10.5826/dpc.1304a231
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2160-9381
3253
en
Elisa Cinotti
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Non-invasive Imaging Techniques for the Diagnosis of Clear Cell Acanthomas: Dermoscopy, Reflectance Confocal Microscopy and Line-Field Confocal Optical Coherence Tomography
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Letter to the Editor
2023-10-31
2023-02-15
2023-10-31
2024-01-15
e2023231
Dermatol Pract Concept
Elisa Cinotti
2023/10/31
10.5826/dpc.1304a231
e2023231
Dermatology Section, Department of Medical, Surgical, and Neurological Sciences, Santa Maria Alle Scotte Hospital, Siena, Italy
2160-9381
en
e2023231
Orsini C, Taddeucci P, Bertello M, Cinotti E, Cortonesi G, Rubegni P, et al. Line‐field confocal optical coherence tomography for the diagnosis of nodular scabies mimicking breast cancer skin metastasis. Int J Dermatol. 2022 Oct 17;ijd.16457.
Non-invasive Imaging Techniques for the Diagnosis of Clear Cell Acanthomas: Dermoscopy, Reflectance Confocal Microscopy and Line-Field Confocal Optical Coherence Tomography
https://dpcj.org/index.php/dpc/article/download/3253/2354
Non-invasive Imaging Techniques for the Diagnosis
of Clear Cell Acanthomas: Dermoscopy, Reflectance
   Confocal Microscopy and Line-Field Confocal
          Optical Coherence Tomography
      Giulio Cortonesi1, Carolina Donelli1, Pietro Rubegni1, Clelia Miracco2, Elisa Cinotti1


1 Dermatology Section, Department of Medical, Surgical, and Neurological Sciences, Santa Maria Alle Scotte Hospital, Siena, Italy
2 Pathology Section, Department of Medical, Surgical, and Neurological Sciences, Santa Maria Alle Scotte Hospital, Siena, Italy



Citation: Cortonesi G, Donelli C, Rubegni P, Miracco C, Cinotti E. Non-invasive Imaging Techniques for the Diagnosis of Clear Cell
Acanthomas: Dermoscopy, Reflectance Confocal Microscopy and Line-Field Confocal Optical Coherence Tomography. Dermatol Pract
Concept. 2023;13(4):e2023231. DOI: https://doi.org/10.5826/dpc.1304a231
Accepted: April 20, 2023; Published: October 2023
Copyright: ©2023 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
Email: carolina.donelli@gmail.com




Dear Editor,                                                             lichenoid keratosis, inflamed seborrheic keratosis, and psori-
                                                                         asis [4]. For that reason, noninvasive imaging techniques are
    Clear cell acanthoma (CCA) is a benign tumor with vari-              useful for a better evaluation to avoid excisional biopsy for
able clinical morphology that is usually recognized by its               histopathological examination. Reflectance confocal micros-
histopathological features [1]. The primary lesion is a red              copy (RCM) at the spinous layer level shows a well-defined
papule, in general well-demarcated, shiny erythematous- to               papular lesion edged by a highly refractile collarette structure
brown-colored, and flattened with minimal scaling [2]. On                and, at the dermal-epidermal junction level shows the tips of
polarized dermoscopy, there are multiple coiled vessels in a             the dermal papillae as large, dark, irregular space. Blood ves-
serpiginous arrangement, as well as curved polarizing-specific           sels are seen as convoluted, black luminal or tubular struc-
white lines that are parallel to the serpiginous arrangement of          tures located at the level of the papillary dermis and filled by
said vessels. The white lines are not present on non-polarized           variably reflecting moving cells [5]. RCM was successfully
dermoscopy [3]. Glomerular blood vessels and red clods in                used to have differential diagnoses between CCAs and neo-
a reticular and curvilinear pattern, resembling a pearl neck-            plastic or infective diseases but there are no reports in the
lace, with combined thin and thick white intersecting lines              literature that describe line-field confocal optical coherence
are typical clues for the diagnosis. The primary clinical and            tomography (LC-OCT) images of clear cell acanthomas [6].
pathological differential diagnoses that must be considered              In this paper, we describe a series of seven CCAs studied with
include eccrine poroma, basal cell carcinoma, squamous                   dermoscopy, RCM and LC-OCT. The clinical presentation
cell carcinoma, amelanotic melanoma, pyogenic granuloma,                 was very typical: a pinkish roundish papule (Figure 1A)


Letter to the Editor | Dermatol Pract Concept. 2023;13(4):e2023231                                                                      1
                           Figure 1. (A) Clinical, (B) Dermoscopic, (C, D) Reflectance confocal microscopy
                           (E, F), Line-field confocal optical coherence tomography, and (G) ­Histological
                           examination (H&E, 20x) images of clear cell acanthoma.


with, in dermoscopy (­Figure 1B), multiple coiled vessels in        compact acanthosis that is sharply demarcated from the sur-
a serpiginous arrangement, resembling a pearl necklace.             rounding epidermis, papillomatosis of varying degrees, focal
RCM images were comparable with what was described in               parakeratosis and, in the dermis (Figure 1F) dilated vessels
the literature: convoluted structures located at the level of       and a polymorphous cellular infiltrate. All these images well
the papillary dermis, filled and surrounded by variably re-         correlated to the histopathological examination (H&E stain)
flecting moving cells (Figure 1, C and D). LC-OCT exam              (Figure 1G), allowing us to associate the lesions with a clear
showed, in the epidermis (Figure 1E) enlarged keratinocytes,        cell acanthoma. In conclusion, our preliminary results find



2                                                                    Letter to the Editor | Dermatol Pract Concept. 2023;13(4):e2023231
that most of the histological features of CCA can be visual-               2020;6(9):829–831. DOI: 10.1016/j.jdcr.2020.07.008. PMID:
ized on LC-OCT. Our findings suggest that LC-OCT may be                    32885010; PMCID: PMC7452362.
                                                                      4.   Cozzani E, Herzum A, Russo R, et al. Soft, Erythematous
useful for the non-invasive diagnosis of CCA, permitting it
                                                                           Nodule of the Ankle with a String of Pearls Vascular Pat-
to be distinguished from other neoplastic or infectious dis-
                                                                           tern: A Quiz. Acta Derm Venereol. 2020;100(17):adv00288.
eases [7,8]. LC-OCT may help decrease the need for surgical                DOI: 10.2340/00015555-3651. PMID: 32985678. PMCID:
excision to confirm the diagnosis of benign tumors, that can               PMC9274922.
be removed with less invasive surgical techniques. However,           5.   Ardigo M, Buffon RB, Scope A, et al. Comparing In Vivo Re-
further studies with a larger number of cases are necessary to             flectance Confocal Microscopy, Dermoscopy, and Histology of
                                                                           Clear-Cell Acanthoma. Dermatol Surg. 2009;35(6):952–959.
demonstrate the diagnostic utility of LC-OCT in the clinical
                                                                           DOI: 10.1111/j.1524-4725.2009.01162.x. PMID: 19397663.
setting.
                                                                      6.   Campoli M, Cortonesi G, Tognetti L, Rubegni P, Cinotti E. Non-
                                                                           invasive imaging techniques for the diagnosis of cutaneous larva

References                                                                 migrans. Skin Res Technol. 2022;28(2):374–376. DOI: 10.1111
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Letter to the Editor | Dermatol Pract Concept. 2023;13(4):e2023231                                                                         3
