Cases for Diagnosis
Pigmented Vascular Tumoral Lesion on the Upper Back
Lesión tumoral pigmentada y vascular en dorso alto
Unidad de cirugía dermatológica, Departamento de Dermatología Hospital de Clínicas “Dr. Manuel Quintela”, Universidad de la República, Montevideo, Uruguay
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Della Santa, J. Magliano" "autores" => array:2 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Della Santa" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Magliano" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731021004397?idApp=UINPBA000044" "url" => "/00017310/0000011300000008/v1_202208290519/S0001731021004397/v1_202208290519/es/main.assets" ] ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Cases for Diagnosis</span>" "titulo" => " Pigmented Vascular Tumoral Lesion on the Upper Back" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T813" "paginaFinal" => "T814" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R.D. Santa, J. Magliano" "autores" => array:2 [ 0 => array:4 [ "nombre" => "R.D." "apellidos" => "Santa" "email" => array:1 [ 0 => "rodrigodellasanta@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Magliano" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de cirugía dermatológica, Departamento de Dermatología Hospital de Clínicas “Dr. Manuel Quintela”, Universidad de la República, Montevideo, Uruguay" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesión tumoral pigmentada y vascular en dorso alto" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 500 "Ancho" => 376 "Tamanyo" => 37274 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy of the lesion.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 77-year-old man with a history of high blood pressure and ischemic heart disease was seen for a tumor located in the upper third of the back (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a tumor (1.2<span class="elsevierStyleHsp" style=""></span>cm in diameter) consisting of 2 well-differentiated elements: a tumor nodule with a pearly sheen and telangiectasias; and a dark brown pigmented macule. Dermoscopy showed arborescent telangiectasias, gray-brown globules, and crystalline structures in the nodule, and an atypical reticular pattern with thick lines in the macule (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The lesion was situated on intensely photodamaged skin, on which solar lentigines, actinic keratoses, and solar elastosis were evident. The clinical differential diagnosis included basal cell carcinoma (BCC) and melanoma. The lesion was resected.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathology revealed 2 contiguous, non-overlapping lesions (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The first was a basophilic dermal tumor lesion continuous with the epithelium, compromising the upper dermis, consisting of nodular nests of cells with a high nucleus to cytoplasm ratio, forming peripheral palisades and retraction clefts in the stroma (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B).</p><p id="par0025" class="elsevierStylePara elsevierViewall">The second was an atypical, intraepidermal, irregular melanocytic lesion, with melanocytes grouped into thecae of varying sizes. Anisocytosis and anisokaryosis, large hyperchromatic nuclei, and irregularly distributed melanin pigment were also observed. In addition, isolated melanocytes had migrated into the upper layers of the epidermis. Neither atypical mitoses nor skin invasion were observed (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>C).</p><p id="par0030" class="elsevierStylePara elsevierViewall">What is Your Diagnosis?</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Collision tumor consisting of a nodular BCC and a lentigo maligna (LM).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Resection margins were extended to 5<span class="elsevierStyleHsp" style=""></span>mm, and no residual tumor was detected in the analyzed sample.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comments</span><p id="par0045" class="elsevierStylePara elsevierViewall">BCC can coexist with other skin lesions, but collision of BCC with melanoma is rare. BCC most commonly co-occurs with benign melanocytic lesions, seborrheic keratosis, and neurofibroma, and a few cases of BCC colliding with melanoma have been reported.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">LM melanoma and BCC are 2 distinct tumors that classically develop in the elderly and on sun-exposed skin. Since the formation of both tumors is promoted by changes caused by sun damage, their development in the same site, although unusual, can be easily explained.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Dermoscopic diagnosis of BCC is based on specific, well-described criteria. These include arborescent vessels, superficial fine telangiectasias, blue-gray nests, blue-gray dots and globules, focused dots, maple leaf-like areas, cart wheel structures, concentric structures, ulceration, multiple small erosions, bright red unstructured areas, and whitish structures.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In our patient we observed thick arborescent telangiectasias and gray-brown globules.</p><p id="par0060" class="elsevierStylePara elsevierViewall">LM manifests as a slow-growing pigmented macule in areas of chronic sun exposure, as in the present case. It is characterized by morphological asymmetry and pigmentation. Dermoscopy of extrafacial LM reveals superficial spreading melanoma patterns, including asymmetric structures, dots/globules, and pseudopods, combined with LM dermoscopic findings such as rhomboid structures and asymmetric perifollicular pigmentation.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Treatment of mixed tumors is carried out according to the guidelines recommended for individual tumors, depending on which tumor has the worst prognosis.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comments" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 500 "Ancho" => 375 "Tamanyo" => 50019 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical image.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 500 "Ancho" => 376 "Tamanyo" => 37274 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy of the lesion.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 500 "Ancho" => 474 "Tamanyo" => 95035 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathological study. A, Image showing tumor collision. B, Basal cell carcinoma. C, Lentigo maligna melanoma.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Collision tumor of cutaneous malignant melanoma and basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Hirakawa" 1 => "H. Miki" 2 => "S. Kobayashi" 3 => "Y. Nomura" 4 => "M. Ohmori" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0344-0338(98)80102-7" "Revista" => array:6 [ "tituloSerie" => "Pathol Res Pract" "fecha" => "1998" "volumen" => "194" "paginaInicial" => "649" "paginaFinal" => "653" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9793966" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A collision tumor involving Basal cell carcinoma and lentigo maligna melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Belisle" 1 => "M.S. Gautier" 2 => "F. Ghozali" 3 => "F. Plantier" 4 => "J. Wechsler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.dad.0000164603.49026.6a" "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "2005" "volumen" => "27" "paginaInicial" => "319" "paginaFinal" => "321" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16121053" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopy in the diagnosis and management of basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Lallas" 1 => "Z. Apalla" 2 => "D. Ioannides" 3 => "G. Argenziano" 4 => "F. Castagnetti" 5 => "E. Moscarella" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2217/fon.15.193" "Revista" => array:6 [ "tituloSerie" => "Future Oncol" "fecha" => "2015" "volumen" => "11" "paginaInicial" => "2975" "paginaFinal" => "2984" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26450622" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Melanoma characteristics at diagnosis from the Spanish National Cutaneous Melanoma Registry: 15 years of experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Ríos" 1 => "E. Nagore" 2 => "J.L. López" 3 => "P. Redondo" 4 => "R.M. Martí" 5 => "R. Fernández-de-Misa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2013.02.003" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2013" "volumen" => "104" "paginaInicial" => "789" "paginaFinal" => "799" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23622931" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Maligner Kollisionstumor der Haut: Melanom, kutanes Plattenepithelkarzinom und Basalzellkarzinom" "tituloTraducido" => "Malignant collision tumor of the skin: Melanoma, squamous cell carcinoma and basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Sterz" 1 => "M. Kendler" 2 => "J.C. Simon" 3 => "M. Ziemer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00292-019-0622-3" "Revista" => array:6 [ "tituloSerie" => "Pathologe" "fecha" => "2019" "volumen" => "40" "paginaInicial" => "534" "paginaFinal" => "538" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31168637" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011300000008/v1_202208290519/S000173102200610X/v1_202208290519/en/main.assets" "Apartado" => array:4 [ "identificador" => "6149" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Casos para el diagnóstico" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011300000008/v1_202208290519/S000173102200610X/v1_202208290519/en/main.pdf?idApp=UINPBA000044&text.app=https://www.actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173102200610X?idApp=UINPBA000044" ]
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