DermDx: Papule on Neck

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A 58-year-old woman is requesting removal of a lesion on her neck. The patient notes that the growth has been present for approximately 1 year. The papule is occasionally irritated by clothing but is otherwise asymptomatic and had never bled. Examination reveals a 0.6-cm flesh-colored papule with a hyperkeratotic center. During the physical examination, actinic keratoses and lentigines are also noted on her face.

Warty dyskeratoma is an uncommon benign skin growth that usually manifests as an isolated papule with a central keratotic plug. The lesion was first described by Szymanski in 1957, when he differentiated the disorder from keratosis follicularis (Darier disease).1 The...

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Warty dyskeratoma is an uncommon benign skin growth that usually manifests as an isolated papule with a central keratotic plug. The lesion was first described by Szymanski in 1957, when he differentiated the disorder from keratosis follicularis (Darier disease).1 The latter condition is characterized by more widespread involvement and autosomal dominance.

The most common sites of warty dyskeratomas are the face, scalp, and neck and the condition most commonly occurs in middle-aged and elderly individuals. Rare variants of the condition include oral and genital lesions.2,3

The diagnosis of warty dyskeratomas is made by clinical appearance and biopsy. Dermoscopy is nonspecific revealing pink to gray structureless homogeneous areas surrounding a central yellowish to brown star-like configuration but may help to rule out other skin tumors.4 The most common histopathologic pattern is that of a plug comprised of acantholytic dyskeratotic cells that manifest central basophilia and pyknotic nuclei surrounded by a clear halo.5 Malignant transformation has not been reported.

Treatment of warty dyskeratoma is surgical removal. Therapeutic modalities such as tazarotenic acid gel, laser therapy, tretinoin, and 5-fluorouracil may prove of benefit when multiple lesions are encountered.6

Sara Mahmood, DPM, is a podiatrist who completed a joint dermatology/podiatry fellowship and is on staff at DermDox Dermatology Centers. Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Szymanski FJ. Warty dyskeratoma; a benign cutaneous tumor resembling Darier’s disease microscopically. AMA Arch Derm. 1957;75:567-572. doi:10.1001/archderm.1957.01550160093012

2. Ghasemi Basir HR, Alirezaei P, Ebrahimi B, Khanali S. Oral warty dyskeratoma: an unusual presentation. Dermatol Reports. 2020;12(1):8236. doi:10.4081/dr.2020.8236

3. Torres KM, Junkins-Hopkins JM. Cystic acantholytic dyskeratosis of the vulva: an unusual presentation of a follicular adnexal neoplasm. Indian Dermatol Online J. 2016;7:272-274.

4. Ingordo V, Ferrara G, Ingordo I, Argenziano G. A case of post-inflammatory warty dyskeratoma of the chest: other dermoscopic features. Dermatol Reports. 2020;12(2):8791. doi:10.4081/dr.2020.8791

5. Kaddu S, Dong H, Mayer G, Keri H, Cerroni L.  Warty dyskeratoma—“follicular dyskeratoma”: analysis of clinicopathologic features of a distinctive follicular adnexal neoplasmJ Am Acad Dermatol. 2002;47(3):423-428. doi:10.1067/mjd.2002.122756

6. Abramovits W, Abdelmalek N. Treatment of warty dyskeratoma with tazarotenic acid. J Am Acad Dermatol. 2002;46(2 Suppl Case Reports):S4. doi:10.1067/mjd.2002.104963

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