Malignant melanoma arising in a seborrheic keratosis
TL;DR: It is concluded that seborrheic keratoses are common and association with malignant melanoma is very rare, and because of the association of other malignancies, a biopsy of any suspect or changing sebor rheological keratosis is essential.
Abstract: We report a case of malignant melanoma associated with seborrheic keratosis. This has been reported rarely in the literature, with disagreement regarding whether it is coincidental or whether malignant transformation occurs. Because seborrheic keratoses are common and association with malignant melanoma is very rare, we conclude that the association is coincidental. However, because of the association of other malignancies, a biopsy of any suspect or changing seborrheic keratosis is essential.
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01 Jan 2010
111 citations
TL;DR: The incidence of associated lesions, in particular malignancy arising within seborrhoeic keratoses may be higher than previously thought and should be considered for biopsy and histological examination.
Abstract: Seborrhoeic keratoses are benign epidermal neoplasms that are rarely associated with other skin lesions especially malignancies. In this study, the aim was to assess the incidence of associated lesions occurring either adjacent to or contiguous with a seborrhoeic keratosis. A retrospective case series over a 12-month period was carried out. In total, 639 consecutive histologically diagnosed seborrhoeic keratoses were identified, of which 85 (9%) were found to be associated with other lesions. Of these associated lesions, 44 (7%) were malignant, with four of these found to be arising within the seborrhoeic keratosis. These associated lesions included premalignant lesions, malignancies, melanocytic lesions and miscellaneous lesions. Men (59%) were affected more commonly than women. The average age was 74 years (range 33-98 years). Seborrhoeic keratoses associated with other lesions were found most commonly on the head and neck. The incidence of associated lesions, in particular malignancy arising within seborrhoeic keratoses may be higher than previously thought. This may be an incidental phenomenon, or seborrhoeic keratosis could represent a precursor lesion. Therefore, seborrhoeic keratoses that have undergone recent clinical change should be considered for biopsy and histological examination.
51 citations
TL;DR: The most helpful criteria in correctly diagnosing SK-like melanomas were the presence of blue-white veil, pseudopods or streaks, and pigment network, while hyperkeratosis and fissures and ridges were independent risk markers of dermoscopically SK- like melanomas.
Abstract: Importance Melanomas that clinically mimic seborrheic keratosis (SK) can delay diagnosis and adequate treatment. However, little is known about the value of dermoscopy in recognizing these difficult-to-diagnose melanomas. Objective To describe the dermoscopic features of SK-like melanomas to understand their clinical morphology. Design, Setting, and Participants This observational retrospective study used 134 clinical and dermoscopic images of histopathologically proven melanomas in 134 patients treated in 9 skin cancer centers in Spain, France, Italy, and Austria. Without knowledge that the definite diagnosis for all the lesions was melanoma, 2 dermoscopy-trained observers evaluated the clinical descriptions and 48 dermoscopic features (including all melanocytic and nonmelanocytic criteria) of all 134 images and classified each dermoscopically as SK or not SK. The total dermoscopy score and the 7-point checklist score were assessed. Images of the lesions and patient data were collected from July 15, 2013, through July 31, 2014. Main Outcomes and Measures Frequencies of specific morphologic patterns of (clinically and dermoscopically) SK-like melanomas, patient demographics, and interobserver agreement of criteria were evaluated. Results Of the 134 cases collected from 72 men and 61 women, all of whom were white and who had a mean (SD) age of 55.6 (17.5) years, 110 (82.1%) revealed dermoscopic features suggestive of melanoma, including pigment network (74 [55.2%]), blue-white veil (72 [53.7%]), globules and dots (68 [50.7%]), pseudopods or streaks (47 [35.1%]), and blue-black sign (43 [32.3%]). The remaining 24 cases (17.9%) were considered likely SKs, even by dermoscopy. Overall, lesions showed a scaly and hyperkeratotic surface (45 [33.6%]), yellowish keratin (42 [31.3%]), comedo-like openings (41 [30.5%]), and milia-like cysts (30 [22.4%]). The entire sample achieved a mean (SD) total dermoscopy score of 4.7 (1.6) and a 7-point checklist score of 4.4 (2.3), while dermoscopically SK-like melanomas achieved a total dermoscopy score of only 4.2 (1.3) and a 7-point checklist score of 2.0 (1.9), both in the range of benignity. The most helpful criteria in correctly diagnosing SK-like melanomas were the presence of blue-white veil, pseudopods or streaks, and pigment network. Multivariate analysis found only the blue-black sign to be significantly associated with a correct diagnosis, while hyperkeratosis and fissures and ridges were independent risk markers of dermoscopically SK-like melanomas. Conclusions and Relevance Seborrheic keratosis–like melanomas can be dermoscopically challenging, but the presence of the blue-black sign, pigment network, pseudopods or streaks, and/or blue-white veil, despite the presence of other SK features, allows the correct diagnosis of most of the difficult melanoma cases.
43 citations
TL;DR: P pseudoepitheliomatous hyperplasia is a reactive epithelial proliferation that occurs in response to underlying infectious, inflammatory, and neoplastic conditions and may simulate squamous cell carcinoma and may obscure an underlying malignant process.
Abstract: Background: Pseudoepitheliomatous hyperplasia (PEH) is a reactive epithelial proliferation that occurs in response to underlying infectious, inflammatory, and neoplastic conditions. The histologic features of PEH may simulate squamous cell carcinoma and may obscure an underlying malignant process. The association of PEH with benign melanocytic nevi is well described in the literature. However, reports documenting the association of PEH with melanoma are rare.
Methods: We examined the demographic and histologic features in 13 cases of melanoma in association with PEH. In addition, we evaluated the possible pathogenic role of epidermal growth factor receptor (EGFR) using immunohistochemical methods.
Results: In each case, histologic examination revealed epidermal hyperplasia with irregular cords of well-differentiated epithelial cells extending into the dermis and infiltrating the melanoma. Although overlap existed, two patterns of epidermal hyperplasia were noted. The majority of cases (69%) exhibited acanthosis, hyperkeratosis, papillomatosis, and irregular infiltrating epithelial cords with squamous eddies. The remaining cases demonstrated basaloid acanthosis, laminated orthokeratosis, and horn cysts. EGFR immunohistochemical studies revealed strong staining within the basal layer of the epithelium, with no discernible difference between the hyperplastic epithelium overlying the melanoma cells and adjacent normal skin. Immunostaining among the melanoma cells was absent to weak in each of the cases. All cases exhibited intense EGFR immunoreactivity in macrophages underlying the epidermal lesions.
Conclusions: Melanoma is capable of presenting in a variety of histologic guises, including a pattern with PEH. The etiology of PEH, as rarely seen in conjunction with melanoma, unlikely involves EGFR and remains to be elucidated.
42 citations
References
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TL;DR: The term compound tumor is proposed to designate the finding of two distinctive neoplasms either directly contiguous with each other or immediately adjacent to each other in this association of malignant neoplasm.
Abstract: The association of malignant neoplasms arising contiguous with or adjacent to seborrheic keratoses has been previously documented. In this study a retrospective analysis was performed to further characterize these combined neoplasms. A total of 54 examples of malignant neoplasms in conjunction with seborrheic keratoses were found, of which 43 were basal cell carcinomas, six were Bowen's disease, three were keratoacanthomas, and two were malignant melanomas. The average age of the patients was over 65 years. Men were affected more frequently then women. The posterior thorax was the most common site for malignant neoplasms associated with seborrheic keratoses. The superficial type of basal cell carcinoma was the most common type of basal cell carcinoma found in this association. All subtypes of seborrheic keratosis may be found together with malignant neoplasms. We believe the appellation collision tumor is not valid because it is unknown whether the association of seborrheic keratoses with malignant neoplasms is a random event or whether there is, in fact, a pathogenic relationship in the development of two distinctive neoplasms together. Therefore, the term compound tumor is proposed to designate the finding of two distinctive neoplasms either directly contiguous with each other or immediately adjacent to each other.
123 citations
TL;DR: Five cases of verrucous malignant melanoma--a rare variant of melanoma that was described in 1967, but is rarely mentioned today--are presented and the clinical and histopathologic criteria defining this variant are discussed.
Abstract: • Five cases of verrucous malignant melanoma—a rare variant of melanoma that was described in 1967, but is rarely mentioned today—are presented and the clinical and histopathologic criteria defining this variant are discussed. The importance of this rare entity in the differential diagnosis of verrucous pigmented skin lesions is emphasized. (Arch Dermatol1988;124:1534-1537)
39 citations
Journal Article•
37 citations
31 citations
TL;DR: The flashlamp puIsed dye laser (FPDL; 58 S nm} is used to treat the facial tclangiectasia of lupus erythematosus lelangiectoides.
Abstract: SiR. Lupus erythematosus lelangiectoides is an extremely rare variant of lupus erythematosus. It is characterized by symmetrical, persistent, circumscribed patches, showing dilated hlood vessels, on the cheeks, leaser treatment has proved useful in clearing cutaneous vascular lesions in patients with certain connective tissue diseases. The argon laser and the COi laser have been used lor the vascular lesions of discoid lupus erythematosus.''' We have used the flashlamp puIsed dye laser (FPDL; 58 S nm} to treat the facial tclangiectasia of lupus erythematosus lelangiectoides.
29 citations