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Case Study

This is a 47 year old man who presents with a scaly nodule on the shoulder.

Diagnosis

Cystic (Inverted) Warty Dyskeratoma

Discussion

Warty dyskeratomas are relatively common epithelial lesions characterized by invaginated cup-shaped cyst with an extensive keratotic and parakeratotic plug. Characteristically there is suprabasilar acantholysis with papillary fronds and numerous acantholytic cells with dyskeratosis forming corp ronds and corp grains. This recent paper cited below describes several histological variants including tumors which may exhibit follicular differentiation. PCR analysis for HPV DNA was negative in all cases, distinguishing it from verruca vulgaris and cystic verruca.

References

Warty Dyskeratoma and other Acanthomas

Kaddu S, Dong H, Mayer G, Kerl H, Cerroni L. Warty dyskeratoma--"follicular dyskeratoma": analysis of clinicopathologic features of a distinctive follicular adnexal neoplasm. J Am Acad Dermatol 2002 Sep;47(3):423-8

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