Derm Dx: Asymptomatic Growth on the Chest - Clinical Advisor

Derm Dx: Asymptomatic Growth on the Chest

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A 48-year-old woman with fair skin presents for evaluation of a growth on the middle of her chest. She first noted the lesion approximately 3 months ago, and it has remained asymptomatic. Despite having a basal carcinoma removed from her temple at age 44 and undergoing treatment for actinic keratoses several times, she admits to ample sun exposure with only intermittent use of sunscreen.

Can you diagnose this condition?

Acantholytic dyskeratotic acanthoma, an uncommon finding, was first described in a case report 12 years ago.1 As the name implies, on histologic evaluation, the neoplasm demonstrates both acantholysis and dyskeratosis similar to that of Darier disease, Grover disease, Hailey-Hailey disease,...

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Acantholytic dyskeratotic acanthoma, an uncommon finding, was first described in a case report 12 years ago.1 As the name implies, on histologic evaluation, the neoplasm demonstrates both acantholysis and dyskeratosis similar to that of Darier disease, Grover disease, Hailey-Hailey disease, and warty dyskeratoma.

The majority of cases occur in middle-aged to elderly women. Lesions usually present as a solitary hyperkeratotic plaque located on the trunk or extremities.2 Acantholytic dyskeratotic acanthomas have been reported in immunocompromised individuals as well as in patients receiving vemurafenib.3-5 Lesions are benign; to date, no malignant transformations have been reported.

Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Omulecki A, Lesiak A, Narbutt J, Woźniacka A, Piekarski J, Biernat W.   Plaque form of warty dyskeratoma – acantholytic dyskeratotic acanthoma. J Cutan Pathol. 2017;34(6):494-496

2. Goldberg A, Lee RA, Cohen PR. Acantholytic dyskeratotic acanthoma: case report and review of the literature. Dermatol Pract Concept. 2014;4(3):25-30  

3. Ramos-Caro FA, Sexton FM, Browder JF, Flowers FP. Acantholytic acanthomas in an immunosuppressed patient. J Am Acad Dermatol. 1992;27(3):452-453.  

4. Kanitakis J, Gouillon L, Jullien D, Ducroux E. Multiple acantholytic dyskeratotic acanthomas in a liver-transplant recipient. Dermatol Online J. 2019;25(4). Apr 15;25(4).

5. Komori T, Otsuka A, Kaku Y, Honda T, Kabashima K. Acantholytic dyskeratotic acanthoma: a possible skin adverse event of vemurafenib treatment. J Eur Acad Dermatol Venereol. 2017;31(10):e474-475.    

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