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Solitary hyperpigmented island in a sea of elastosis (anelastosis)
Author(s) -
RamosCaro Francisco A.,
Sevigny Gina,
Mullins Diane
Publication year - 1998
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1046/j.1365-4362.1998.00571.x
Subject(s) - medicine , scars , biopsy , lesion , punch biopsy , dermatology , dermis , papule , skin biopsy , physical examination , asymptomatic , pathology , surgery
A 77‐year‐old Caucasian woman presented to our clinic for skin screening with a history of multiple, cutaneous, actinic keratoses and basal cell carcinomas treated in the past. She has had prolonged and intense exposure to the sun throughout her life. On physical examination, a tanned, leathery skin was present on her face, neck, V‐area of the chest, and upper extremities. Multiple scars of previously treated areas were present. As an incidental finding, a solitary, 2 cm × 2 cm, square‐shaped, hyperpigmented, well‐demarcated, depressed, soft plaque with a “skin‐graft” appearance was noted on her right anterior neck ( Fig. 1). This area was surrounded by leathery skin, but unaffected by it. On further questioning, she denied any surgery of the area, including skin‐grafting (there was no donor scar anywhere on her body). She could not recall precisely how long it had been there, or if it had grown in size, as it was asymptomatic. She did state that it had been there for many years, and possibly since childhood. She was asked to bring any old photographs that might picture this area, but could not find any. With her permission, a skin biopsy was performed of the edge of the lesion to include the hyperpigmented area and the surrounding skin. 1Well‐circumscribed patch surrounded by severely sun‐damaged skin on the neck Histologically, the shave biopsy taken from the edge of the lesion on the right neck revealed marked elastosis in the papillary dermis of the surrounding skin ( Fig. 2). The lesional skin did not demonstrate any elastosis in the papillary dermis, and had a thin epidermis with relatively increased pigmentation of the basal layer. No melanophages were seen. The elastic stain enhances the demarcation between the surrounding elastosis and the anelastotic lesion. There was no elastic tissue, normal or damaged, in the papillary dermis of the affected skin ( Fig. 3). 2Demarcation between the lesion (left) and the elastotic skin (right). No solar elastosis is present in the papillary dermis of the lesion (right or left) (hematoxylin and eosin, ×4)3Elastic stain. No solar elastosis in the lesional papillary dermis (left) (×10)