear arrangements are reticular and strikingly symmetric when fully developed. In some cases the vascular reticular pattern is incomplete or partly developed, either representing a forme fruste or a compression artefact but still distinctly recognisable. This vascular pattern is distinct from that of other lesions. Dotted or glomeruloid vessels can be a feature of inflammatory dermatoses, such as psoriasis, pityriasis lichenoides and discoid eczema.17–20 However, in these conditions the red dots or glomeruloid vessels are uniformly distributed and do not coalesce to form linear or vascular reticular arrays.17–20 Glomeruloid vessels can be seen on dermoscopy
Dermoscopy of clear cell acanthoma
Figure 6 Dermoscopic vascular features of clear-cell acanthoma (CCA).
Red pin-point dots
Red globular dots
Linear or serpiginous formation
Reticular/net-like pattern
in Bowen’s disease and red dots in dysplastic naevi, spitz naevi or melanomas.17,20–22 In these tumours the vessels may be regularly spaced, grouped or irregularly arranged but they do not form the characteristic vascular reticular pattern seen in clear cell acanthoma.17,20–22 Other dermoscopic features of CCA include the variable presence of areas of haemorrhage, orange crusts and a peripheral collarette of translucent scales. The frequent presence of crystalline structures when CCA is observed using polarised dermoscopy was also noted, a finding that has not been previously described in the literature. The largest and most significant study assessing for crystalline structures included 11 225 lesions (both melanocytic and non-melanocytic), but no clear cell acanthomas.23
6.
7. 8.
9. 10.
11.
12.
CONCLUSION Clear cell acanthoma has a distinctive dermoscopic appearance, characterized by a complete or incomplete vascular reticular pattern that helps in reaching a confident clinical diagnosis and minimizing the need for biopsy.
13.
REFERENCES
15.
1.
2. 3.
4.
5.
Degos R, Delort J, Civatte J et al. Epidermal tumour with an unusual appearance: clear cell acanthoma. Ann. Dermatol. Syphiligr. 1962; 89: 361–17. Degos R, Civatte J. Clear-cell acanthoma. Experience of 8 years. Br. J. Dermatol. 1970; 83: 248–54. Zedek DC, Langel DJ, White WL. Clear-cell acanthoma versus acanthosis: a psoriasisform reaction pattern lacking tricholemmal differentiation. Am. J. Dermatopathol. 2007; 29: 378–84. Finch TM, Tan CY. Clear cell acanthoma developing on a psoriatic plaque: further evidence of an inflammatory aetiology? Br. J. Dermatol. 2000; 142: 842–4. Bugatti L, Filosa G, Broganelli P et al. Psoriasis-like dermoscopic pattern of clear cell acanthoma. J. Eur. Acad. Dermatol. Venerol. 2003; 17: 452–5.
14.
16.
17.
18.
19.
5
Glomeruloid structures
Inaloz HS, Laider P, Marks R. Is clear cell acanthoma a form of localised psoriasis? Br. J. Dermatol. 1999; 141 (Suppl. 55): 121. Weedon D. Weedon’s Skin Pathology. New York: Churchill Livingstone, 2010. Morrison K, Duffey M, Janik M et al. Clear-cell acanthoma: a rare clinical diagnosis prior to biopsy. Int. J. Dermatol. 2010; 49: 1008–11. Trau H, Fisher BK, Schewach-Millet M. Multiple clear cell acanthomas. Arch. Dermatol. 1980; 116: 433–4. Akin FY, Ertam I, Ceylan C et al. Clear cell acanthoma: new observations on dermatoscopy. Indian J. Dermatol. Venereol. Leprol. 2008; 74: 285–7. Tanaka T, Arai T, Ishikawa T et al. Pedunculated clear cell acanthoma. Report of a case with dermoscopic observation. EJD 2010; 20: 132–3. Köse OK, Durdu M, Heper AO et al. Value of the Tzanck smear test and dermatoscopy in the diagnosis of clear cell acanthoma. Clin. Exp. Dermatol. 2011; 36: 314–5. Ardigo M, Buffon RB, Scope A et al. Comparing in vivo reflectance confocal microscopy, dermoscopy, and histology of clearcell acanthoma. Dermatol. Surg. 2009; 35: 952–9. Zalaudek I, Hofmann-Wellenhof R, Argenziano G. Dermoscopy of clear-cell acanthoma differs from dermoscopy of psoriasis. Dermatology 2003; 207: 428. Blum A, Metzler G, Bauer J et al. The dermatoscopic pattern of clear cell acanthoma resembles psoriasis vulgaris. Dermatology 2001; 203: 50–2. Lacarrubba F, de Pasquale R, Micali G. Videodermatoscopy improves the clinical diagnostic accuracy of multiple clear cell acanthoma. Eur. J. Dermatol. 2003; 13: 596–8. Pan Y, Chamberlain A, Bailey M et al. Dermatoscopy aids in the diagnosis of the solitary red scaly patch or plaque-features distinguishing superficial basal cell carcinoma, intraepidermal carcinoma, and psoriasis. J. Am. Acad. Dermatol. 2008; 59: 268–74. Vázquez-López F, Manjón-Haces JA, Maldonado-Seral C et al. Dermoscopic features of plaque psoriasis and lichen planus: new observations. Dermatology 2003; 207: 151–6. Agenziano G, Zalaudek I, Corona R et al. Vascular structures in skin tumours. A dermoscopy study. Arch. Dermatol. 2004; 140: 1485–9. © 2014 The Australasian College of Dermatologists
6 20. 21. 22.
G Lyons et al. Bowling J. Diagnostic Dermatology: The Illustrated Guide. Oxford: Wiley-Blackwell, 2012. Martin JM, Bella-Navarro R, Jordà E. Vascular patterns in dermoscopy. Actas Dermosifiliogr 2012; 103: 357–75. Soyer HP, Argenziano G, Hofmann-Wellenhof R et al. Dermoscopy: The Essentials. Edinburgh: Saunders, 2012.
© 2014 The Australasian College of Dermatologists
23.
Balagula Y, Braun RP, Rabinovitz HS et al. The significance of crystalline/chrysalis structures in the diagnosis of melanocytic and nonmelanocytic lesions. J. Am. Acad. Dermatol. 2012; 67: 194 e1–e8.
Australasian Journal of Dermatology (2014) ••, ••–••
doi: 10.1111/ajd.12206
DERMOSCOPY
Dermoscopic features of clear cell acanthoma: five new cases and a review of existing published cases Georgina Lyons, Alex J Chamberlain and John W Kelly Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia
CASE REPORTS Case 1 INTRODUCTION Clear-cell acanthoma (CCA), or Degos acanthoma, is a rare clinical entity first described by Degos and colleagues in 1962.1 Traditionally thought to be a form of benign epidermal neoplasia,2 CCA has also been suggested to be a form of non-specific reactive dermatosis3,4 or localised psoriasis, in view of changes in the dermal microvasculature and immunohistochemical findings.3–6 On histopathology CCA is characterised by a well-demarcated area of psoriasiform epidermal hyperplasia with keratinocytes with palestaining cytoplasm. Mild spongiosis, exocytosis of neutrophils and thinning of the suprapapillary plates may also be evident.7 CCA typically arises on the lower extremities, with a peak age of incidence of 60 years and both sexes are equally affected.8 In most cases CCA presents as a solitary, slowgrowing pink, red or brown papule or nodule that is moist, well-circumscribed and typically 3 mm–2 cm in diameter. The surface may resemble a vascular lesion such as pyogenic granuloma. Occasionally patients present with multiple lesions.9 CCA is commonly mistaken for basal cell carcinoma, irritated seborrhoeic keratosis, squamous cell carcinoma, amelanotic melanoma or even psoriasis.8 Dermoscopic recognition of CCA may help to avoid unnecessary biopsies or surgical excision. There are few reports on the dermoscopic features of CCA and we endeavour here to review comprehensively the features of all dermoscopic images of CCA presented in the literature. We review these images and report five new cases of our own (a total of 20 cases) in order to delineate the key dermoscopic features of CCA.
A 64 year-old woman presented with a 5-year history of a red, scaly papule over the posterior aspect of her left ankle (Fig. 1a). The lesion bled intermittently, did not respond to topical corticosteroids or cryotherapy and was increasing in size. Dermoscopy revealed red dots, globules and glomeruloid structures, some of which were linear in arrangement, forming an incomplete vascular reticular pattern (Fig. 1b,c). A peripheral collarette of translucent scale was the only non-vascular feature of note.
Case 2 A 58 year-old man with a family history of non-melanoma skin cancer presented with a pruritic pink nodule on the left wrist of 6 weeks’ duration (Fig. 2a). On dermoscopy (Fig. 2b) red dots and globules were present, forming a vascular reticular pattern. Areas of haemorrhage and orange crusts were also evident.
Case 3 A 55 year-old man presented with a tender bleeding nodule over the left posterior ankle of 2 years’ duration (Fig. 3a). Dermoscopy revealed red pin-point dots and globules, some of which were arranged in a linear formation (Fig. 3b).
Case 4 A 48 year-old woman with a family history of melanoma presented with a pink nodule on her right thigh (Fig. 4a). On dermoscopy, linear and serpiginous arrangements of red dots, globules and glomeruloid structures covered the entire lesion, with translucent scaling around the periphery (Fig. 4b).
Case 5 Correspondence: Dr Georgina Lyons, Royal Children’s Hospital, 50 Flemington Road, Parkville Vic. 3052, Australia. Email: [email protected] Georgina Lyons, MBBS(Hons). Alex J Chamberlain, FACD. John W Kelly, FACD. Conflict of interest: none Submitted 2 April 2014; accepted 8 June 2014. © 2014 The Australasian College of Dermatologists
A 75-year-old woman presented with a 1-year duration of a scaly pink papule on the lateral aspect of her right knee Abbreviation: CCA
clear-cell acanthoma
2
G Lyons et al.
B
A
Figure 1 (a) Macroscopic image; (b–c) dermoscopic images of the lesion with red pin-point and globular dots, some arranged in a linear or ‘string-of-pearls’ formation (long arrows) and a border of translucent scale (short arrows).
C
Table 1
Studies presenting dermoscopic images of clear-cell acanthoma (CCA)
Study
Year
Dermoscopic images of CCA (n)
Patient: sex, age
Location
Blum et al.15 Bugatti et al.5
2001 2003
1 4
Zalaudek et al.14 Lacarrubba et al.16 Akin et al.10 Ardigo et al.13
2003 2003 2008 2009
1 3 1 3
Tanaka et al.11 Köse et al.12 Lyons et al.
2010 2010 2014
1 1 5
Male, 45 Female, 47 Female, 63 Male, 45 Male, 69 Not stated Male, 69 (multiple CCAs in same patient) Male, 65 Female, 78 Male, 61 Male, 68 Female, 85 Male, 64 Female, 64 Male, 58 Male, 55 Female, 48 Female, 75
Upper leg Calf Leg Lower leg Leg Not stated Legs Posterior leg Shoulder Thigh Chest Lower leg Calf Posterior ankle Wrist Posterior ankle Thigh Lateral knee
Total = 20
(Fig. 5a). Dermoscopy revealed a vascular reticular pattern composed of red dots and globules (Fig. 5b).
METHODS A consultant dermatologist (AJC) reviewed the 15 dermoscopic cases of CCA (Table 1) presented in the © 2014 The Australasian College of Dermatologists
literature,5,10–16 in addition to the five new cases reported here. Each of the cases had been confirmed as CCA on histopathology. The dermoscopic features of these 20 lesions are summarised in Table 2. Dermoscopic descriptions in the literature of CCA without accompanying images were not included, as the features of these dermoscopic images could not be assessed.
Dermoscopy of clear cell acanthoma Table 2
Frequency of dermoscopic criteria in clear cell acanthoma (CCA)
Pin-point red dots Globular red dots Glomeruloid structures Linear, serpiginous or ‘string-of-pearls’ formation Pale pink background Vascular reticular pattern Complete Partial Collarette of translucent scales Orange crusts Haemorrhagic areas Crystalline structures (NB: only five CCAs assessed were examined using polarised dermoscopy)
CCA (n = 20)
Percentage
20 20 11 20 18
100 100 55 100 90
12 8 8 3 7 3
60 40 40 15 35 60 of CCAs visualised with polarised dermoscopy
A
A
B
B
Figure 3
Figure 2
3
(a) Macroscopic image; (b) dermoscopic image.
RESULTS Irregularly spaced, pin-point red dots and globular red dots were observed in all 20 cases, with at least some of these
(a) Macroscopic image; (b) dermoscopic image.
dots arranged in a linear or serpiginous formation (Fig. 6). These linear formations tended to coalesce to form a vascular reticular pattern, covering whole (complete pattern) or part (incomplete pattern) of the lesion. In addition, glomeruloid vessels were observed in over half of the CCA images (at low magnification). It would appear that these © 2014 The Australasian College of Dermatologists
4
G Lyons et al.
A A
B Figure 4
(a) Macroscopic image; (b) dermoscopic image.
glomeruloid vessels are better appreciated at higher magnifications;16 however examination of lesions under high magnification (>10×) may be impractical in a clinical setting. In some images the vascular patterning was less prominent centrally, perhaps due to compression artefact. This could be minimised by the use of non-contact polarised dermoscopy, which also enables the visualisation of crystalline structures (seen in 60% of the lesions examined using polarised dermoscopy). Other non-vascular structures observed included a collarette of translucent scale around the periphery of the lesion (40%), haemorrhagic areas (35%) and orange crusts (15%). The background upon which the red dots were set was typically pale pink (90%); however in some cases, such as in that of Akin and colleagues (2008), the patient had more heavily pigmented skin and the background colour was crimson or brown.10
DISCUSSION Dermoscopy is a non-invasive, in vivo technique that relies on bright light-emitting diode illumination and magnifica© 2014 The Australasian College of Dermatologists
B Figure 5
(a) Macroscopic image; (b) dermoscopic image.
tion (usually ×10) of skin lesions, exposing subsurface colours and structures that are not ordinarily visible to the naked eye. On dermoscopy CCA has a unique appearance, characterised by red dots, globules and, in some cases, glomeruloid vessels, at least some of which are arranged in linear or serpiginous patterns. These linear arrangements are reticular and strikingly symmetric when fully developed. In some cases the vascular reticular pattern is incomplete or partly developed, either representing a forme fruste or a compression artefact but still distinctly recognisable. This vascular pattern is distinct from that of other lesions. Dotted or glomeruloid vessels can be a feature of inflammatory dermatoses, such as psoriasis, pityriasis lichenoides and discoid eczema.17–20 However, in these conditions the red dots or glomeruloid vessels are uniformly distributed and do not coalesce to form linear or vascular reticular arrays.17–20 Glomeruloid vessels can be seen on dermoscopy
Dermoscopy of clear cell acanthoma
Figure 6 Dermoscopic vascular features of clear-cell acanthoma (CCA).
Red pin-point dots
Red globular dots
Linear or serpiginous formation
Reticular/net-like pattern
in Bowen’s disease and red dots in dysplastic naevi, spitz naevi or melanomas.17,20–22 In these tumours the vessels may be regularly spaced, grouped or irregularly arranged but they do not form the characteristic vascular reticular pattern seen in clear cell acanthoma.17,20–22 Other dermoscopic features of CCA include the variable presence of areas of haemorrhage, orange crusts and a peripheral collarette of translucent scales. The frequent presence of crystalline structures when CCA is observed using polarised dermoscopy was also noted, a finding that has not been previously described in the literature. The largest and most significant study assessing for crystalline structures included 11 225 lesions (both melanocytic and non-melanocytic), but no clear cell acanthomas.23
6.
7. 8.
9. 10.
11.
12.
CONCLUSION Clear cell acanthoma has a distinctive dermoscopic appearance, characterized by a complete or incomplete vascular reticular pattern that helps in reaching a confident clinical diagnosis and minimizing the need for biopsy.
13.
REFERENCES
15.
1.
2. 3.
4.
5.
Degos R, Delort J, Civatte J et al. Epidermal tumour with an unusual appearance: clear cell acanthoma. Ann. Dermatol. Syphiligr. 1962; 89: 361–17. Degos R, Civatte J. Clear-cell acanthoma. Experience of 8 years. Br. J. Dermatol. 1970; 83: 248–54. Zedek DC, Langel DJ, White WL. Clear-cell acanthoma versus acanthosis: a psoriasisform reaction pattern lacking tricholemmal differentiation. Am. J. Dermatopathol. 2007; 29: 378–84. Finch TM, Tan CY. Clear cell acanthoma developing on a psoriatic plaque: further evidence of an inflammatory aetiology? Br. J. Dermatol. 2000; 142: 842–4. Bugatti L, Filosa G, Broganelli P et al. Psoriasis-like dermoscopic pattern of clear cell acanthoma. J. Eur. Acad. Dermatol. Venerol. 2003; 17: 452–5.
14.
16.
17.
18.
19.
5
Glomeruloid structures
Inaloz HS, Laider P, Marks R. Is clear cell acanthoma a form of localised psoriasis? Br. J. Dermatol. 1999; 141 (Suppl. 55): 121. Weedon D. Weedon’s Skin Pathology. New York: Churchill Livingstone, 2010. Morrison K, Duffey M, Janik M et al. Clear-cell acanthoma: a rare clinical diagnosis prior to biopsy. Int. J. Dermatol. 2010; 49: 1008–11. Trau H, Fisher BK, Schewach-Millet M. Multiple clear cell acanthomas. Arch. Dermatol. 1980; 116: 433–4. Akin FY, Ertam I, Ceylan C et al. Clear cell acanthoma: new observations on dermatoscopy. Indian J. Dermatol. Venereol. Leprol. 2008; 74: 285–7. Tanaka T, Arai T, Ishikawa T et al. Pedunculated clear cell acanthoma. Report of a case with dermoscopic observation. EJD 2010; 20: 132–3. Köse OK, Durdu M, Heper AO et al. Value of the Tzanck smear test and dermatoscopy in the diagnosis of clear cell acanthoma. Clin. Exp. Dermatol. 2011; 36: 314–5. Ardigo M, Buffon RB, Scope A et al. Comparing in vivo reflectance confocal microscopy, dermoscopy, and histology of clearcell acanthoma. Dermatol. Surg. 2009; 35: 952–9. Zalaudek I, Hofmann-Wellenhof R, Argenziano G. Dermoscopy of clear-cell acanthoma differs from dermoscopy of psoriasis. Dermatology 2003; 207: 428. Blum A, Metzler G, Bauer J et al. The dermatoscopic pattern of clear cell acanthoma resembles psoriasis vulgaris. Dermatology 2001; 203: 50–2. Lacarrubba F, de Pasquale R, Micali G. Videodermatoscopy improves the clinical diagnostic accuracy of multiple clear cell acanthoma. Eur. J. Dermatol. 2003; 13: 596–8. Pan Y, Chamberlain A, Bailey M et al. Dermatoscopy aids in the diagnosis of the solitary red scaly patch or plaque-features distinguishing superficial basal cell carcinoma, intraepidermal carcinoma, and psoriasis. J. Am. Acad. Dermatol. 2008; 59: 268–74. Vázquez-López F, Manjón-Haces JA, Maldonado-Seral C et al. Dermoscopic features of plaque psoriasis and lichen planus: new observations. Dermatology 2003; 207: 151–6. Agenziano G, Zalaudek I, Corona R et al. Vascular structures in skin tumours. A dermoscopy study. Arch. Dermatol. 2004; 140: 1485–9. © 2014 The Australasian College of Dermatologists
6 20. 21. 22.
G Lyons et al. Bowling J. Diagnostic Dermatology: The Illustrated Guide. Oxford: Wiley-Blackwell, 2012. Martin JM, Bella-Navarro R, Jordà E. Vascular patterns in dermoscopy. Actas Dermosifiliogr 2012; 103: 357–75. Soyer HP, Argenziano G, Hofmann-Wellenhof R et al. Dermoscopy: The Essentials. Edinburgh: Saunders, 2012.
© 2014 The Australasian College of Dermatologists
23.
Balagula Y, Braun RP, Rabinovitz HS et al. The significance of crystalline/chrysalis structures in the diagnosis of melanocytic and nonmelanocytic lesions. J. Am. Acad. Dermatol. 2012; 67: 194 e1–e8.
