Reflectance confocal microscopy features of facial angiofibromas

Abstract

Facial angiofibromas are benign tumors presenting as firm, dome-shaped flesh-colored to pink papules, typically on the nose and adjoining central face. Clinically and dermoscopically they can mimic melanocytic nevi or basal cell carcinomas (BCC). Reflectance confocal microscopy (RCM) is a noninvasive imaging tool that is useful in diagnosing melanocytic and non-melanocytic facial lesions. To date no studies have described the RCM features of facial angiofibromas. Herein, we present two cases of facial angiofibromas that were imaged with RCM and revealed tumor island-like structures that mimicked BCC, leading to skin biopsy.

Dermoscopy of Facial Angiofibromas in Four Patients of Skin of Color with Tuberous Sclerosis Complex: A Case-Series

“…Dermal melanophages appear dermoscopically as unevenly distributed dots/ specks of brown pigment and surface crypts represent pseudo-follicular openings. Upon dermoscopy, previous investigators have reported findings of facial angiofibromas as yellow-white dots/ globules, over a brown-pink, gray background, and red dots in skin of color and appearance of a structureless whitish-pink background reported in phototype I-II [1][2][3]. We were able to appreciate the uneven brown specks/ dots correlating with focally increased dermal melanophages, however red dots were not visualized, instead blurred vessels depicting capillary proliferation were evident.…”

“…Although FAs seen in TSC are clinically indistinguishable from those present in Birt-Hogg-Dubé syndrome (BHD), facial papules in the latter typically consist of fibrofolliculoma and trichodiscoma as well [4]. Recently, reflectance confocal microscopy on FAs has also revealed regular epidermal honeycombed pattern with nodular structures with no palisading, thick collagen bundles around hair follicles, horizontal linear and vertical round vessels, along with small and angulated bright cells (corresponding to inflammatory cells) [3].…”