10.5826/dpc.1201a03
text/xml
2160-9381
1720
en
Nicola Di Meo
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
hyperkeratosis
Dermoscopic Features of Nevoid Hyperkeratosis of the Nipple and Areola
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-02-02
2021-03-14
2022-02-02
2022-02-09
e2022003
Dermatol Pract Concept
Nicola Di Meo
2022/02/02
10.5826/dpc.1201a03
e2022003
Dermatology Clinic, University of Trieste, Maggiore Hospital, Piazza dell’Ospitale 1, Trieste, Italy
2160-9381
hyperkeratosis
en
e2022003
Mazzella C, Costa C, Fabbrocini G, et al. Nevoid hyperkeratosis of the nipple mimicking a pigmented basal cell carcinoma. JAAD Case Rep. 2016;2(6):500-501. DOI: 10.1016/j.jdcr.2016.09.007. PMID: 28004028; PMCID: PMC5161776.
Dermoscopic Features of Nevoid Hyperkeratosis of the Nipple and Areola
https://dpcj.org/index.php/dpc/article/download/1720/1459
                    Dermatology Practical & Conceptual


     Dermoscopic Features of Nevoid Hyperkeratosis
               of the Nipple and Areola
       Conforti Claudio1, Dri Arianna1, Giuffrida Roberta2, Zalaudek Iris1, di Meo Nicola1


1 Dermatology Clinic, University of Trieste, Maggiore Hospital, Piazza dell’Ospitale 1, Trieste, Italy
2 Experimental Dermatology Section, Division of Dermatology, University of Messina, Messina, Italy



Key words: nevoid hyperkeratosis of the nipple and areola, asymptomatic plaques, hyperpigmented plaque, hyperkeratosis
Citation: Conforti C, Dri A, Giuffrida R, Zalaudek I, di Meo N. Dermoscopic features of nevoid hyperkeratosis of the nipple and areola.
Dermatol Pract Concept. 2022;12(1):e2022003. DOI: https://doi.org/10.5826/dpc.1201a03
Accepted: April 11, 2021; Published: January 2022
Copyright: ©2022 Conforti 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: Claudio Conforti, MD, Dermatology Clinic, University of Trieste, Trieste, Italy.
E-mail: claudioconforti@yahoo.com




Introduction                                                              atic, and the patient denied pain, pruritus or discharge. She
                                                                          was otherwise healthy, and breast examination and general
Nevoid hyperkeratosis of the nipple and areola (NHNA)                     physical examination were negative. Hair, nails, and mucosal
is a rare benign condition characterized by verrucous, pig-               sites were normal. The patient was not on medication, and
mented, and asymptomatic plaques involving the nipples and                she was not pregnant.
areolas. Only a few cases have been reported in literature                    Dermoscopic evaluation (×20, DermLite) showed the
since this entity was firstly described in 1923. The etiology             presence of a homogeneous brown network with some
is still unknown, but it is hypothesized that it occurs in cor-           hyperkeratotic areas showing yellow-brown scales (Figure 2,
relation with hormonal changes because it is more frequent                A and B). These dermoscopic findings are in accordance with
in women during childbearing age, and it worsens during                   other previous cases of NHNA, and the diagnosis was later
pregnancy.                                                                confirmed performing a biopsy.


Case Presentation                                                         Discussion and Conclusions
We present the case of a 27-year-old Caucasian woman                      Cinotti et al reported that at dermoscopic examination the
referred in for consultation to our skin cancer department                NHNA showed a papillomatous surface with pink homoge-
with a 9-month history of a lesion involving the right nipple             nous areas, whitish desquamation, red dots, and erosions [1].
and the areola. Examination revealed a hyperpigmented                     Mazzella et al reported a peculiar case of NHNA resembling
plaque of about 35 mm in diameter and with well-defined                   a pigmented basal cell carcinoma with multiple blue-gray
borders (Figure 1B). The lesion was completely asymptom-                  globules and leaf-like areas [2].




Research Letter | Dermatol Pract Concept. 2022;12(1):e2022003                                                                             1
Figure 1. Clinical appearance of the nipples and areolas of a 27-year-old woman. (A) left nipple. (B) right nipple. On the right side a pigmented
and asymptomatic plaque involving nipple and areola is showed.




Figure 2. Dermoscopic evaluation (DermLite, 3Gen) (magnification x 20). (A) homogeneous brown network with diffuse hyperkeratotic areas showing
yellow-brown scales (black arrows). (B) a blue structureless area (black asterisk).




    In the past, skin biopsy was certainly the most accurate                  All the above pathologies can be diagnosed well with
way to make a diagnosis of NHNA, but it could create a scar               dermoscopy, and for this reason our case underlines the impor-
in a delicate and intimate area. Histopathological examina-               tance of a dermoscopic evaluation of hyperpigmented or non-
tion of NHNA can show variable findings such as acanthosis,               pigmented lesions of the areola and nipple to reduce excision
hyperkeratosis, papillomatosis, keratin plugging, perivascular            rate and increase diagnostic accuracy of special-site lesions.
infiltrates of CD41 lymphocytes, melanophages and plasma
cells in the superficial dermis, and hyperpigmentation of                 Informed consent: Written informed consent for publication
the basal layer and dermal fibrosis [1]. Although the histo-              of her clinical details and clinical images was obtained from
pathological examination remains the gold standard for the                the patient.
diagnosis, sometimes the patient does not accept this option.
Dermoscopy offers the possibility of making a correct diag-
                                                                          References
nosis without resorting to incisional biopsy, even if standard
dermoscopic diagnostic criteria have not been defined yet.                 1. Cinotti E, Provvidenziale L, Miracco C, Rubegni P. Treatment
The role of dermoscopy is certainly crucial for the differential              of nevoid hyperkeratosis of the areola and nipple with topical
                                                                              tacalcitol: A case report. Dermatol Ther. 2018;31(4):e12602.
diagnosis of areola and nipple lesions, which include sebor-
                                                                              DOI: 10.1111/dth.12602. PMID: 29624812.
rheic keratosis, acanthosis nigricans, Darier disease, epider-
                                                                           2. Mazzella C, Costa C, Fabbrocini G, et al. Nevoid hyperkeratosis
mal nevus, basal cell carcinoma, Bowen disease, Paget disease,                of the nipple mimicking a pigmented basal cell carcinoma. JAAD
contact allergic dermatitis, chronic eczema, dermatophytosis,                 Case Rep. 2016;2(6):500-501. DOI: 10.1016/j.jdcr.2016.09.007.
mycosis fungoides, and reticulate papillomatosis.                             PMID: 28004028; PMCID: PMC5161776.



2                                                                              Research Letter | Dermatol Pract Concept. 2022;12(1):e2022003
