Adult Xanthogranuloma Mimicking Basal Cell Carcinoma: Dermoscopy, Reflectance Confocal Microscopy and Pathological Correlation

Lovato, Louise; Salerni, Gabriel; Puig, Susana; Carrera, Cristina; Palou, Josep; Malvehy, Josep

doi:10.1159/000264670

Cited by 27 publications

(25 citation statements)

References 34 publications

(23 reference statements)

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“…The remaining misdiagnosed lesions belonged to rare benign skin tumours (i.e. angiomyxoma, apocrine hydrocystoma, xanthogranuloma) for which RCM diagnostic findings have been discovered, with the exception of xanthogranuloma, and this can explain well the discordance with the histopathological diagnosis.…”

Section: Discussionmentioning

confidence: 98%

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Is confocal microscopy a valuable tool in diagnosing nodular lesions? A study of 140 cases

et al. 2013

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SummaryBackground Nodular lesions pose diagnostic challenges because nodular melanoma may simulate all kinds of melanocytic and nonmelanocytic lesions. Reflectance confocal microscopy (RCM) is a novel technique that allows visualization of the skin at nearly histological resolution although limited laser depth penetration hampers visualization of the deep dermis. Objectives We sought to assess whether the diagnostic accuracy of RCM was comparable to histopathology for the diagnosis of nodular lesions, and to identify possible limitations of this technique. Methods We retrospectively evaluated 140 nodules by means of RCM while blinded from the histopathological diagnosis. At the end of the study the patient codes were broken and the evaluations were matched with histopathological diagnosis before performing statistical analysis. Results The study consisted of 140 nodular lesions (23 'pure' nodular melanomas, nine melanoma metastases, 28 BCCs, six invasive SCCs, 32 naevi, 14 seborrhoeic keratoses, 17 dermatofibromas, five vascular lesions and six other lesions). RCM correctly diagnosed 121 of 140 lesions (86Á4%); eight of 140 (5Á7%) lesions revealed discordance between histopathology and confocal microscopy. Eight of the 140 (5Á7%) cases were not evaluable by means of RCM due to the presence of ulceration or hyperkeratosis and three cases showed a nonspecific pattern. Interestingly, confocal microscopy reached a 96Á5% sensitivity and 94Á1% specificity (area under curve 0Á970) (95% CI 0Á924-1Á015) (P < 0Á001) for the diagnosis of melanoma. Conclusions The study is retrospective and lesions were not included on the basis of their diagnostic difficulty. Despite the limited laser depth penetration of RCM, this imaging tool represents an effective instrument in diagnosing nodular lesions; however, for fully ulcerated lesions or when a marked hyperkeratosis is present, biopsy should always be performed. Prospective studies on difficult-todiagnose nodules should be performed to analyse further the pros and cons of RCM in skin cancer diagnosis.

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Section: Discussionmentioning

confidence: 98%

“…Thirty‐six RCM criteria according to distinct diagnosis are reported in Table along with the references where they were first described . RCM criteria for melanoma metastasis (in transit) have not been described and we used the same diagnostic criteria as for melanoma.…”

Section: Methodsmentioning

confidence: 99%

Is confocal microscopy a valuable tool in diagnosing nodular lesions? A study of 140 cases

et al. 2013

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“…The most prevalent dermoscopic feature of juvenile xanthogranuloma (JXG) is the “setting sun appearance,” which is defined as orange–yellow background with a subtle erythematous border; however, JXG alters its features gradually in terms of clinical, histopathological, and dermoscopic appearance. Song et al .…”

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confidence: 99%

Alteration of dermoscopic features in a juvenile xanthogranuloma during follow‐up of 43 months

et al. 2014

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Additionally, to our knowledge, the case presented in this study is the first of nodular hidradenoma in an infant showing spontaneous regression after skin biopsy. All patients in the cases mentioned above had undergone surgical excision. 2-5 Moreover, the authors in the previous cases recommended total surgical excision because nodular hidradenoma has a high local recurrence rate. However, we encountered a nodular hidradenoma that underwent spontaneous regression in an infant. Therefore, close follow-up can be considered as an alternate course of action when nodular hidradenoma occurs in infancy, because it can regress spontaneously.

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“…Thus, it was suggested that cases with deeper extension of tumor cells to the dermis more closely mimic pigmented basal cell carcinoma on dermoscopy. In any case, arborizing vessels were observed not only in basal cell carcinoma but also in various kinds of benign skin tumors such as xanthogranuloma [8], angiohistiocytoma, hidradenoma and intraepidermal poroma [9]. Another 3 cases showed the coexistence of comedo-like openings and hairpin vessels, although they were irregularly shaped, and therefore seborrheic keratosis was suspected.…”

Section: Discussionmentioning

confidence: 99%

Dermoscopy of Pigmented Poromas

Minagawa

Koga²

2010

Dermatology

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Background: To date, little is known about the dermoscopic features of pigmented poromas. Methods: Twelve cases of pigmented poromas examined by dermoscpy at the Department of Dermatology, Shinshu University Hospital (Matsumoto, Japan), between January 2000 and February 2009 were collected. Retrospectively, digital dermoscopic images were evaluated for the presence of dermoscopic structures. Results: Vascular structures were observed in 8 of 12 cases. Hairpin vessels were found in 3 cases. Most were elongated and irregularly shaped. Polymorphous vessels were observed in 3 cases, of which 2 showed combinations of dotted vessels and linear-irregular vessels and 1 combinations of hairpin vessels and glomerular vessels. Arborizing vessels were observed in 2 cases. Globule-like structures occurred in 7 cases. Globule-like structures and arborizing vessels coexisted in 2 cases. Comedo-like openings were observed in 3 cases, all of which were accompanied by hairpin vessels. Conclusions: Pigmented poromas mimic a number of skin tumors, including pigmented basal cell carcinomas, seborrheic keratosis and malignant melanoma, because they present various clinical, dermoscopic and histopathological features.

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Adult Xanthogranuloma Mimicking Basal Cell Carcinoma: Dermoscopy, Reflectance Confocal Microscopy and Pathological Correlation

Cited by 27 publications

References 34 publications

Is confocal microscopy a valuable tool in diagnosing nodular lesions? A study of 140 cases

Is confocal microscopy a valuable tool in diagnosing nodular lesions? A study of 140 cases

Alteration of dermoscopic features in a juvenile xanthogranuloma during follow‐up of 43 months

Dermoscopy of Pigmented Poromas

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