Dermatology Online Journal

Multiple warty dyskeratomas on the scalp
Melek Koç MD¹, Mukaddes Kavala MD¹, Emek Kocatürk MD¹, Özgür Mete MD², Burce Can MD¹, Ilkin Zindanci MD¹, Selin Aktas MD¹
Dermatology Online Journal 15 (2): 8

1. Göztepe Training and Research Hospital, Department of Dermatology, Istanbul, Turkey
2. Istanbul University, Istanbul Faculty of Medicine, Department of Pathology, Division of Dermatopathology, Istanbul, Turkey

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Abstract

Warty dyskeratoma is usually characterized by solitary papules or nodules which reveal acantholytic dyskeratosis histopathologically. Warty dyskeratoma most commonly presents as a single lesion, but there are a few case reports of patients with multiple lesions. Herein we report a female patient presenting with multiple verrucous papules on the scalp diagnosed clinically and histopathologically as warty dyskeratoma.

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Introduction

Warty dyskeratoma (WD), also known as nodular-type focal acantolytic dyskeratosis, is characterized as a reddish-brown or skin colored solitary papule or nodule with central follicular plugging [1]. It is usually localized on the sun-exposed areas of the body, but has occasionally been reported on oral and vulvar mucosae [2, 3].

Case report

A 52-year-old woman with a 1½-year history of pruritic papules on the scalp presented to our outpatient clinic. Her lesions appeared as papules; the number and the size of the lesions were increasing gradually. She had no other dermatologic disease. On physical examination there were approximately 15 skin colored, verrucous papules with central yellow keratotic plugs. The papules varied in size between 0.5-1.3 cm and were all located on the occipital area (Fig. 1).

Figure 1	Figure 2
Figure 1. Verrucous papules on the scalp Figure 2. Suprabasal acantholysis, corp rond and grain formation leading to villus (H&E x100)

Histological examination showed prominent dilatation of follicles and invagination down to the dermis. Suprabasal clefts, acantholysis with villous formation, luminal keratin plugs, dyskeratotic cells, and a few corps ronds were observed (Fig. 2). Warty dyskeratoma was diagnosed and the papules were surgically excised.

Discussion

Warty dyskeratoma is a benign growth that is more prevalent in males and elderly people. The usual location favors the face, scalp, and neck [4]. Warty dyskeratoma usually presents singly, but multiple lesions in Japanese people have been reported. One patient with umblicated lesions on cheeks, hands, and neck, in addition, grouped verrucous papules on the scalp have been reported [5]. In our patient the pruritic papules on the scalp were also grouped and verrucous.

The etiology of WD is unknown, but ultraviolet light, autoimmunity, viral infections, chemical carcinogens, and smoking have been postulated to play a role [1]. Multiple wartly dyskeratomas were described in three patients with renal failure [5]. In our patient renal function was normal.

Histopathologically, acantholysis, dyskeratosis forming corps ronds and grains, and villi surrounded by a layer of basal cells extending into lacunae are seen in WD lesions; these findings resemble Darier disease [2]. Lymphocytic infiltration is often observed around the tumor, which is surrounded by a fibrotic capsule that is partially PAS positive. Focal acantholytic dyskeratosis is also observed in diseases such as Darier disease, linear epidermal nevus, actinic keratosis, and Grover disease. But besides the characteristic histopathological features, the clinical appearance of WD is distinctive and is composed of discrete papules or nodules [5, 6]. The clinical differential diagnoses includes hypertrophic actinic keratosis and squamous cell carcinoma. In our patient the clinical and histopathological features supported the diagnosis of WD.

Well-demarcated and slow-growing WD lesions are usually stable by the time they reach 1-2 cm in size. Total surgical excision is the treatment of choice and recurrence is rare. Malignant transformation of WD has not been reported [4]. In our patient, there was no sign of recurrence after 1 year of follow-up.

References

1. DiMaio D.J, Cohen P.R: Incidental focal acantholytic dyskeratosis. J Am Acad Dermatol. 1998;38:243. [PubMed]

2. Laskaris G ,Sklavounou A: Warty dyskeratoma of the oral mucosa. Br J Oral Maxillofac Surg. 1985 Oct;23(5):371-5. [PubMed]

3. Duray PH, Merino MJ, Axiotis C: Warty dyskeratoma of the vulva. Int J Gynecol Pathol. 1983;2(3):286-93 [PubMed]

4. Kargi E, Altinyazar HC, Hosnuter M, Babuccu O, Numanoglu G, Babuccu B:

An atypical lesion on the forehead: Warty dyskeratoma. Plast Reconstr Surg. 2003 Apr 1;111(4):1562-3. [PubMed]

5. Azuma Y, Matsukawa A: Warty dyskeratoma with multiple lesions. J Dermatol. 1993 Jun;20(6):374-7. [PubMed]

6. Griffiths TW, Hashimoto K, Sharata HH, Ellis CN: Multiple Warty dyskeratomas of the scalp. Clin Exp Dermatol. 1997 Jul;22(4):189-91. [PubMed]

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