Streaks in pigmented squamous cell carcinoma in situ

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Clinical presentation

A woman in her 70s with a personal history of nonmelanoma skin cancer presented for skin cancer surveillance examination. On her left mid-back, a new 1-cm brown, scaly plaque with irregular borders was seen (Fig 1).

Dermoscopic appearance

Dermoscopy revealed focal streaks at the periphery and within the borders of the lesion (Fig 2). The streaklike projections did not converge toward the geometric center of the lesion as seen in melanocytic lesions, nor did they connect to a common base to form a leaflike structure as is seen in pigmented basal cell carcinoma (BCC). Scattered brown dots, some aligned linearly, were also present.

Histologic diagnosis

Histopathologic examination revealed acanthosis, hyperkeratosis, and full-thickness keratinocyte atypia without dermal invasion (Fig 3). Abundant melanin was present along the basal layer. These features were diagnostic of a pigmented squamous cell carcinoma in situ.

Key message

While the dermoscopic presence of streaks (radial lines) is highly specific for melanocytic neoplasms, similar structures can occasionally be seen in BCC, seborrheic keratoses, and pigmented Bowen disease.1, 2 Streaks in

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Publication of this article was supported by 3Gen.

Funding sources: None.

Conflicts of interest: None declared.

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