Collision lesions

From dermoscopedia

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Author(s) Andreas Blum · Rainer Hofmann · Florentia Dimitriou
Responsible author Andreas Blum→ send e-mail
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Status update July 5, 2018
Status by Ralph P. Braun


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Detectable by dermoscopy, Collision tumors/lesions of the skin can occur in all possible combinations of the different growths of the epidermal and/or dermal cell layers (Table 1 & Figure 1)[1].

  • They are associated with advancing age and cumulative UV-exposure[2].
  • Compared with combinations of epidermal-dermal collision tumors, epidermal-epidermal collision tumors are more likely to be found in older patients and on the head and neck areas. In addtion, Collision tumors with a basal cell carcinoma component are more common on the head and neck compared to collision tumors with a melanocytic component that are more common on the trunk[2].
  • Collision tumors pose a diagnostic challenge. To correctly diagnose any possible collision tumor/lesion, the dermoscopic analysis of colors and structures must be performed in all four "quadrants" of the inspected lesion[3].
  • Using both polarized and non-polarized dermoscopy may be helpful in the diagnosis of these lesions[4][5].



Table 1 - Skin lesions or tumors with their original cell types of the different skin layers (focused only on skin lesions detectable by dermoscopy).[2]


Layer of the Skin Cell Type or Functional Structure Associated Proliferations / Neoplasms
Epidermis Keratinocytes Solar lentigo

Seborrheic keratosis
Actinic keratosis
Bowen's disease
Keratoacanthoma
Squamous cell carcinoma

Basal cell layer (non-differentiated folliculo-sebaceous-apocrine germ) Trichoblastoma

Basal cell carcinoma

Melanocytes Melanocytic nevus

Melanoma

Merkel cells Merkel cell carcinoma
Dermis Blood capillaries Angioma
Melanocytes Melanocytic (dermal or blue) nevus

Melanoma

Fibroblasts Dermatofibroma

Dermatofibrosarcoma protuberans

Non-Langerhans cells/histiocystes Xanthogranuloma
Infundibulo-follicular-sebaceous unit Sebaceous hyperplasia

Milia cyst
Pilomatrixoma
Trichoepithelioma
Adnexal (benign or malignant) tumor

Myocytes Kaposi sarcoma







References:

  1. An Atlas of Dermoscopy, Second Edition. Marghoob A. et al. CRC Press; 2012.
  2. 2.02.12.2 Blum et al.: Collision skin lesions-results of a multicenter study of the International Dermoscopy Society (IDS). Dermatol Pract Concept 2017;7:51-62. PMID: 29230351. DOI.
  3. Braga et al.: Melanoma mimicking seborrheic keratosis: an error of perception precluding correct dermoscopic diagnosis. J. Am. Acad. Dermatol. 2008;58:875-80. PMID: 18328596. DOI.
  4. Kittler et al.: Standardization of terminology in dermoscopy/dermatoscopy: Results of the third consensus conference of the International Society of Dermoscopy. J. Am. Acad. Dermatol. 2016;74:1093-106. PMID: 26896294. DOI.
  5. Wang et al.: Differences in dermoscopic images from nonpolarized dermoscope and polarized dermoscope influence the diagnostic accuracy and confidence level: a pilot study. Dermatol Surg 2008;34:1389-95. PMID: 18637816. DOI.