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4676-MD
CORRESPONDENCE
IN C ER O V P A Y R M IG E H DI T C ® A
Dermoscopy of sebaceous carcinoma: an unusual image cutaneous malignancies.1 Its location is mainly periocular; 75% of all SC can be found in that area.2 SC can be associated with visceral neoplasms in Muir-Torre syndrome, an autosomal dominant genetic syndrome, with variable expression and high penetrance. It corresponds to the association of at least one sebaceous neoplasm and an internal malignancy, or the association of multiple keratoacanthomas, internal malignancies and a family history of Muir-Torre syndrome. Visceral malignancies may include colorectal, genitourinary, breast, and upper gastrointestinal carcinomas. Muir-Torre syndrome is related to germline mutations in DNA mismatch repair genes, such as MSH-2, MHL-1 and MSH-6.3 SC can appear as a small, slowly growing, firm, deepseated yellow or red nodule,2 but its clinical presentation is highly variable. Histologically consists of well-circumscribed lobules of cells with foamy eosinophilic cytoplasm and severe atypia. Nuclear pleomorphism and high mitotic activity are also present.1 It can be mistaken as basall cell carcinoma with sebaceous differentiation, sebaceous adeno-
M
TO THE EDITOR: A healthy 35-year-old man presented with a 2 cm verrucous red-orange plaque on his back, which had been there for 3 years (Figure 1). On dermoscopy, ulcerated areas and telangectasias over a white-yellow background were seen (Figure 2). Biopsy informed infiltrating, poorly differentiated sebaceous carcinoma with 1 mm free-margins. We performed wide excision and sentinel lymph node biopsy, both with negative results. We also performed a thorax, abdomen, and pelvis CT scan and colonoscopy as screening of concurrent neoplasm, all which resulted normal. Another patient, a 63-year-old woman, visited us complaining for a 4 mm yellow papule on her left eyebrow (Figure 3), which had been there for 10 years. On dermoscopy, multiple telangectasias over yellow globules were observed (Figure 4). Histopathology of the lesion showed infiltrating, moderately differentiated sebaceous carcinoma, and widening of margins was performed. Sebaceous carcinoma (SC) is a malignant tumor, derived from sebaceous glands epithelium. The median age at diagnosis is 70 years.¹ It represents 0.2% to 4.6% of all
Figure 1.—A 2 cm verrucous red-orange plaque on the back of the first case.
Vol. 150 - No. 2
Figure 2.—Ulcerated areas and telangectasias over white-yellow background in our first case dermoscopy.
GIORNALE ITALIANO DI DERMATOLOGIA E VENEREOLOGIA
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IN C ER O V P A Y R M IG E H DI T C ® A
Figure 3.—Yellow papule on the left eyebrow of the second case.
ma, sebaceous epithelioma, squamous cell carcinoma, other poorly differentiated adnexal tumours, prostate or renal cell carcinoma metastasis, clear-cell eccrine hidradenocarcinoma and clear cell sarcoma.2 It has been estimated a histologic misdiagnosis of 20% to 50% of cases,4 and a mean delay from onset until diagnosis of 1 to 2.9 years. Misdiagnosis and delay imply a risk of local invasion and metastasis, for SC and for a possible associated visceral neoplasm. As clinical and histopathological study can be equivocal, dermoscopy could have an important role in SC diagnosis. There is scarce literature about dermoscopy of non pigmented skin tumors. Specifically on dermoscopy of SC, we found just one article,5 with extraocular SC, where yellow and milky red tumors with polymorphic vessels and ulcerated areas are described. The difference with a benign sebaceous lesion is the vascular pattern, which is regular in sebaceous hyperplasia and sebaceous adenoma, but irregular and widely distributed in SC. Then, the key to differentiate SC from other cutaneous carcinomas would be the characteristic yellow background. To our knowledge, this is the second report about dermoscopy in SC. Dermoscopic features found in our patients are similar to those found in the previous report.5 As clinical and histopathological diagnosis can be challenging, dermoscopy can help to identify this neoplasia. The limitation for the use of dermoscopy in SC is the general lack of experience with dermoscopy of non pigmented skin tumors and scarcity of reports about dermoscopy in this neoplasm in particular.
M
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies (either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo, or other proprietary information of the Publisher.
CORRESPONDENCE
J. MANRÍQUEZ Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago Chile Email:
[email protected]
K. CATALDO-CERDA Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago Chile
2
Figure 4.—Multiple telangectasias over yellow globules in the dermoscopy in the second case.
S. ÁLVAREZ-VÉLIZ Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago Chile C. VERA-KELLET Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago Chile G ITAL DERMATOL VENEREOL 2015;150:626-8
References
1. Bassetto F, Baraziol R, Vicari M, Scarpa C, Montesco M. Biological behavior of the sebaceous carcinoma of the head. Dermatol Surg 2004;30:472-6. 2. Nelson BR, Hamlet KR, Gillard M, Railan D, Johnson TM. Sebaceous carcinoma. J Am Acad Dermatol 1995;33:1-15. 3. Abbas O, Mahalingam M. Cutaneous sebaceous neoplasms as markers of Muir-Torre syndrome: a diagnostic algorithm. J Cutan Pathol 2009:36:613-9. 4. Doxanas MT, Green WR. Sebaceous gland carcinoma: review of 40 cases. Arch Ophthalmol 1984;102:245-9. 5. Coates D, Bowling J, Haskett M. Dermoscopic features of extraocular sebaceous carcinoma. Aust J Dermatol 2011;52:212-3.
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