10.5826/dpc.1401a62
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2160-9381
3548
en
Elisa Cinotti
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
imaging
Non-Invasive Imaging Techniques (Dermoscopy, Reflectance Confocal Microscopy and Line-Field Confocal Optical Coherence Tomography) for the Diagnosis of Warty Dyskeratoma
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https://dpcj.org/index.php/dpc
Research Letter
2024-01-31
2023-05-18
2024-01-31
2024-02-21
e2024062
Dermatol Pract Concept
Elisa Cinotti
2024/01/31
10.5826/dpc.1401a62
e2024062
Dermatology Section, Department of Medical, Surgical, and Neurological Sciences, Santa Maria Alle Scotte Hospital, Siena, Italy
2160-9381
imaging
en
e2024062
Giacomel J, Zalaudek I, Argenziano G. Dermatoscopy of Grover's disease and solitary acantholytic dyskeratoma shows a brown, star-like pattern. Australas J Dermatol. 2012;53(4):315-316.
Non-Invasive Imaging Techniques (Dermoscopy, Reflectance Confocal Microscopy and Line-Field Confocal Optical Coherence Tomography) for the Diagnosis of Warty Dyskeratoma
https://dpcj.org/index.php/dpc/article/download/3548/2549
     Non-Invasive Imaging Techniques (Dermoscopy,
    Reflectance Confocal Microscopy and Line-Field
    Confocal Optical Coherence Tomography) for the
            Diagnosis of Warty Dyskeratoma
  Giulio Cortonesi1, Carolina Donelli1, Mariano Suppa2, Clement Lenoir2, Pietro Rubegni1,
                                        Elisa Cinotti1


1 Dermatology Section, Department of Medical, Surgical, and Neurological Sciences, Santa Maria Alle Scotte Hospital, Siena, Italy
2 Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium



Key words: dyskeratoma, acantholytic, warty, non-invasive, imaging
Citation: Cortonesi G, Donelli C, Suppa M, Lenoir C, Rubegni P, Cinotti E. Non‐Invasive Imaging Techniques (Dermoscopy, Reflectance
Confocal Microscopy and Line-Field Confocal Optical Coherence Tomography) for the Diagnosis of Warty Dyskeratoma. Dermatol Pract
Concept. 2024;14(1):e2024062. DOI: https://doi.org/10.5826/dpc.1401a62
Accepted: August 8, 2023; Published: January 2024
Copyright: ©2024 Cortonesi 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: Carolina Donelli, MD, Dermatology Section, Santa Maria Alle Scotte Hospital. Viale Bracci 16, 53100 Siena, Italy.
E-mail: carolina.donelli@gmail.com




Introduction                                                             contagiosum. He had no personal history of atopic der-
                                                                         matitis or viral skin infections, nor declared non-marital
Acanthomas are benign tumors arising from epidermal ke-                  sexual intercourse. Dermoscopy showed a pinkish papule
ratinocytes. Warty dyskeratoma (or papular acantholytic                  with a central yellowish area (Figure 1B). Reflectance con-
dyskeratoma) is an uncommon type of acanthoma mainly                     focal ­microscopy (RCM; Vivascope® 3000 MAVIG GmbH)
localized on the head or neck of adults and histologically               showed medium refractive discohesive keratinocytes in
characterized by acantholysis with dyskeratosis [1].                     the center of the lesion that were smaller and less refrac-
                                                                         tive than molluscum contagiosum bodies or others infec-

Case Presentation                                                        tious diseases (Figure 2A) [2-4]. Line-field confocal optical
                                                                         coherence tomography (LC-OCT; DeepLive®, DAMAE
                                                                         ­
A 47-year-old man presented for the evaluation of tender,                Médical) revealed mild hyperkeratosis and acanthosis, su-
cup-shaped, small papules with an umbilicated center on                  prabasal epidermal clefting, and a central crateriform in-
the left side of his abdomen (Figure 1A). They appeared six              vagination in the stratum corneum less defined than that
months earlier and clinically resembled much molluscum                   one of m
                                                                                ­ olluscum contagiosum or other viral or infective




Research Letter | Dermatol Pract Concept. 2024;14(1):e2024062                                                                         1
              Figure 1. (A-D) On the left small, cup-shaped, papules with an umbilicated center, and on the right pinkish
              papular lesions with a central yellowish area; they represent clinic (A,C) and dermoscopic (B,D) images of
              two different (A-D) warty dyskeratomas.




infections (Figure 2, C and D) [3,5]. The histopathological          Clinically, it is frequently diagnosed as molluscum conta-
examination revealed mild hyperkeratosis and acanthosis              giosum, seborrheic keratosis, or basal cell carcinoma. Der-
and suprabasal acantholysis and focal dyskeratosis sugges-           moscopy is not specific, even if a brown star-like pattern
tive of acantholytic dyskeratoma (Figure 2F). His personal           (tan to brown, star-like shapes consisting of surface scale or
or family history was negative for keratosis follicularis            superficial indentations ‘micro-fissures’) can be found [6].
(Darier disease) and transient acantholytic dermatosis               Besides the diagnosis remains essentially histological, RCM
(­Grover disease). A similar presentation, with a less evident       and LC-OCT can represent further tools for the non-­
umbilicated center, was seen in a younger patient (Figure 1,         invasive assessment of these lesions, allowing identifying
C and D) with comparable RCM (Figure 2B) and LC-OCT                  hyperkeratosis, acanthosis, and discohesive keratinocytes
(Figure 2E) images.                                                  that can guide to suggest a correct diagnosis, excluding
                                                                     other neoplastic or infective diseases that can present with

Conclusions                                                          papules. To validate these non‐invasive imaging techniques
                                                                     for the differential diagnosis of warty dyskeratoma, further
Warty dyskeratoma is histologically characterized by                 studies with a wider sample of patients are needed, to avoid
parakeratotic hyperkeratosis, acantholytic dyskeratosis              useless biopsies for benign tumors that can be removed
at all levels of the epidermis, and focal suprabasal clefts.         with less invasive surgical techniques.




2                                                                         Research Letter | Dermatol Pract Concept. 2024;14(1):e2024062
                 Figure 2. (A,B) Medium refractive discohesive keratinocytes in the center of the lesion in e­ flectance confo-
                 cal microscopy; (C-E) Mild hyperkeratosis (double-headed green arrow) and acanthosis (­double-headed
                 white arrow), suprabasal epidermal clefting (red asterisk), and a central crateriform invagination in the
                 stratum corneum (single-headed yellow arrow) in Line-field confocal optical coherence tomography;
                 (F) Mild hyperkeratosis and acanthosis and suprabasal acantholysis and focal dyskeratosis in histolog-
                 ical examination. (A-E) They are images of two different warty dyskeratomas.




References                                                                    2022;36(12):e1066-e1067. DOI: 10.1111/jdv.18452. PMID:
                                                                              35855673.
 1. Goldenberg A, Lee RA, Cohen PR. Acantholytic dyskeratotic              4. Campoli M, Cortonesi G, Tognetti L, Rubegni P, Cinotti E.
    acanthoma: case report and review of the literature. Dermatol             Noninvasive imaging techniques for the diagnosis of cutaneous
    Pract Concept. 2014;4(3):25–30. DOI: 10.5826/dpc.0403a03.                 larva migrans. Skin Res Technol. 2022;28(2):374–376. C DOI:
    PMID: 25126453. PMCID: PMC4131993.                                        10.1111/srt.13126. PMID: 34923675. PMCID: PMC9907695.
 2. Orsini C, Cortonesi G, Lamberti A, Campoli M, Rubegni P,               5. Orsini C, Taddeucci P, Bertello M, et al. Line-field confocal optical
    Cinotti E. Optical Super-High Magnification Dermoscopy: a                 coherence tomography for the diagnosis of nodular scabies mimick-
    Complementary Means in the Diagnosis of Trombiculosis. Der-               ing breast cancer skin metastasis. Int J Dermatol. 2023;62(3):e195–
    matol Pract Concept. 2023;13(2):e2023074. DOI: 10.5826/                   e196. DOI: 10.1111/ijd.16457. PMID: 36250785.
    dpc.1302a74. PMID: 37196272. PMCID: PMC10188139.                       6. Giacomel J, Zalaudek I, Argenziano G. Dermatoscopy of Grover’s
 3. Cortonesi G, Rubegni P, Tognetti L, et al. Line-field confo-              disease and solitary acantholytic dyskeratoma shows a brown,
    cal optical coherence tomography imaging of human cow-                    star-like pattern. Australas J Dermatol. 2012;53(4):315–316.
    pox virus skin infection. J Eur Acad Dermatol Venereol.                   DOI: 10.1111/j.1440-0960.2012.00955.x. PMID: 23157785.




Research Letter | Dermatol Pract Concept. 2024;14(1):e2024062                                                                                   3
