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Dermatology Practical & Conceptual

ISSN 2160-9381

January 2014 | Volume 4, No. 1

An atypical pigmented lesion on the nose

Francesco Savoia1, Giuseppe Gaddoni1, Vincenzo Albano1, Vera Tengattini2, Lorenza Ricci2, Annalisa Patrizi2, Emilia Crisanti3 1 Unit of Dermatology, AUSL Ravenna, Italy 2 Department of Specialized, Diagnostic and Experimental Medicine, Division of Dermatology, University of Bologna, Italy 3 Unit of Pathologic Anatomy, AUSL Ravenna, Italy

Keywords:  pigmented squamous cell carcinoma, dermoscopy, pigmented lesion, melanoma, cutaneous carcinoma, dermatoscopy

Citation: Savoia F, Gaddoni G, Albano V, Tengattini V, Ricci L, Patrizi A, Crisanti E. An atypical pigmented lesion of the nose. Dermatol Pract Concept. 2014;4(1):12. http://dx.doi.org/10.5826/dpc.0401a12

Received:  August 20, 2013;  Accepted:  November 1, 2013;  Published: January 31, 2014

Copyright: ©2014 Savoia et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

All authors have contributed significantly to this publication.

Corresponding author: Dr. Vera Tengattini, Department of Specialized, Diagnostic and Experimental Medicine, Division of Dermatology, University of Bologna, Via Massarenti, 1, 40138 Bologna, Italy. Tel. +390516364198; Fax. +390516363091. Email: vera.tengattini@hotmail.com

The patient

A 56-year-old Caucasian woman, with skin phototype III, presented with an asymptomatic, slow-growing, gray-black plaque on her nose. The lesion had appeared almost 6 months prior, was 10 x 5 mm in size and presented with a paler, raised and scaly central area (Figure 1). This area could be hardly differentiated from ulceration, however, that was excluded on histology.

Figure 1. Clinical picture: a gray-black plaque on the nose, with a paler, raised and scaly central area. [Copyright: ©2014 Savoia et al.]

Dermatoscopy with a non-contact polarizing dermatoscope revealed an unspecific pattern, structureless and asymmetric (Figure 2), characterized by blue-gray radial lines, disposed centrifugally at the periphery of a structureless scaly center, with some blood spots. Other dermatoscopic features were few peripheral ectatic linear vessels in the lower and less pigmented area, a few discrete blue-gray blotches and a pink-white halo around the lesion.

Figure 2. Non-contact polarized dermoscopy revealed an unspecific pattern, characterized by a rim of confluent blue-gray radial lines, with relatively ill-defined edges, ectasia of a few peripheral linear vessels, a few discrete blue-gray globules blotches (inferiorly), a central area with some whitish surface scale and blood spots, and a pink-white halo around the lesion. [Copyright: ©2014 Savoia et al.]

No prior topical treatment was used before our consultation.

The diagnoses proposed to the pathologist included basal cell carcinoma, adnexal tumor and melanoma, but the lesion was described as non-specific.

Surgical excision was performed with 2 mm margins. Histopathologic examination revealed an aggregation of atypical epithelial cells in the dermis (Figure 3), severe solar eosinophilic elastosis, squamous eddy, atypical and necrotic epithelial squamous cells and pigmented deposits of melanin (Figure 4).

Figure 3. Aggregations of atypical epithelial cells in the dermis. (H&E 4x). [Copyright: ©2014 Savoia et al.]

Figure 4. Histology: a closer view showing severe solar eosinophilic elastosis, squamous eddy, numerous atypical and necrotic epithelial squamous cells and pigmented deposits of melanin. (H&E 20x). [Copyright: ©2014 Savoia et al.]

What is your diagnosis?

Please send your answer to dpc@derm101.com. The first correct answer will receive a DL3N hand dermoscope [cordially sponsored by 3GEN]. The case and the answer to the question will be presented in the next issue of Dermatology Practical and Conceptual.

October 2013 quiz answer

The correct answer to the Dermatoscopy quiz in the October 2013 issue is superficial basal cell carcinoma (http://dx.doi.org/10.5826/dpc.0304a10). Congratulations to Dr. John Paoli, Department of Dermatology, Sahlgrenska University Hospital, Gothenburg, Sweden, who was the first to send us the correct answer!