Clear Cell acanthoma

From dermoscopedia

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Also known as "Acanthome cellules claires of Degos and Civatte", "Degos acanthoma," and "Pale cell acanthoma", clear cell acanthoma(also known as "Acanthome cellules claires of Degos and Civatte," "Degos acanthoma," and "Pale cell acanthoma") is a benign clinical and histological lesion initially described as neoplastic, which some authors now regard as a reactive dermatosis. It usually presents as a moist solitary firm, brown-red, well-circumscribed, 5 mm to 2 cm nodule or plaque on the lower extremities of middle-aged to elderly individuals The lesion has a crusted, scaly peripheral collarette and vascular puncta on the surface. It is characterized by slow growth, and may persist for years. The clinical differential diagnosis includes: dermatofibroma, inflamed seborrheic keratosis, pyogenic granuloma, basal cell carcinoma, squamous cell carcinoma, verruca vulgaris, psoriatic plaque, and melanoma. is a benign clinical and histological lesion initially described as neoplastic, which some authors now regard to as a reactive dermatosis. It usually presents as a moist solitary firm, brown-red, well-circumscribed, 5 mm to 2 cm nodule or plaque on the lower extremities of middle-aged to elderly individuals. The lesion has a crusted, scaly peripheral collarette and vascular puncta on the surface. It is characterized by slow growth, and may persist for years [1].


'String of pearlsCoiled or dotted vessels arranged in lines clear cell acanthoma'

Even though clear cell acanthoma has a non-specific clinical appearance, it has a relatively specific and easy to recognize dermoscopic feature called 'string of pearlsCoiled or dotted vessels arranged in lines clear cell acanthoma', referring to dotted vesselstiny pinpoint vessels that are arranged in a linear of serpiginous pattern [2]. The linear formations tend to coalesce into a reticular patternA lesion with a reticular pattern has typical pigment network throughout the entire lesion., covering whole or part of the lesion [1].

The 'string of pearls' sign was found to be related to angio-eccrine hyperplasia and vascular hyperplasia of the papillary dermis, corresponding to the cappilaries oriented perpendicular within the elongated dermal papillae [3].

Clear cell acanthoma.jpg

Additional dermoscopic features[1]

  • Pale pink background (90% of cases)
  • Shiny white lines (60% of cases)
  • Glomerular vesselsThis glossary term has not yet been described. (55% of cases)
  • Collarette of translucent scale around the periphery of the lesion (40% of cases)
  • Haemorrhagic areas (35% of cases)
  • Orange crusts (15% of cases)

CP (5).JPG

Differential diagnosisis the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines with variations in the use of logic, analytics, and experience to determine "cause and effect". In systems engineering and computer science, it is typically used to determine the causes of symptoms, mitigations, and solutions

The clinical differential diagnosis includes: dermatofibromaDermatofibromas are hard solitary slow-growing papules (rounded bumps) that may appear in a variety of colours, usually brownish to tan; they are often elevated or pedunculated. A dermatofibroma is associated with the dimple sign; by applying lateral pressure, there is a central depression of the dermatofibroma., inflamed seborrheic keratosisThis glossary term has not yet been described., pyogenic granulomaThis glossary term has not yet been described., actinic keratosisActinic keratosis (also called solar keratosis and senile keratosis; abbreviated as AK) is a pre-cancerous patch of thick, scaly, or crusty skin., basal cell and squamous cell carcinomaThis glossary term has not yet been described., verruca vulgaris, psoriatic plaque, eccrine poromaThis glossary term has not yet been described., clear cell hidradenoma and melanomaThis glossary term has not yet been described. [4].

In a recent report it was demonstrated that the 'string of pearls' sign can be seen with other epidermal lesions, as two seborrheic keratosesThis glossary term has not yet been described. and one lichen planusThis glossary term has not yet been described.-like keratosis presented with the classic 'string of pearls' sign. [5]


ReferencesThis is material contained in a footnote or bibliography holding further information.
  1. 1.01.11.2 Lyons et al.: Dermoscopic features of clear cell acanthoma: five new cases and a review of existing published cases. Australas. J. Dermatol. 2015;56:206-11. PMID: 25495637. DOI.
  2. Tiodorovic-Zivkovic et al.: DermoscopyThe examination of [skin lesions] with a 'dermatoscope'. This traditionally consists of a magnifier (typically x10), a non-polarised light source, a transparent plate and a liquid medium between the instrument and the skin, and allows inspection of skin lesions unobstructed by skin surface reflections. Modern dermatoscopes dispense with the use of liquid medium and instead use polarised light to cancel out skin surface reflections. of clear cell acanthoma. J. Am. Acad. Dermatol. 2015;72:S47-9. PMID: 25500041. DOI.
  3. Paolino et al.: Clinicopathological and dermoscopic features of angio-eccrine hyperplasia in clear cell acanthoma. J. Am. Acad. Dermatol. 2016;74:1259-1261.e3. PMID: 27185430. DOI.
  4. Tiodorovic-Zivkovic et al.: Dermoscopy of clear cell acanthoma. J. Am. Acad. Dermatol. 2015;72:S47-9. PMID: 25500041. DOI.
  5. Espinosa et al.: "String of pearls pattern": report of three cases of non clear-cell acanthoma. An Bras Dermatol 2017;92:142-144. PMID: 29267474. DOI.