A proposed new classification system for lichenoid keratosis

Glaun, Russel S; Dutta, B.; Helm, Klaus F.

doi:10.1016/s0190-9622(96)90749-5

Cited by 23 publications

(13 citation statements)

References 10 publications

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“…In our case, a differential diagnosis was made with cutaneous carcinoma 6 and, in particular, lymphoma which mimics numerous lesions. Because of its location, cutaneous leishmaniasis 7 was ruled out by histology.…”

Section: Discussionmentioning

confidence: 90%

“…SBLK shows focal parakeratosis, exocytosis of lymphocytes, elastosis, and some “lentigo senilis”‐like changes at the borders of the lesion, whereas lichen planus shows more hypergranulosis, melanophages, dilated vessels, and hyaline bodies 1 . Other authors have differentiated between SBLK and a further entity called lichenoid actinic keratosis, which shows confluent parakeratosis and atypical keratinocytes 5,6 …”

Section: Discussionmentioning

confidence: 99%

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The papulokeratotic type of solitary benign lichenoid keratosis

et al. 2003

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A 67‐year‐old housewife was referred to us for a papulonodular keratotic lesion on the left side of the left eyebrow (Fig. 1). The lesion had started to develop 6 months earlier and had gradually reached a size of 2 cm in diameter. It was firm, nonitching, and painless on pressure. 1 Papulokeratotic lesion on the left eyebrow Histologic examination of a punch biopsy obtained from the reddish edge of the nodule showed a jagged epidermal profile with areas of hyperplasia alternating with areas in which the epidermis was thin. The epidermis showed multifocal acanthosis, diffuse hypergranulosis, and hyperorthokeratosis; only focal hyperparakeratosis was present. The basal layer showed spotty areas of liquefaction degeneration, with superimposed lymphocytic infiltrate, and exocytoses that indented the profile of the dermo‐epidermal junction. Focally, some eosinophilic bodies were present. Keratinocytes with hyperchromatic nuclei were also present in the lower layer of the epidermis (Fig. 2). 2 Histologic examination showing epidermis with acanthosis, hypergranulosis, and hyperorthokeratosis; keratinocytes with hyperchromatic nuclei can also be seen in the lower layer. The papillary dermis shows a band‐like lymphocytic infiltrate (original magnification, × 10) The papillary dermis showed a mostly band‐like infiltrate consisting predominantly of lymphocytes, a few melanin‐poor histiocytes, and very rare eosinophils; telangiectases and solar elastosis were also present.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

The papulokeratotic type of solitary benign lichenoid keratosis

et al. 2003

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“…13,14 In our opinion, the issue of nonspecific MART-1 staining is far from being settled. This finding is in keeping with prior reports from Dalton et al and Glaun et al, which point to the danger of misdiagnosing severely inflamed melanocytic lesions as LPLK.…”

Section: Discussionmentioning

confidence: 97%

MART-1 Is a Reliable Melanocytic Marker in Lichen Planus-Like Keratosis: A Study on 70 Cases

Gavino

Woods

Andea

2011

The American Journal of Dermatopathology

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Recent studies have proposed that MART-1 may falsely stain clusters of intraepidermal nonmelanocytic cells in lichenoid dermatitides. This may become an issue especially in isolated lesions of lichen planus-like keratosis (LPLK), a condition also known as benign lichenoid keratosis, and one that is often mistaken clinically for a malignant cutaneous neoplasm. LPLKs are known to exhibit basal epidermal pseudonests, mimicking a regressing melanocytic lesion histologically, and often may prompt the pathologist to obtain a MART-1 stain. If MART-1 is falsely positive, it may seal an incorrect diagnosis. To determine whether or not pseudonests in LPLK decorated with MART-1, we reviewed 70 cases from our institution, stained them with MART-1 (Thermo Fisher-Lab Vision, Ab3 clone, 1:400 dilution, heat-induced epitope retrieval with 0.02M citrate buffer at pH 6.0), and evaluated them for the presence or absence of staining within pseudonests. Four cases demonstrated an occasional MART-1-positive junctional nest. In these cases, microphthalmia transcription factor was also positive, confirming a true melanocytic origin. None of the other cases showed a MART-1 pattern that would have been suspicious for a melanocytic lesion. We propose that this discrepancy between our study and prior ones may be explained by differences in staining protocols or by a very low incidence of non-specific staining. Our study suggests that MART-1 is a useful marker in differentiating melanocytic nests from pseudonests in LPLK.

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“…If used in broader, non-specific fashion, i.e., for various types of regressing neoplasms affected by a lichenoid tissue reaction, it necessarily includes not only viral warts but also some solar keratoses, squamous-cell carcinomas, melanocytic nevi, and melanomas. In fact, it has been proposed to classify lichenoid keratoses into lesions “(1) associated with epithelial changes (lichenoid: seborrheic/actinic keratosis, squamous cell carcinoma, basal cell carcinoma, verruca, solar lentigo); (2) associated with melanocytic changes (lichenoid: melanocytic nevus, lentigo maligna, melanoma); and (3) miscellaneous (lichen planus, drug eruption, lupus erythematosus, cutaneous T-cell lymphoma).” [19] Evidently, any usefulness of the term “lichenoid keratosis” is sacrificed by that approach.…”

Section: Discussionmentioning

confidence: 99%

Regressing basal-cell carcinoma masquerading as benign lichenoid keratosis

Kulberg

Weyers

2016

Dermatol Pract Concept

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BackgroundBenign lichenoid keratosis (BLK, LPLK) is often misdiagnosed clinically as superficial basal-cell carcinoma (BCC), especially when occurring on the trunk. However, BCCs undergoing regression may be associated with a lichenoid interface dermatitis that may be misinterpreted as BLK in histopathologic sections.MethodsIn order to assess the frequency of remnants of BCC in lesions interpreted as BLK, we performed step sections on 100 lesions from the trunk of male patients that had been diagnosed as BLK.ResultsDeeper sections revealed remnants of superficial BCC in five and remnants of a melanocytic nevus in two specimens. In the original sections of cases in which a BCC showed up, crusts tended to be more common, whereas vacuolar changes at the dermo-epidermal junction and melanophages in the papillary dermis tended to be less common and less pronounced.ConclusionsLesions from the trunk submitted as BCC and presenting histopathologically as a lichenoid interface dermatitis are not always BLKs. Although no confident recommendations can be given on the basis of this limited study, deeper sections may be warranted if lesions are crusted and/or associated with only minimal vacuolar changes at the dermo-epidermal junction and no or few melanophages in the papillary dermis.

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A proposed new classification system for lichenoid keratosis

Cited by 23 publications

References 10 publications

The papulokeratotic type of solitary benign lichenoid keratosis

The papulokeratotic type of solitary benign lichenoid keratosis

MART-1 Is a Reliable Melanocytic Marker in Lichen Planus-Like Keratosis: A Study on 70 Cases

Regressing basal-cell carcinoma masquerading as benign lichenoid keratosis

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