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A pearly papule with arborizing vessels
A pearly papule with arborizing vessels Helena Collgros, MD,a and Pascale Guitera, PhDb Barcelona, Spain, and Sydney, Australia
CLINICAL PRESENTATION A 64-year-old white man with a past history of basal cell carcinoma presented for a full skin check. He had recently noted a new lesion on his scalp, which was occasionally tender when touched. On examination, a 4-mm pink pearly papule was seen on the left parietal area of scalp (Fig 1, A).
Fig 1. A, Clinical picture of a pink papule, tender when touched on the scalp. B, Dermatoscopy image (DermLite II ProHR, 3Gen LLC, California) of the lesion showing branched vessels as well as blue and yellow clods. C, Histopathology: Circumscribed polylobulated basophilic ovoid nodule located in the dermis, well encapsulated with regular borders. The tumor contains 3 cell types: small basaloid cells with dense hyperchromatic nuclei, located at the periphery of the nodules, larger cuboidal cells with pale eosinophilic cytoplasm, located in the center, as well as scattered lymphocytes. Ductal structures, sparse cystic cavities, dilated vascular channels, and homogeneous eosinophilic material are also seen within the nodules. The overlying epidermis is intact. (Hematoxylin and eosin stain; original magnification: 3100.)
DERMOSCOPIC APPEARANCE The dermoscopic evaluation revealed a pink papule with telangiectatic-branched vessels, blue-gray ovoid nests, and a yellowish clod on 1 side of the lesion (Fig 1, B).
HISTOLOGIC DIAGNOSIS An excisional biopsy specimen was obtained, and the histopathologic analysis was consistent with eccrine spiradenoma (Fig 1, C ).
From the Department of Dermatology, Hospital Universitari Sagrat Cor,a Universitat de Barcelona, Spain, and the Melanoma Institute Australia, The University of Sydney and Sydney Melanoma Diagnostic Centre,b Royal Prince Alfred Hospital, New South Wales, Australia. Publication of this article was supported by 3Gen. Funding sources: None. Conflicts of interest: None declared.
Reprint requests: Helena Collgros, MD, Department of Dermatology, Hospital Universitari Sagrat Cor C/ Parıs 83-85, E-08029 Barcelona, Spain. E-mail: [email protected]. J Am Acad Dermatol 2015;72:S25-6. 0190-9622/$36.00 ª 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.04.058
S25
S26 Collgros and Guitera
J AM ACAD DERMATOL
JANUARY 2015
KEY MESSAGE Eccrine spiradenoma is a rare, benign adnexal neoplasm. It usually presents as a solitary soft to firm nodule of 1 to 2 cm located on the trunk or head. It affects both men and women, developing between 20 and 40 years of age. It has been classified as one of the painful tumors of the skin; however, many reports describe no tenderness or pain. When multiple spiradenomas are present, the Brooke-Spiegler syndrome, an autosomal dominant inherited syndrome that features multiple adnexal neoplasms, must be ruled out. Complete surgical excision is the recommended treatment to confirm the diagnosis and to rule out malignant transformation to spiradenocarcinoma. Clinically and dermatoscopically this lesion may resemble other tumors such as basal cell carcinoma and trichoblastoma, all featuring branched vessels and blue clods.1 This highlights that arborizing vessels and blue clods are not exclusive to basal cell carcinoma and can be found in other neoplasms.2
The authors thank Dr Pablo Umbert-Millet for his collaboration with the histopathologic diagnosis and Francesc Zarzuela-Serrat for his enthusiasm and help with the histologic pictures. REFERENCES 1. Tschandl P. Dermatoscopic pattern of a spiradenoma. Dermatol Pract Concept 2012;2:9. 2. Argenziano G, Zalaudek I, Corona R, Sera F, Cicale L, Petrillo G, et al. Vascular structures in skin tumors. Arch Dermatol 2004;140:1485-9.
CLINICAL PRESENTATION A 64-year-old white man with a past history of basal cell carcinoma presented for a full skin check. He had recently noted a new lesion on his scalp, which was occasionally tender when touched. On examination, a 4-mm pink pearly papule was seen on the left parietal area of scalp (Fig 1, A).
Fig 1. A, Clinical picture of a pink papule, tender when touched on the scalp. B, Dermatoscopy image (DermLite II ProHR, 3Gen LLC, California) of the lesion showing branched vessels as well as blue and yellow clods. C, Histopathology: Circumscribed polylobulated basophilic ovoid nodule located in the dermis, well encapsulated with regular borders. The tumor contains 3 cell types: small basaloid cells with dense hyperchromatic nuclei, located at the periphery of the nodules, larger cuboidal cells with pale eosinophilic cytoplasm, located in the center, as well as scattered lymphocytes. Ductal structures, sparse cystic cavities, dilated vascular channels, and homogeneous eosinophilic material are also seen within the nodules. The overlying epidermis is intact. (Hematoxylin and eosin stain; original magnification: 3100.)
DERMOSCOPIC APPEARANCE The dermoscopic evaluation revealed a pink papule with telangiectatic-branched vessels, blue-gray ovoid nests, and a yellowish clod on 1 side of the lesion (Fig 1, B).
HISTOLOGIC DIAGNOSIS An excisional biopsy specimen was obtained, and the histopathologic analysis was consistent with eccrine spiradenoma (Fig 1, C ).
From the Department of Dermatology, Hospital Universitari Sagrat Cor,a Universitat de Barcelona, Spain, and the Melanoma Institute Australia, The University of Sydney and Sydney Melanoma Diagnostic Centre,b Royal Prince Alfred Hospital, New South Wales, Australia. Publication of this article was supported by 3Gen. Funding sources: None. Conflicts of interest: None declared.
Reprint requests: Helena Collgros, MD, Department of Dermatology, Hospital Universitari Sagrat Cor C/ Parıs 83-85, E-08029 Barcelona, Spain. E-mail: [email protected]. J Am Acad Dermatol 2015;72:S25-6. 0190-9622/$36.00 ª 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.04.058
S25
S26 Collgros and Guitera
J AM ACAD DERMATOL
JANUARY 2015
KEY MESSAGE Eccrine spiradenoma is a rare, benign adnexal neoplasm. It usually presents as a solitary soft to firm nodule of 1 to 2 cm located on the trunk or head. It affects both men and women, developing between 20 and 40 years of age. It has been classified as one of the painful tumors of the skin; however, many reports describe no tenderness or pain. When multiple spiradenomas are present, the Brooke-Spiegler syndrome, an autosomal dominant inherited syndrome that features multiple adnexal neoplasms, must be ruled out. Complete surgical excision is the recommended treatment to confirm the diagnosis and to rule out malignant transformation to spiradenocarcinoma. Clinically and dermatoscopically this lesion may resemble other tumors such as basal cell carcinoma and trichoblastoma, all featuring branched vessels and blue clods.1 This highlights that arborizing vessels and blue clods are not exclusive to basal cell carcinoma and can be found in other neoplasms.2
The authors thank Dr Pablo Umbert-Millet for his collaboration with the histopathologic diagnosis and Francesc Zarzuela-Serrat for his enthusiasm and help with the histologic pictures. REFERENCES 1. Tschandl P. Dermatoscopic pattern of a spiradenoma. Dermatol Pract Concept 2012;2:9. 2. Argenziano G, Zalaudek I, Corona R, Sera F, Cicale L, Petrillo G, et al. Vascular structures in skin tumors. Arch Dermatol 2004;140:1485-9.