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| LETTER TO EDITOR |
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| Year : 2017 | Volume
: 1
| Issue : 2 | Page : 83-85 |
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Growth arising over a linear verrucous plaque: A rare clinical entity
Suvarna Samudrala, M Ramesh Bhat
Department of Dermatology, Father Muller Medical College, Mangalore, Karnataka, India
| Date of Web Publication | 28-Jul-2017 |
Correspondence Address:
Suvarna Samudrala
Department of Dermatology, Father Muller Medical College, Mangalore - 575 002, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/CDR.CDR_5_17
How to cite this article:
Samudrala S, Bhat M R. Growth arising over a linear verrucous plaque: A rare clinical entity. Clin Dermatol Rev 2017;1:83-5 |
Sir,
Epidermal nevi are asymptomatic lesions present since birth or appearing within the 1st year of life. They are usually stable and do not require any treatment.[1] However, reports of benign and malignant changes occurring over these lesions have been reported, such as psoriasis, keratoacanthoma, squamous cell carcinoma, and basal cell carcinoma.[2],[3],[4],[5],[6],[7] To the best of our knowledge, there have only been four case reports of keratoacanthoma developing over a preexisting epidermal nevus, and only one case from India.[1],[5],[6],[7]
A 47-year-old male presented with a single asymptomatic dark-raised lesion over the left forehead since birth. He developed an asymptomatic growth over this lesion for 6 months, which progressively increased to its present size. It was not associated with pain, oozing, bleeding, or ulceration. There was no history of recent change of color of the lesion. There was no history of preceding trauma. There was no family history of similar complaints. He had a history of taking treatment for pulmonary tuberculosis 5 years ago. Cutaneous examination showed a single, well-defined hyperpigmented plaque measuring about 4 cm × 3 cm with a verrucous surface over the left temple, above the lateral canthus. A single exophytic hyperpigmented growth was present over the inferior aspect of the above lesion [Figure 1]. Systemic examination did not reveal any abnormality. Blood and urine routine investigations were within normal limits. The lesions were removed by radiofrequency ablation. Histopathological examination of the plaque showed mild hyperkeratosis, irregular acanthosis, flat, broad papillomatosis, focal hypergranulosis, and increase in basal melanin pigment. Dermis showed congested ectatic blood vessels and dense perivascular and perifollicular lymphocytic infiltrate. These features were in favor of epidermal nevus [Figure 2] and [Figure 3]. The overlying growth on histopathological examination showed a large hyperkeratotic plug overlying multiple, discrete, dilated, and keratin-filled follicular infundibula, with irregular acanthotic growth from the base of the infundibula into the base of the epidermis. There was no evidence of dysplasia or malignancy. These features were consistent with keratoacanthoma [Figure 4] and [Figure 5]. Based on the above findings, a final diagnosis of keratoacanthoma overlying an epidermal nevus was made. | Figure 1: A single, well-defined hyperpigmented, verrucous plaque above the left lateral canthus, with an exophytic hyperpigmented growth over its inferior aspect
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 | Figure 2: Section of the plaque showing hyperkeratosis, irregular acanthosis, flat, broad papillomatosis, focal hypergranulosis, and increase in basal melanin pigment (H and E, ×10)
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 | Figure 3: Section showing numerous ectatic blood vessels in the dermis, along with perivascular and periadnexal infiltrate (H and E, ×10)
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 | Figure 4: Section of the growth showing a large, central hyperkeratotic plug overlying multiple discrete, dilated, keratin-filled follicular infundibula (H and E, ×10)
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 | Figure 5: Section of the growth showing irregular acanthotic epidermal downgrowth from the base of the dilated infundibula, along with numerous ectatic vessels in the dermis (H and E, ×10)
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Epidermal nevi are the most common type of keratinocytic nevi.[1] These are asymptomatic lesions present since birth or appearing within the 1st year of life.[2] Rarely, they may develop even in adolescence.[1] They may increase in size till adolescence, after which they usually remain stable. They do not require any treatment, except for cosmetic purposes, although they may rarely be complicated by secondary infection, maceration, or neoplastic changes.[1],[2] Recently, reports of benign and malignant changes occurring over these lesions have been noted, including the development of psoriasis, keratoacanthoma, squamous cell carcinoma, and basal cell carcinoma.[3],[4],[5],[6],[7] Malignant transformation is more likely to occur in the middle and elderly age groups.[2]
To the best of our knowledge, there have only been four case reports of keratoacanthoma developing over a preexisting epidermal nevus and only one case from India.[2],[6],[7],[8] We present the above case in view of the rarity of its occurrence.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
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| 2. | Kumar H, Kushwaha P, Kulkarni S, Ghorpade A. Keratoacanthoma arising in linear epidermal verrucous nevus. J Clin Exp Dermatol Res 2014;5:244. |
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| 4. | Horn MS, Sausker WF, Pierson DL. Basal cell epithelioma arising in a linear epidermal nevus. Arch Dermatol 1981;117:247. [ PUBMED] |
| 5. | Cramer SF, Mandel MA, Hauler R, Lever WF, Jenson AB. Squamous cell carcinoma arising in a linear epidermal nevus. Arch Dermatol 1981;117:222-4. [ PUBMED] |
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| 7. | Rosen T. Keratoacanthomas arising within a linear epidermal nevus. J Dermatol Surg Oncol 1982;8:878-80. [ PUBMED] |
| 8. | Nagai Y. Keratoacanthoma arising on epidermal nevus. Rinsho Derma 2002;44:133-4. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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