Warty dyskeratoma
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Mugilan Poongkunran M.B.B.S [2]
Synonyms and keywords: Isolated dyskeratosis follicularis
Overview
Warty dyskeratoma (WD), is a benign[1] epidermal proliferation with distinctive histologic findings that may mimic invasive squamous cell carcinoma[2] and commonly manifests as an umbilicated (having a central mark or depression resembling a navel) lesion with a keratotic plug,[3]
Historical Perspective
Warty dyskeratoma was first described by Graham and Helwig as isolated Darier’s disease in 1954. This name, warty dyskeratoma was first coinedby Szymanski in 1957 after his review of the cases.
Causes
The etiology of warty dyskeratoma is unclear, but a viral infection, smoking, autoimmunity, and ultraviolet light have been postulated to play a role. Several hypothesis reveal histopathologic similarities to viral warts but it's not caused by HPV and the majority of these lesions display overall histopathologic features consistent with a follicular adnexal neoplasm.[4]
Differentiating Warty Dyskeratoma from other Conditions
Warty dyskeratoma can also be thought of as one of the manifestations of focal acantholytic dyskeratosis, an epidermal reaction pattern that can be seen in several disorders, including Darier's disease and Grover's disease.[5] But the main Difference between Darier disease and Warty dyskeratoma, is that Darier disease inherited dermatosis (autosomal dominant) consisting of multiple keratotic papules on the face, trunk, and extremities, while WD occurs as an isolated, noninherited, single keratotic nodule mainly confined to the head and neck as mentioned earlier.[6]
Warty dyskeratoma must be differentiated from viral-induced squamous lesions and others such as
- Bowenoid papulosis
- Condyloma
- Squamous carcinoma
- Actinic keratosis
- Basal cell carcinoma
- Vulvar dysplasia[6]
Epidemiology and Demographics
Warty dyskeratoma is a rare epidermal tumor that frequently arises as a papule or nodule on the head or neck of middle-aged or older persons.
Diagnosis
History and Symptoms
The patient usally comes complaing of pruritus. It is usually limited to the head, neck,[6] scalp[7] or face and vulva.[6] Lesions are generally solitary and sporadic and may be associated with a follicular unit. Oral involvement,[3] particularly the hard palate, and genital involvement have been reported. They may also complain of recurrent foul-smelling cheesy drainage from the lesions. There may be central bleeding associated with trauma to the lesion.
Laboratory Findings
Hisotopathological examination of the lesions may reveal a cup-shaped invagination filled with a keratotic plug. The invagination contains numerous acantholytic dyskeratotic cells and typical corps ronds can be seen at the entrance to the invagination. The lower portion of the invagination may show the presence of many villi that are often covered by a single layer of basaloid cells and these villi protrude upward. They may also present as nodular lesions showing small, well circumscribed, solid aggregations of epithelial cells in the dermis and cystic lesions have shown large, well-defined, cystic structures in the dermis, which were lined by epithelial cells and filled with masses of keratin material. Mostly the lesions involve single hair follicle but cases involving adjoing follicles have been reported.
Treatment
The treatment of choice of WD is surgical excision. Other possible modalities of treatment are
- Curettement with electro-desiccation
- Irradiation with X-ray.[8]
- Tazarotenic acid gel.[9]
The other modalities are frequently associated with recurrences.
References
- ↑ Diallo M, Cribier B, Scrivener Y (2007). "[Warty dyskeratoma: infundibular histogenesis. Anatomoclinical study of 43 cases]". Ann Dermatol Venereol (in French). 134 (8–9): 633–6. PMID 17925685.
- ↑ Chau MN, Radden BG (1984). "Oral warty dyskeratoma". J. Oral Pathol. 13 (5): 546–56. doi:10.1111/j.1600-0714.1984.tb01455.x. PMID 6434720. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 Kaugars GE, Lieb RJ, Abbey LM (1984). "Focal oral warty dyskeratoma". Int. J. Dermatol. 23 (2): 123–30. doi:10.1111/j.1365-4362.1984.tb05686.x. PMID 6698687. Unknown parameter
|month=ignored (help) - ↑ Kaddu S, Dong H, Mayer G, Kerl H, Cerroni L (2002). "Warty dyskeratoma--"follicular dyskeratoma": analysis of clinicopathologic features of a distinctive follicular adnexal neoplasm". J. Am. Acad. Dermatol. 47 (3): 423–8. doi:10.1067/mjd.2002.122756. PMID 12196754. Unknown parameter
|month=ignored (help) - ↑ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
- ↑ 6.0 6.1 6.2 6.3 Duray PH, Merino MJ, Axiotis C (1983). "Warty dyskeratoma of the vulva". Int. J. Gynecol. Pathol. 2 (3): 286–93. doi:10.1097/00004347-198303000-00006. PMID 6642851.
- ↑ Griffiths TW, Hashimoto K, Sharata HH, Ellis CN (1997). "Multiple warty dyskeratomas of the scalp". Clin. Exp. Dermatol. 22 (4): 189–91. doi:10.1111/j.1365-2230.1997.tb01059.x. PMID 9499610. Unknown parameter
|month=ignored (help) - ↑ Tanay A, Mehregan AH (1969). "Warty dyskeratoma". Dermatologica. 138 (3): 155–64. PMID 5773508.
- ↑ Abramovits W, Abdelmalek N (2002). "Treatment of warty dyskeratoma with tazarotenic acid". J Am Acad Dermatol. 46 (2 Suppl Case Reports): S4. PMID 11807455.