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Huang C, Runge M, Hrycaj SM, Harms PW, Fullen DR, Chan MP. Proliferating inverted follicular keratosis of genital skin: Case series of a challenging variant. J Cutan Pathol 2024. [PMID: 38736174 DOI: 10.1111/cup.14644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/12/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Inverted follicular keratosis (IFK) is a benign cutaneous epithelial tumor typically presenting as a small papule on the head and neck. We have encountered deep endophytic tumors on genital skin with some characteristics of IFK but also atypical features, raising concern for squamous cell carcinoma (SCC). METHODS Four such tumors were identified in our database. Histopathologic analysis and ancillary studies were performed. RESULTS All patients were young women who presented with a solitary 0.5-1.0 cm lesion on the vulva, perineum, or inner buttock. Each showed a squamous proliferation arising from the epidermis, with endophytic growth that was deep and bulbous but not infiltrative. The tumor lobules contained eosinophilic keratinocytes, forming numerous squamous eddies. Small irregular spaces and dyskeratotic cells were frequently found. Nuclear pleomorphism was minimal to absent. All demonstrated wild-type p53 expression and lack of p16 block positivity. In situ hybridizations for human papillomavirus were negative. None of the three cases with follow-up data showed evidence of recurrence. CONCLUSIONS The absence of infiltrative growth or significant pleomorphism, the presence of numerous squamous eddies, the reassuring immunoprofile, and the lack of evidence of recurrence support a variant of IFK and speak against SCC. We propose the term "proliferating IFK" to highlight the florid squamous proliferation. Recognition of this unusual variant would avoid overdiagnosis of SCC.
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Affiliation(s)
- Chelsea Huang
- Department of Pathology, Loma Linda University, Loma Linda, California, USA
| | - Mason Runge
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven M Hrycaj
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul W Harms
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Douglas R Fullen
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - May P Chan
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
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Rashid KNA, Zainon IH, Othman NAN. Inverted Follicular Keratosis: A Rare Presentation in External Ear Canal. Indian J Otolaryngol Head Neck Surg 2024; 76:1244-1246. [PMID: 38440449 PMCID: PMC10908669 DOI: 10.1007/s12070-023-04241-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/21/2023] [Indexed: 03/06/2024] Open
Abstract
Inverted follicular keratosis is a benign skin lesion that typically presents as an asymptomatic, solitary nodule that may mimic malignant lesions, especially squamous cell carcinoma, both clinically and pathologically. It is developed from the hair follicle infundibulum and can be considered a variant of seborrheic dermatitis. We present a case of a 26-year-old gentleman with a soft tissue mass at the external auditory canal which was later confirmed as inverted follicular keratosis and was treated by endoscopic transcanal excision of the mass with temporalis fascia graft reconstruction. He is currently under surveillance follow-up with no symptoms and signs of recurrence.
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Affiliation(s)
- Khairul Naimah Abdul Rashid
- Department of Otorhinolaryngology Hospital Sultanah Bahiyah, Alor Setar, Kedah Malaysia
- Department of Otorhinolaryngology–Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan 16150 Malaysia
| | - Izny Hafiz Zainon
- Department of Otorhinolaryngology Hospital Sultanah Bahiyah, Alor Setar, Kedah Malaysia
| | - Nik Adilah Nik Othman
- Department of Otorhinolaryngology–Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan 16150 Malaysia
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3
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Gorai S, Ahmad S, Raza SSM, Khan HD, Raza MA, Etaee F, Cockerell CJ, Apalla Z, Goldust M. Update of pathophysiology and treatment options of seborrheic keratosis. Dermatol Ther 2022; 35:e15934. [PMID: 36226729 DOI: 10.1111/dth.15934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/13/2022] [Accepted: 10/05/2022] [Indexed: 11/28/2022]
Abstract
Seborrheic keratosis (SK) is a common, benign tumor that can occur on everybody site and can be conservatively managed. Cosmetic concerns, especially when a lesion involves the facial area, are the most common reason for excision. SK shows male gender preponderance and increasing age is an independent association with the condition. Even though more prevalent in the elderly, it has also been reported in younger age groups like adolescents and young adults. Precise pathogenesis is still obscure, but ultra-violet exposure represents a predisposing factor to SK by altering the biochemical concentration and expression of factors like Glutamine deaminases, endothelin, and stem cell factor. Moreover, the accumulation of amyloid-associated protein has also been postulated. Involvement of genitalia has been associated with human papillomavirus infection. Recently, Merkel cell polyomavirus nucleic acid was also detected in SK. Several oncogenic mutations involving FGFR-3 and FOXN1 have been identified. SKs are usually classified clinically and histologically. Dermatoscopy is a noninvasive alternative diagnostic technique widely used in differentiating SK from other benign and malignant tumors. In terms of treatment, topical agents, shave dissection, cryosurgery, electrodesiccation, laser application and curettage under local anesthesia are safe methods for eradication of SKs, mostly for cosmetic purposes. Though generally safe, the latter techniques may occasionally cause post-procedure depigmentation, scarring, and recurrence. Nanosecond-pulsed electric field technology is a promising new technique with fewer side-effects.
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Affiliation(s)
- Surajit Gorai
- Department of Dermatology, Apollo Multispeciality Hospital, Kolkata, West Bengal, India
| | - Shahzaib Ahmad
- King Edward Medical University Lahore, Mayo Hospital Lahore, Lahore, Pakistan
| | | | | | - Muhammad Asad Raza
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, USA
| | - Farshid Etaee
- Yale School of Medicine, Yale-New Haven Health System, New Haven, Connecticut, USA
| | - Clay J Cockerell
- Departments of Dermatology and Pathology, The University of Texas Southwestern Medical Center, Dallas, Texas, Cockerell Dermatopathology, Dallas, Texas, USA
| | - Zoe Apalla
- Second Dermatology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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4
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Nahata VL. Cutaneous Horn Overlying Inverted Follicular Keratosis: A Rare Case Report. Indian Dermatol Online J 2021; 12:636-638. [PMID: 34430483 PMCID: PMC8354396 DOI: 10.4103/idoj.idoj_632_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/09/2020] [Accepted: 12/14/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Vaishali L Nahata
- Belle'Skin Care and Laser Clinic, Ahilyadevi Holkar Marg, Near Tupsakhare Lawns, Mumbai Naka, Nashik, Maharashtra, India
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5
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Ray A, Panda M, Samant S, Mohanty P. A rare case of inverted follicular keratosis in an elderly male: Dermoscopic and histopathological overview with therapeutic response to imiquimod. Indian J Dermatol Venereol Leprol 2021; 87:455. [PMID: 33943061 DOI: 10.25259/ijdvl_224_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 09/01/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Arunima Ray
- Department of DVL, IMS and SUM Hospital, Siksha O Anusundhan University, Bhubaneshwar, Odisha, India
| | - Maitreyee Panda
- Department of DVL, IMS and SUM Hospital, Siksha O Anusundhan University, Bhubaneshwar, Odisha, India
| | - Swati Samant
- Department of Ophthalmology IMS and SUM Hospital, Siksha O Anusundhan University, Bhubaneshwar, Odisha, India
| | - Pranita Mohanty
- Department of Pathology, IMS and SUM Hospital, Siksha O Anusundhan University, Bhubaneshwar, Odisha, India
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Díez-Montero C, González González D, Pérez Martínez E, Schellini S, Galindo-Ferreiro A. Periocular inverted follicular keratosis: a retrospective series over 17 years. Jpn J Ophthalmol 2019; 63:210-214. [PMID: 30604112 DOI: 10.1007/s10384-018-00650-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 10/22/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the demographic, clinical, and histopathologic characteristics of periocular inverted follicular keratosis (IFK), a very rare lesion with poorly defined characteristics. STUDY DESIGN Retrospective case series. METHODS We evaluated 11 patients with clinically diagnosed IFK confirmed by histologic analysis. Data were collected on the patients' demographics, clinical presentation and course of the disease, signs and symptoms, location of the lesion, and outcomes of treatment. RESULTS The patients' mean age was 71 years (range, 32-91 years). Seven (64%) of the patients were female. Eight of the patients (72.7%) had no symptoms, two (18.2%) reported itching, and one (9.1%) had edema and bleeding of the lesion. The lesion affected the upper eyelid in 4 of the patients (36%), the lower lid in 3 of the patients (27%), and the inner canthus in 4 of the patients (36%). CONCLUSIONS IFK has no specific clinical characteristic and thus requires histologic confirmation for its diagnosis and appropriate management.
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Affiliation(s)
- Cecilia Díez-Montero
- Department of Ophthalmology, Rio Hortega University Hospital, Dulzaina St. 2, 47012, Valladolid, Spain
| | | | | | - Silvana Schellini
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Alicia Galindo-Ferreiro
- Department of Ophthalmology, Rio Hortega University Hospital, Dulzaina St. 2, 47012, Valladolid, Spain.
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Gray Y, Johnson S, Polley DC, Elston DM. A verrucous lesion of the eyebrow. Indian Dermatol Online J 2016; 7:206-7. [PMID: 27294062 PMCID: PMC4886599 DOI: 10.4103/2229-5178.182370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yulia Gray
- Ackerman Academy of Dermatopathology, New York, USA
| | - Sandrivette Johnson
- Polley Clinic of Dermatology and Dermatologic Surgery, Wilson, North Carolina, New York, USA
| | - Dennis C Polley
- Polley Clinic of Dermatology and Dermatologic Surgery, Wilson, North Carolina, New York, USA
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8
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Karadag AS, Ozlu E, Uzuncakmak TK, Akdeniz N, Cobanoglu B, Oman B. Inverted follicular keratosis successfully treated with imiquimod. Indian Dermatol Online J 2016; 7:177-9. [PMID: 27294052 PMCID: PMC4886589 DOI: 10.4103/2229-5178.182354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Inverted follicular keratosis is a rare benign tumor of the follicular infundibulum characterized by exo-endophytic growing. It is thought to be a rare variant of the seborrheic keratosis. The diagnosis of inverted follicular keratosis is generally established histopathologically because clinical differentiation from other lesions is difficult. Herein, we present one such rare case, successfully treated with topical 5% imiquimod cream.
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Affiliation(s)
- Ayse Serap Karadag
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Emin Ozlu
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Tugba Kevser Uzuncakmak
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Necmettin Akdeniz
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Bengu Cobanoglu
- Department of Pathology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Berkant Oman
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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The spectrum of nephrocutaneous diseases and associations: Genetic causes of nephrocutaneous disease. J Am Acad Dermatol 2016; 74:231-44; quiz 245-6. [PMID: 26775773 DOI: 10.1016/j.jaad.2015.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 12/20/2022]
Abstract
There are a significant number of diseases and treatment considerations of considerable importance relating to the skin and renal systems. This emphasizes the need for dermatologists in practice or in clinical training to be aware of these associations. Part I of this 2-part continuing medical education article reviews the genetic syndromes with both renal and cutaneous involvement that are most important for the dermatologist to be able to identify, manage, and appropriately refer to nephrology colleagues. Part II reviews the inflammatory syndromes with relevant renal manifestations and therapeutic agents commonly used by dermatologists that have drug-induced effects on or require close consideration of renal function. In addition, we will likewise review therapeutic agents commonly used by nephrologists that have drug-induced effects on the skin that dermatologists are likely to encounter in clinical practice. In both parts of this continuing medical education article, we discuss diagnosis, management, and appropriate referral to our nephrology colleagues in the context of each nephrocutaneous association. There are a significant number of dermatoses associated with renal abnormalities and disease, emphasizing the need for dermatologists to be keenly aware of their presence in order to avoid overlooking important skin conditions with potentially devastating renal complications. This review discusses important nephrocutaneous disease associations with recommendations for the appropriate urgency of referral to nephrology colleagues for diagnosis, surveillance, and early management of potential renal sequelae.
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10
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Armengot-Carbo M, Abrego A, Gonzalez T, Alarcon I, Alos L, Carrera C, Malvehy J, Puig S. Inverted follicular keratosis: dermoscopic and reflectance confocal microscopic features. Dermatology 2013; 227:62-6. [PMID: 23988627 DOI: 10.1159/000351715] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 04/29/2013] [Indexed: 11/19/2022] Open
Abstract
Inverted follicular keratosis (IFK) is a rare benign tumor which usually appears as a firm papule on the face. The diagnosis is generally made by histopathology because the clinical appearance is difficult to differentiate from other lesions. Dermoscopic features of IFK have not been established to date. Herein we describe the dermoscopic findings of 4 cases of IFK. Radial peripheral hairpin vessels surrounded by a whitish halo arranged around a central white-yellowish amorphous area were observed in 3 cases, and glomerular vessels were present in the central area of one of them. The fourth case also presented a central white amorphous area but showed arborizing vessels. Reflectance confocal microscopy (available in 1 case) revealed a broadened honeycomb pattern, epidermal projections and hairpin and glomerular vessels. To our knowledge this is the first case series describing the dermoscopic features of inverted follicular keratosis and the first confocal microscopy description of this entity.
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Affiliation(s)
- M Armengot-Carbo
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
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11
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Hall JE, Abdollahian DJ, Sinard RJ. Thyroid disease associated with cowden syndrome: A meta-analysis. Head Neck 2012; 35:1189-94. [DOI: 10.1002/hed.22971] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2011] [Indexed: 12/12/2022] Open
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Jaada N, Zaraa I, Chelly I, Cheikhrouhou R, Trojjet S, Euch DE, Mokni M, Haouet S, Ben Osman A. Pigmented tumor in the nostril. Dermatol Pract Concept 2011; 1:53-6. [PMID: 24396720 PMCID: PMC3881083 DOI: 10.5826/dpc.0101a11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 01/27/2011] [Indexed: 11/17/2022] Open
Abstract
A 64-year-old man was noted to have a single pigmented lesion in the nostril of his nose. Clinical examination revealed a 5 mm nodular growth and brown lesion. With a presumed clinical diagnosis of malignant skin tumor, a biopsy was performed. The histological examination revealed the unexpected diagnosis of pigmented inverted follicular keratosis. The inverted follicular keratosis is an uncommon benign lesion that is usually diagnosed histologically rather than clinically. It commonly simulates other proliferative skin lesions.
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Affiliation(s)
- Nawel Jaada
- Dermatology Department, La Rabta Hospital, Tunis, Tunisia
| | - Ines Zaraa
- Dermatology Department, La Rabta Hospital, Tunis, Tunisia
| | - Ines Chelly
- Pathology Department, La Rabta Hospital, Tunis, Tunisia
| | | | - Sondes Trojjet
- Dermatology Department, La Rabta Hospital, Tunis, Tunisia
| | | | - Mourad Mokni
- Dermatology Department, La Rabta Hospital, Tunis, Tunisia
| | - Slim Haouet
- Pathology Department, La Rabta Hospital, Tunis, Tunisia
| | - Amel Ben Osman
- Dermatology Department, La Rabta Hospital, Tunis, Tunisia
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Desmoplastic trichilemmoma of the facial region mimicking invasive carcinoma. J Maxillofac Oral Surg 2010; 10:71-3. [PMID: 22379325 DOI: 10.1007/s12663-010-0118-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 10/15/2010] [Indexed: 12/27/2022] Open
Abstract
Trichilemmoma is a hamartomatous proliferation arising from cells of hair follicle. Its desmoplastic variant simulates an invasive carcinoma. In this tumor, the cell of origin seems to be located in the superficial level of the hair follicle just below the basement membrane at the sebaceous gland level. We present a similar case which presented with an asymptomatic nodular lesion in the region above the upper lip on left side. Fine needle aspiration cytology raised the cytological possibility of a malignancy for which the lesion was excised. On histopathology the lesion was diagnosed as desmoplastic trichilemmoma. The case highlights the difficulty encountered in differentiating a benign adnexal tumor from malignant lesion based on cytology alone. Moreover, the extensive desmoplasia on histopathology raises the suspicion of invasive malignancy which requires to be carefully excluded. The superficial features of trichilemmoma and lack of cellular atypia is a useful diagnostic clue in such a situation. Positivity of CD34 can also be used to differentiate from basal cell carcinomas. The case reported here had a solitary lesion, but follow up is required for development of more lesions or multiple hamartomas in other organs as a part of Cowden's disease.
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Kanitakis J. Adnexal tumours of the skin as markers of cancer-prone syndromes. J Eur Acad Dermatol Venereol 2010; 24:379-87. [DOI: 10.1111/j.1468-3083.2009.03420.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Casado B, Gómez-Fernández C, Feito M, González-Beato M. Pápulas verrugosas perianales en paciente con síndrome de Bannayan-Riley-Ruvalcaba. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s0001-7310(09)72930-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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16
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Casado B, Gómez-Fernández C, Feito M, González-Beato M. Perianal Verrucous Papules in a Patient With Bannayan-Riley-Ruvalcaba Syndrome. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70572-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Battistella M, Peltre B, Cribier B. Composite tumors associating trichoblastoma and benign epidermal/follicular neoplasm: another proof of the follicular nature of inverted follicular keratosis. J Cutan Pathol 2009; 37:1057-63. [DOI: 10.1111/j.1600-0560.2009.01341.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Inverted follicular keratosis of the nasal vestibule. Otolaryngol Head Neck Surg 2009; 141:288-9. [PMID: 19643268 DOI: 10.1016/j.otohns.2009.02.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 02/23/2009] [Indexed: 11/20/2022]
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Noiles K, Vender R. Are all seborrheic keratoses benign? Review of the typical lesion and its variants. J Cutan Med Surg 2009; 12:203-10. [PMID: 18845088 DOI: 10.2310/7750.2008.07096] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Seborrheic keratosis (SK) is one of the more common benign epidermal neoplasms seen in adult and middle-aged patients. OBJECTIVE As little is written in the literature about the variants of SK, this article aims to categorize and discuss the different subtypes and their important associations. METHODS An in-depth literature search using OVID Medline and PubMed was conducted to classify the various subtypes of SK. Clinical variants were photographed and used to help document the subtypes. The pathology is described for each. RESULTS Six subtypes of SK were identified: dermatosis papulosa nigra, stucco keratosis, inverted follicular keratosis, large cell acanthoma, lichenoid keratosis, and flat seborrheic keratosis. Although the etiology and pathogenesis of SKs are still largely debatable, several underlying mechanisms and contributing factors have been identified. All subtypes represent benign lesions, and treatment is usually done for cosmetic reasons. Several of the subtypes may act as cutaneous markers for internal malignancy and should be monitored closely for any atypical changes. CONCLUSION Although all subtypes of SK are benign, their association with other malignant lesions and ability to serve as cutaneous markers of internal malignancy emphasize the importance of correctly identifying all variants.
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Affiliation(s)
- Kristin Noiles
- Micheal G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 1P3, Canada.
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20
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Benign tumors and cysts of the epidermis. Dermatopathology (Basel) 2009. [DOI: 10.1016/b978-0-7020-3023-9.10002-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
Seborrheic keratosis is related to the intraepidermal hair follicle in its morphogenesis. Squamous eddies in irritated seborrheic keratosis (ISK) are known to develop by focal maturation of basaloid cells, but the significance of squamous eddies is not understood. The purpose of this study was to elucidate the nature of squamous eddies in ISK. Serial sections of paraffin blocks of 20 cases of ISK were examined. We tracked each squamous eddy through the serial sections to observe the different shapes and positions of the same squamous eddy. In 4 cases, squamous eddies revealed hair shafts at their centers in different sections. In 14 cases, squamous eddies contained acrotrichial canals. In 13 cases, squamous eddies were connected to keratotic invaginations we thought to be follicular infundibula. Eighteen of the 20 cases of ISK showed at least 1 of the morphological features of intraepidermal hair follicle structures. We have found that the squamous eddies of ISK are anatomically related to acrotrichia.
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Affiliation(s)
- Hye-Ja Choi
- Department of Dermatology, Chonbuk University Hospital, Institute for Medical Sciences, Chonju, South Korea
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