Malignant melanoma arising in a seborrheic keratosis

Zabel, R; Vinson, Richard P.; McCollough, Martha L.

doi:10.1067/mjd.2000.103634

Cited by 44 publications

(29 citation statements)

References 4 publications

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“…Several practical clinical points have been raised by the current case: (i) eccrine porocarcinoma has a nonspecific clinical appearance; (ii) dermoscopy, a technique that has been shown to increase significantly the clinical diagnosis of pigmented skin lesions, 1-4 may not be as effective for the evaluation of small pink to reddish lesions; (iii) malignant neoplasms can arise within seborrheic keratoses; [17][18][19][20][21] (iv) eccrine porocarcinoma, a potentially fatal tumor, 5,6 may be more effectively treated with Mohs' micrographic surgery. 7 The clinical appearance of eccrine porocarcinoma is nonspecific, and has been reported in the literature as follows: reddish ulcerated nodules or plaques; 5 an enlarging subcutaneous tumor on the scalp; 7 a polypoid tumor with cutaneous metastasis that appeared as multiple, skin-colored or red to purple papules or nodules; 6 a painful swelling that was indurated, firm, and pigmented; 6 a brown to black nodule with a whitish halo; 22 and a smooth, multilobed nodule, deep purple in color, with brown hyperpigmentation.…”

Section: Discussionmentioning

confidence: 99%

Eccrine porocarcinoma arising in a seborrheic keratosis evaluated with dermoscopy and treated with Mohs’ technique

2003

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A 78-year-old white woman returned for a routine 6-month skin cancer examination. She had a history of actinic keratosis and multiple basal cell carcinomas. She had no personal or family history of dysplastic nevi or melanoma. The patient was asymptomatic and unaware of any new or changing skin lesions. The patient had multiple lentigines, hemangiomas, and actinic and seborrheic keratoses on all sun-exposed areas. There were no less than 10 seborrheic keratoses on the right mid-back, and one was found to have a 1-cm, reddish nodule asymmetrically located within it (Figs 1 and 2). A clear papule on the left preauricular area was found on biopsy to be a basal cell carcinoma. The nodule on the back was still present 1 month later and it was felt that further evaluation was indicated. As melanoma has been reported to develop in seborrheic keratoses, we decided to examine the lesion using digital dermoscopy. With digital dermoscopy, a well-demarcated reddish nodule was asymmetrically located within a brown lesion. It blanched significantly with pressure. Within the nodule, there were dotted and irregular linear vessels (atypical vascular pattern; also known as polymorphous vascular pattern) and regular-appearing brown dots. Surrounding the reddish nodule, there were pale and pigmented, comedo-like openings, fissures, and ridges (brain-like appearance). Some of the follicular openings appeared to be within the wall of the nodule (Figs 3 and 4). Comedo-like openings, fissures, and ridges are primary dermoscopic criteria for the diagnosis of a seborrheic keratosis; however, the vascular pattern seen has not been reported in seborrheic keratosis. Due to the patient's age and the rarity of significant pathology arising in a seborrheic keratosis, a shave biopsy was performed. To our surprise, the specimen was interpreted by an experienced dermatopathologist as a well-differentiated eccrine porocarcinoma. Due to the high local recurrence rate and metastatic potential of this carcinoma, the patient was referred for Mohs' surgery. Both the basal cell carcinoma and the eccrine porocarcinoma were excised in one stage. A metastatic work-up was negative and the patient appears to be doing well.

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Section: Discussionmentioning

confidence: 99%

Eccrine porocarcinoma arising in a seborrheic keratosis evaluated with dermoscopy and treated with Mohs’ technique

2003

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“…There are several reports of this association, but most authors believe that it is a coincidence rather than an example of malignant transformation. [4][5][6] In contrast, some reports identify a series of malignant neoplasms associated with seborrheic keratoses. The presence of a concurrent neoplasm, including melanoma, with a seborrheic keratosis raises the possibility of a pathogenic relationship in lesional development.…”

Section: Discussionmentioning

confidence: 80%

Seborrheic keratosis with basal clear cells: A distinctive microscopic mimic of melanoma in situ

Neuhaus¹,

LeBoit

McCalmont

2006

Journal of the American Academy of Dermatology

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“…It is conceivable that the enlarging SK component may eventually mask the underlying nevus. In the unfortunate scenario of the development of a nevus-associated melanoma beneath the SK, the malignancy would of course eventually become visible, as may have occurred in Case 5 presented here [12–15]. Alternative explanations include that some of these lesions may have been melanomas from their inception that were masquerading themselves as SK [16], that normally occurring melanocytes within an SK mutated into melanoma [12], or that the initial lesion was a keratotic melanocytic nevus, which on histology have hyperkeratotic epidermal rete ridges and pseudohorn cysts, and clinically can have a warty appearance [17] mistaken for a seborrheic keratosis.…”

Section: Discussionmentioning

confidence: 99%

Association between melanocytic neoplasms and seborrheic keratosis: more than a coincidental collision?

DeFazio

Zalaudek

Busam

et al. 2012

Dermatol Pract Concept

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Clinical observations and an expanding knowledge of cell-to-cell communication have led us to speculate that the finding of a melanocytic nevus in conjunction with a seborrheic keratosis is more than a coincidental collision of two lesions. Here we present five cases demonstrating dermoscopic features of both melanocytic lesions and seborrheic keratoses with corresponding histology. Four cases demonstrate dermoscopic features of a melanocytic nevus and seborrheic keratosis, and the final case a melanoma arising in association with a seborrheic keratosis.

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Malignant melanoma arising in a seborrheic keratosis

Cited by 44 publications

References 4 publications

Eccrine porocarcinoma arising in a seborrheic keratosis evaluated with dermoscopy and treated with Mohs’ technique

Eccrine porocarcinoma arising in a seborrheic keratosis evaluated with dermoscopy and treated with Mohs’ technique

Seborrheic keratosis with basal clear cells: A distinctive microscopic mimic of melanoma in situ

Association between melanocytic neoplasms and seborrheic keratosis: more than a coincidental collision?

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