Poroma

From dermoscopedia

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 Editor: Ofer Reiter

 Author(s): Ofer Reiter     ·  Mike Marchetti     ·  Christina Kemanetzi
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Description Poromas are uncommon, benignis any condition that is harmless in the long run sweat gland tumors that are clinically and dermoscopically challenging to diagnose. Dermoscopic features associated with poromaThis glossary term has not yet been described. include branched vesselsarborizing vessels Bright red sharply in focus large or thick diameter vessels dividing into smaller vessels BCC with rounded endings, white interlacing areas around vesselsThis glossary term has not yet been described., yellow structureless areas, and milky-red globulesThis glossary term has not yet been described..
Author(s) Ofer Reiter · Mike Marchetti · Christina Kemanetzi
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Status update September 5, 2018
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Summary

Poromas are uncommon, benign sweat gland tumors that are clinically and dermoscopically challenging to diagnose. Dermoscopic features associated with poroma include branched vessels with rounded endings, white interlacing areas around vessels, yellow structureless areas, and milky-red globules.

Introduction and clinical features

Poromas are uncommon benign tumors that are derived from the ducts of eccrine or apocrine sweat glands. They are often located on the volar surfaces of the hands or feet but can be found on any location of the body. Poromas usually present as a red to pink papule, nodule, or plaque. Other clinical features include an indented moat with collarette scale surrounding the lesion and a tendency to bleed with minor traumaThis glossary term has not yet been described. [1][2].

Dermoscopic features

In a study conducted by the International 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. Society [1], 113 poromas from sixteen contributors were examined dermoscopically and compared to 106 clinically matched control lesions. The features found to be most useful for the 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 of poroma included branched vessels with rounded endings (30.1%), white interlacing areas around vessels (23%), yellow structureless areas (31.9%), and milky-red globules (19.5%). Additional findings that were common but not specific for poromas included: polymorphous vesselsmultiple types of vessels are present may indicate malignancy in appropriate context for example in flat melanocytic lesions (36.3%), blood spots (37.2%), erosions/ulcers (25.7%), and milky-red areas (17.7%).

Branched vesselsarborizing vessels Bright red sharply in focus large or thick diameter vessels dividing into smaller vessels BCC with rounded endings:

POROMA vessels.JPG

White interlacing areas around vessels:

POROMA white interlacing.JPG

Yellow structureless areas:

POROMA yellow structureless.JPG

Dermoscopic patternsThis glossary term has not yet been described.

Four dermoscopic patterns were described for poromas:

Pattern 1 - Appears most commonly on hands and feet and includes branched vessels with rounded endings, collarette of scale, blood spots, yellow structureless areas, milky-red globules and milky-red areas.

Pattern 2 – Appears on the trunk or non-acralPertaining to peripheral body parts, especially hands, feet, fingers, and toes. extremities and includes polymorphous vessels, white interlacing areas around vessels, and branched vessels with rounded endings.

Pattern 3 – Appears anywhere on the skin surface as a relatively small papule and is either without vessels or with branched vessels with rounded endings. Clinically, these lesions simulated nodular basal cell carcinomaThis glossary term has not yet been described. but dermoscopically they did not have BCCAbbreviation for Basal Cell Carcinoma-specific features.

Pattern 4 - Appears anywhere on the skin surface as a relatively large keratotic plaque that is pigmented in up to a third of cases. It frequently exhibited blood spots, keratin/scale, and atypical hairpin vessels.

Differential diagnosis

In the aforementioned study, numerous clinical and/or dermoscopic differential diagnoses were considered for poromas, including: melanomaThis glossary term has not yet been described., squamous cell carcinomaThis glossary term has not yet been described., basal cell carcinomais the most common skin cancer, and one of the most common cancers in the United States.[1] While BCC has a very low metastatic risk, this tumor can cause significant disfigurement by invading surrounding tissues, seborrheic keratosisThis glossary term has not yet been described., nevusThis glossary term has not yet been described., skin metastasis, pyogenic granulomaThis glossary term has not yet been described., verruca, collision tumor, 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., among othersThis glossary term has not yet been described.This glossary term has not yet been described.. OthersThis glossary term has not yet been described.This glossary term has not yet been described. have similarly reported that the dermoscopic features of poromas can mimic those found in pyogenic granuloma, angiomaAngiomas are benign tumors derived from cells of the vascular or lymphatic vessel walls (endothelium) or derived from cells of the tissues surrounding these vessels.[1][2] Angiomas are a frequent occurrence as patients age, but they might be an indicator of systemic problems such as liver disease. They are not commonly associated with malignancy., seborrheic keratosis, dermatofibroma, nevus, squamous cell carcinoma, basal cell carcinoma, and melanoma [1][3][4][5][6].



ReferencesThis is material contained in a footnote or bibliography holding further information.
  1. 1.01.11.2 Marchetti et al.: Dermoscopic features and patterns of poromas: a multicentre observational case-control study conducted by the International Dermoscopy Society. J Eur Acad Dermatol Venereol 2017;. PMID: 29194789. DOI.
  2. Ferrari et al.: Eccrine poroma: a clinical-dermoscopic study of sevenThis glossary term has not yet been described. cases. Acta Derm. Venereol. 2009;89:160-4. PMID: 19326001. DOI.
  3. Lallas et al.: Eccrine poroma: the great dermoscopic imitator. J Eur Acad Dermatol Venereol 2016;30:e61-e63. PMID: 26333195. DOI.
  4. Bombonato et al.: Pigmented eccrine poroma: dermoscopic and confocal features. Dermatol Pract Concept 2016;6:59-62. PMID: 27648386. DOI.
  5. Espinosa et al.: Dermoscopy of non-pigmentedThis glossary term has not yet been described. eccrine poromas: study of Mexican cases. Dermatol Pract Concept 2013;3:25-8. PMID: 23785633. DOI.
  6. Minagawa & Koga: Dermoscopy of pigmented poromas. Dermatology (Basel) 2010;221:78-83. PMID: 20516657. DOI.