10.5826/dpc.1302a69
text/xml
2160-9381
2543
en
Je-Ho Mun
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
skin neoplasms
Dermoscopic Features of Schwannoma
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-04-29
2022-04-18
2023-04-29
2023-06-05
e2023069
Dermatol Pract Concept
Je-Ho Mun
2023/04/29
10.5826/dpc.1302a69
e2023069
Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
2160-9381
skin neoplasms
en
e2023069
Williams NM, Navarrete-Dechent C, Marghoob AA, Abarzua-Araya Á, Salerni G, Jaimes N. Differentiating basal cell carcinoma from intradermal nevi along the eyelid margin with dermoscopy: A case series. J Am Acad Dermatol. 2021;84(1):173-175. DOI: 10.1016/j.jaad.2020.04.059. PMID: 32330634. PMCID: PMC8442835
Dermoscopic Features of Schwannoma
https://dpcj.org/index.php/dpc/article/download/2543/2079
                  Dermoscopic Features of Schwannoma
                                                 Dong Hyo Kim1, Je-Ho Mun1


1 Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea



Key words: dermoscopy, dermatoscopy, diagnosis, schwannoma, skin neoplasms
Citation: Kim DH, Mun JH. Dermoscopic Features of Schwannoma. Dermatol Pract Concept. 2023;13(2):e2023069. DOI: https://doi.
org/10.5826/dpc.1302a69
Accepted: July 11, 2022; Published: April 2023
Copyright: ©2023 Kim et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Je-Ho Mun, MD, PhD, Department of Dermatology, Seoul National University College of Medicine, 101,
Daehak-ro, Jongno-gu, Seoul 03080, Korea. Telephone: +82-2-2072-3274, Fax: +82-2-742-7344, E-mail: jehomun@gmail.com




Introduction                                                             diagnoses of the patients included ganglion cyst, epidermal
                                                                         cyst, and lipoma. In all 4 patients, tumors were surgically
Schwannomas present as ill-defined soft tissue masses that               removed. Histopathological examination revealed encapsu-
are painful in one-third of cases [1]. Clinical diagnosis based          lated spindle cell tumor with characteristic hypercellular and
on morphologic patterns alone is often difficult. It requires            hypocellular areas, which is consistent with schwannoma.
differentiation from other dermal or subcutaneous tumors,                Polarized dermoscopy in half of the cases revealed a dermo-
including neurofibroma, intradermal nevus, epidermal cyst,               scopic pattern of arborizing vessels with whitish translucent
lipoma, and basal cell carcinoma [2]. Dermoscopy is a useful             surfaces (Table 1 and Figure 1). Written informed consent
non-invasive diagnostic tool in differentiating various benign           for publication of clinical details and clinical images was ob-
and malignant skin tumors. However, the dermoscopic fea-                 tained from the patients.
tures of schwannomas remain largely unknown.

                                                                         Conclusions
Case Presentation
                                                                         As schwannomas are usually located in the dermis and sub-
Cases of histopathologically confirmed schwannoma with                   cutaneous layer, dermoscopic findings may not be prominent.
available clinical and dermoscopic photographs from the                  Nevertheless, in our case series, schwannomas demonstrated
Department of Dermatology, Seoul National University                     arborizing vessels and translucent surfaces on dermoscopy
Hospital from 2016 to 2021 were analyzed. A total of 4 pa-               in half of the cases. Dermoscopic features of schwannoma
tients (2 males, median age 38.5 [range 30-47] years) were               have been reported previously in the literature [1,3]. One
included. All patients presented with palpable dermal or                 case report described multiple arborizing vessels and speck-
subcutaneous nodules. Fifty percent were accompanied with                led pigmentation on a translucent yellowish surface [1].
pain or tenderness. Two were located on the head and neck,               These findings are similar to our cases. Therefore, we sug-
and 2 were located on the upper limb. The primary clinical               gest that dermoscopy may help differentiate schwannoma



Research Letter | Dermatol Pract Concept. 2023;13(2):e2023069                                                                         1
               Table 1. Clinical and dermoscopic findings of four patients with schwannoma.
                                                                                                                               Size of
                Age                                                                                                            excised
               at first   Duration                         Clinical                         Primary        Dermoscopic          tissue
 No     Sex     visit     of disease     Location         features        Symptoms         diagnosis         features            (cm)
    1   M        30       6 months      Dorsum        0.5 cm sized        (-)             Ganglion        Whitish                0.8 x
                                        of right      palpable                            cyst            translucent            0.6 x
                                        1st finger    dermal or                                           surface with            0.4
                                                      subcutaneous                                        arborizing
                                                      nodule                                              vessels
    2   M        32       18 months     Right         Dermal or           Tenderness      Epidermal       Whitish                1.6 x
                                        shoulder      subcutaneous                        cyst, lipoma    translucent            1.3 x
                                                      nodule                                              surface with            0.9
                                                                                                          arborizing
                                                                                                          vessels
    3   F        45       Unknown       Left          Palpable            (-)             Epidermal       None                   0.5 x
                                        anterior      dermal or                           cyst                                   0.5 x
                                        neck          subcutaneous                                                                0.4
                                                      nodule
    4   F        47       35 years      Left          3cm sized           Pain            Lipoma,         None                   7.0 x
                                        occipital     dermal or                           epidermal                              3.0 x
                                        scalp         subcutaneous                        cyst                                    1.3
                                                      nodule

M = male; F = female.




Figure 1. Clinical photographs (A,E). Dermoscopic image showing a whitish translucent structure with arborizing vessels (B,F). Photographs
of surgically excised tumors (C,G). A histopathologic study revealed an encapsulated spindle cell tumor with a characteristic hypercellular
Antoni A area and hypocellular Antoni B area. (D,H; H&E; original magnifications: x100).




from other dermal or subcutaneous tumors in select cases               basal cell carcinoma presents arborizing vessels, additional
by narrowing down the differential diagnosis. Dermoscopic              features include blue-gray ovoid nests, leaf-like structures,
patterns of neurofibromas include peripheral pigmented                 ulceration, multiple small erosions, and spoke-wheel pig-
networks and pink-red structureless areas [4]. Epidermal               mentations [6].
cysts present a distinctive central punctum [5]. Dermoscopic               The limitations of our study include its small sample
patterns of intradermal nevus include pigmented structures             size. In addition, as we excised the tumors with linear in-
such as dots, globules, and comma-like vessels [6]. Although           cision and extirpation methods, we could not investigate



2                                                                           Research Letter | Dermatol Pract Concept. 2023;13(2):e2023069
the association between the location or depth of the tumors           3. Miyamoto K, Yanagi T, Maeda T, et al. Dermoscopic features of
and the presence of dermoscopic findings in schwannomas.                 haemorrhagic schwannoma. Australas J Dermatol. 2021;62(2)
                                                                         :e322-e323. DOI: 10.1111/ajd.13477. PMID: 33094832.
Further studies are warranted to elucidate the dermoscopic
                                                                      4. Duman N, Elmas M. Dermoscopy of cutaneous neurofibromas
patterns of schwannomas.
                                                                         associated with neurofibromatosis type 1. J Am Acad Dermatol.
                                                                         2015;73(3):529-531. DOI: 10.1016/j.jaad.2015.05.021. PMID:
                                                                         26282805.
References                                                            5. Suh KS, Kang DY, Park JB, et al. Usefulness of dermoscopy in
                                                                         the differential diagnosis of ruptured and unruptured epider-
 1. Daulatabad D, Pandhi D, Tanveer N, Sharma S, Kaur I. Solitary        mal cysts. Ann Dermatol. 2017;29(1):33-38. DOI: 10.5021
    dome-shaped erythematous lump of long duration on the palm.          /ad.2017.29.1.33. PMID: 28223744. PMCID: PMC5318524.
    Indian J Dermatol Venereol Leprol. 2018;84(4):437-439. DOI:       6. Williams NM, Navarrete-Dechent C, Marghoob AA,
    10.4103/ijdvl.IJDVL_845_16. PMID: 29380752.                          Abarzua-Araya Á, Salerni G, Jaimes N. Differentiating basal cell
 2. Park JS, Moon J, Cho SI, Mun JH. Schwannoma presenting as a          carcinoma from intradermal nevi along the eyelid margin with der-
    scalp mass: A case report with magnetic resonance imaging find-      moscopy: A case series. J Am Acad Dermatol. 2021;84(1):173-175.
    ings. Ann Dermatol. 2020;32(1):64-68. DOI: 10.5021/ad.2020           DOI: 10.1016/j.jaad.2020.04.059. PMID: 32330634. PMCID:
    .32.1.64. PMID: 33911711. PMCID: PMC7992636.                         PMC8442835.




Research Letter | Dermatol Pract Concept. 2023;13(2):e2023069                                                                           3
