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This article deals with '''dermatologic neoplasms'''.  It includes '''dermatologic cancer''', which can be deadly.  Collectively, dermatologic cancers are the most common form of cancer.   
This article deals with '''dermatologic neoplasms''', also known as '''skin tumours'''.  It includes '''dermatologic cancer''', which can be deadly.  Collectively, dermatologic cancers are the most common form of cancer.   


An introduction to dermatopathy is found in the ''[[dermatopathology]]'' article.  Non-malignant disease is covered in the ''[[non-malignant skin disease]]'' article.
An introduction to dermatopathy is found in the ''[[dermatopathology]]'' article.  Non-malignant disease is covered in the ''[[non-malignant skin disease]]'' article.


=The Big Three=
=The Big Three malignant=
==Squamous cell carcinoma==
==Basal cell carcinoma==
{{Main|Squamous carcinoma}}
{{Main|Basal cell carcinoma}}
===General===
Precursor:<ref name=Ref_PBoD8_1180>{{Ref PBoD8|1180}}</ref>
*[[Actinic keratosis]] (solar keratosis).
**Clinical: yellow-brown scaly, patches, sandpaper sensation.


Risk factors:<ref name=Ref_PBoD8_1180>{{Ref PBoD8|1180}}</ref>
==Squamous cell carcinoma of the skin==
*Sun exposure.
*Abbreviated ''skin SCC'', ''SCC of the skin'', and ''SCC of skin''.
*Immune suppression (e.g. organ transplant recipients).
{{Main|Squamous cell carcinoma of the skin}}


Notes:
==Melanoma==
*[[Keratoacanthoma]].
{{Main|Malignant melanoma}}
**Some don't believe this entity exists.
*Known as the great mimicker in pathology; it may look like many things.
***These people sign this entity as ''low grade squamous cell carcinoma, keratoacanthoma type''.<ref>RS. 17 May 2010.</ref>


===Microscopic===
=Less common malignant=
*See ''[[squamous cell carcinoma]]''.
==Dermatofibrosarcoma protuberans==
*Abbreviated ''DFSP''.
{{Main|Dermatofibrosarcoma protuberans}}


====Bowen disease====
==Cutaneous B-cell lymphoma==
'''Bowen disease''' is ''squamous cell carcinoma in situ'' of the skin. 
*Abbreviated CBCL.
*Its histomorphologic appearance may be similar to [[Paget disease]], Toker cell hyperplasia and [[melanoma]].  **[[IHC]] is used to separate the entities definitively.


Histologic DDx of Bowen disease:
===General===
*Benign Toker cell hyperplasia.
*CBCL is less common than cutaneous T-cell lymphoma (CTCL).<ref>URL: [http://emedicine.medscape.com/article/1099540-overview http://emedicine.medscape.com/article/1099540-overview]. Accessed on: 24 August 2010.</ref>
*[[Malignant melanoma]].
*[[Eccrine carcinoma]].


Images:
===Microscopic===
*[http://commons.wikimedia.org/wiki/File:Bowen_disease_%281%29.jpg Bowen disease - 1 (WC)].
Features:
*[http://commons.wikimedia.org/wiki/File:Bowen_disease_%283%29.jpg Bowen disease - 3 (WC)].
*Dermal lymphoid infiltrate.
*"Grenz zone" - space between the epidermis and the dermal infiltrate - '''key feature'''.


===IHC===
===IHC===
Bowen's disease panel:
*B cell and T cell markers.  
*CK5/6 +ve.<ref>RS. May 2010.</ref>
**Usu. -ve in [[Paget disease of the breast]]/[[Extramammary Paget disease]].
*S100 -ve, HMB-45 -ve.
**Both typically +ve in melanoma.
*CEA -ve<ref name=emed_pagets>URL: [http://emedicine.medscape.com/article/1101235-workup#a0721 http://emedicine.medscape.com/article/1101235-workup#a0721]. Accessed on: 2 September 2011.</ref> (+ve in [[Paget disease of the breast]]/[[Extramammary Paget disease]], -ve in Toker cells).
*CK7 -ve.
**Toker cells CK7 +ve.<ref name=pmid19601945>{{Cite journal  | last1 = Nofech-Mozes | first1 = S. | last2 = Hanna | first2 = W. | title = Toker cells revisited. | journal = Breast J | volume = 15 | issue = 4 | pages = 394-8 | month =  | year =  | doi = 10.1111/j.1524-4741.2009.00743.x | PMID = 19601945 }}</ref>


==Basal cell carcinoma==
==Cutaneous T-cell lymphoma==
===General===
*Abbreviated CTCL.
*Very common.
{{Main|Cutaneous T-cell lymphoma}}
*Sun exposed skin.
*Very rarely metastasizes - so rare... some don't think this is really a malignancy.


====Clinical====
==Merkel cell carcinoma==
*Telangiectasias.
{{Main|Merkel cell carcinoma}}
*Raised pearly nodule.


====As part of a syndrome====
==Eccrine carcinoma==
*[[Nevoid basal cell carcinoma syndrome]] (NBCCS), AKA ''Gorlin syndrome''.
===General===
*Bazex syndrome (X-linked).<ref>URL: [http://emedicine.medscape.com/article/1101146-diagnosis http://emedicine.medscape.com/article/1101146-diagnosis]. Accessed on: 6 May 2010.</ref>
*Arises from the proximal sweat duct.


===Microscopic===
===Microscopic===
Features:<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref>
Features:
*Nest of hyperchromatic (i.e. blue) cells (similar in appearance to basal cells) with:
*Pleomorphic nuclei with nucleoli.
**Palisading of cells at the edge of the cell nests.
*Duct-like structures - '''key feature'''.
**Artefactual separation of cells (forming the nests) from the underlying stroma.
*Extends from dermis into epidermis (follows path of a benign sweat duct).


Notes:
Notes:
*Palisading = the long axes of the cells are alined and the axes are perpendicular to the interface between the (basaloid cell) nests and stroma.
*May resemble [[Extramammary Paget's disease]]/[[Paget's disease of the breast]].
*There are various subtypes: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970110-3 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970110-3].
 
==Kaposi sarcoma==
:See ''[[Kaposi sarcoma]]''.
 
==Sebaceous carcinoma==
{{Main|Sebaceous carcinoma}}
 
==Microcystic adnexal carcinoma==
{{Main|Microcystic adnexal carcinoma}}


DDx:
==Trichilemmal carcinoma==
*[[Trichoepithelioma]] - no artefactual cleft.<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref>
{{Main|Trichilemmal carcinoma}}


==Melanoma==
==Lymphomatoid papulosis==
{{Main|Malignant melanoma}}
===General===
===General===
*Known as the great mimicker in pathology; it may look like many things.
*Rare.
*Benign behaviour.


===Microscopic===
===Microscopic===
Features:
Features:
*Classic appearance of melanoma:
*Dermal lymphocytosis.
**Loosely cohesive; mix of small nests of cells, single cells.
**No epidermal lymphocytes.
**Mixed of spindle and ovoid cell morphology.
*Focal nuclear atypia.
**+/-Occasional large binucleated cells.
 
**Cytoplasm: brown pigment (melanin).
DDx:
**Prominent (large) red nucleoli (like in ''serous carcinoma'' of the ovary).
*[[CTCL]].
**Marked nuclear pleomorphism - variation in cell size, shape & staining (like in ''serous carcinoma'' of the ovary).
*Cutaneous [[ALCL]].
**[[Nuclear pseudoinclusions]] (like in ''papillary thyroid carcinoma'').
 
===IHC===
*CD30 +ve.<ref>URL: [http://path.upmc.edu/cases/case513/dx.html http://path.upmc.edu/cases/case513/dx.html]. Accessed on: 25 January 2012.</ref>


=Malignant=
=Rare malignant=
==Dermatofibrosarcoma protuberans==
==Basosquamous carcinoma==
*Abbreviated ''DFSP''.
:Should '''not''' be confused with ''basaloid [[squamous cell carcinoma]]'' ([[AKA]] ''squamous cell carcinoma, basaloid variant'').
===General===
===General===
*Dermal location.
*Very rare.
*Destroys adnexal structures.
**Largest case series, as of 2000, 35 cases.<ref name=pmid10717618>{{Cite journal  | last1 = Martin | first1 = RC. | last2 = Edwards | first2 = MJ. | last3 = Cawte | first3 = TG. | last4 = Sewell | first4 = CL. | last5 = McMasters | first5 = KM. | title = Basosquamous carcinoma: analysis of prognostic factors influencing recurrence. | journal = Cancer | volume = 88 | issue = 6 | pages = 1365-9 | month = Mar | year = 2000 | doi =  | PMID = 10717618 }}
 
</ref>
Treatment:<ref name=Ref_PBoD8_1183>{{Ref PBoD8|1183}}</ref>
*May be considered an aggressive variant of [[basal cell carcinoma]].<ref name=pmid10717618/>
*Wide excision.
*Aggressive behaviour.<ref name=pmid12859383>{{Cite journal  | last1 = Bowman | first1 = PH. | last2 = Ratz | first2 = JL. | last3 = Knoepp | first3 = TG. | last4 = Barnes | first4 = CJ. | last5 = Finley | first5 = EM. | title = Basosquamous carcinoma. | journal = Dermatol Surg | volume = 29 | issue = 8 | pages = 830-2; discussion 833 | month = Aug | year = 2003 | doi =  | PMID = 12859383 }}.</ref>
*May include [[imatinib]] (Gleevec).


===Microscopic===
===Microscopic===
Features:<ref name=Ref_PBoD8_1183>{{Ref PBoD8|1183}}</ref>
Features:
*Dermal spindle cell lesion with storiform pattern.
*Has features of both [[basal cell carcinoma]] and [[squamous cell carcinoma of the skin|squamous cell carcinoma]].<ref name=pmid12859383/>
**Spokes of the wheel-pattern.
**BCC component usually predominant.<ref name=Ref_Derm397>{{Ref Derm|397}}</ref>
*Contains adipose tissue within the tumour -- '''key feature'''.
**Described as "honeycomb pattern" and "Swiss cheese pattern".


Notes:
Note:
*Adnexal structure within tumour are preserved -- this is unusual for a malignant tumour -- '''important'''.
*''Busam'' notes that there is disagreement about what defines this tumour;<ref name=Ref_Derm372>{{Ref Derm|372}}</ref> however, he goes on the describe it as a ''[[collision tumour]]''.<ref name=Ref_Derm397>{{Ref Derm|397}}</ref>


DDx:
*Basaloid [[squamous cell carcinoma]].
*[[Basal cell carcinoma]] with squamous differentiation.


Main DDx:
=Intermediate=
*[[Dermatofibroma]] - has entrapment of collagen bundles at the edge of the lesion.
==Atypical fibroxanthoma==
*Abbreviated ''AFX''.
{{Main|Atypical fibroxanthoma}}


DDx of storiform pattern:
=Benign=
*DFSP, dermatofibroma, [[solitary fibrous tumour]], [[undifferentiated pleomorphic sarcoma]].
==Syringoma==
===General===
*Benign sweat duct tumour.
*Eccrine differentiation.
*Usually close to lower [[eyelid]].<ref>{{Ref PBoD8|1177}}</ref>


Images:
===Microscopic===
*[http://commons.wikimedia.org/w/index.php?title=File:Storiform_pattern_-_intermed_mag.jpg DFSP - storiform pattern - intermed. mag. (WC)].
Features:<ref>URL: [http://emedicine.medscape.com/article/1059871-diagnosis http://emedicine.medscape.com/article/1059871-diagnosis]. Accessed on: 12 May 2010.</ref>
*[http://commons.wikimedia.org/wiki/File:Storiform_pattern_-_very_high_mag.jpg DFSP - storiform pattern - very high mag. (WC)].
*Proliferation of benign ducts with lined by a bilayer (as in normal sweat ducts) with abnormal architecture:
**Tadpole like appearing ducts.


===IHC===
DDx:
Panel:<ref>AP. May 2009.</ref>
*Syringomatous adenomas of nipple (AKA syringoma of the nipple).<ref name=pmid22355740>{{Cite journal | last1 = Boecker | first1 = W. | last2 = Junkers | first2 = T. | last3 = Reusch | first3 = M. | last4 = Buerger | first4 = H. | last5 = Korsching | first5 = E. | last6 = Metze | first6 = D. | last7 = Decker | first7 = T. | last8 = Loening | first8 = T. | last9 = Lange | first9 = A. | title = Origin and differentiation of breast nipple syringoma. | journal = Sci Rep | volume = 2 | issue = | pages = 226 | month = | year = 2012 | doi = 10.1038/srep00226 | PMID = 22355740 |URL = http://www.nature.com/srep/2012/120117/srep00226/full/srep00226.html }}</ref>
*CD34 +ve.
*[[Chondroid syringoma]]. (???)
**Usually negative in dermatofibroma.<ref name=pmid7694515>{{cite journal |author=Abenoza P, Lillemoe T |title=CD34 and factor XIIIa in the differential diagnosis of dermatofibroma and dermatofibrosarcoma protuberans |journal=Am J Dermatopathol |volume=15 |issue=5 |pages=429–34 |year=1993 |month=October |pmid=7694515 |doi= |url=}}</ref><ref name=pmid9129699>{{cite journal |author=Goldblum JR, Tuthill RJ |title=CD34 and factor-XIIIa immunoreactivity in dermatofibrosarcoma protuberans and dermatofibroma |journal=Am J Dermatopathol |volume=19 |issue=2 |pages=147–53 |year=1997 |month=April |pmid=9129699 |doi= |url=}}</ref>
*Factor XIIIa -ve.
**Usually positive in dermatofibroma.<ref name=pmid7694515>{{cite journal |author=Abenoza P, Lillemoe T |title=CD34 and factor XIIIa in the differential diagnosis of dermatofibroma and dermatofibrosarcoma protuberans |journal=Am J Dermatopathol |volume=15 |issue=5 |pages=429–34 |year=1993 |month=October |pmid=7694515 |doi= |url=}}</ref><ref name=pmid9129699>{{cite journal |author=Goldblum JR, Tuthill RJ |title=CD34 and factor-XIIIa immunoreactivity in dermatofibrosarcoma protuberans and dermatofibroma |journal=Am J Dermatopathol |volume=19 |issue=2 |pages=147–53 |year=1997 |month=April |pmid=9129699 |doi= |url=}}</ref>
*S100 -ve (screen for melanoma).
*Caldesmin -ve (screen for muscle differentiation).
*Beta-catenin. (???)
*MIB-1 (proliferation marker).
**Should not be confused with ''MIB1'' a gene that regulates [[apoptosis]].


===Molecular===
Images:
A characteristic [[translocation]] is seen:<ref>{{Ref PBoD8|1249}}</ref>
*[http://www.flickr.com/photos/euthman/2329061316/ Syringoma (flickr.com)].
t(17;22)(q22;q15)
*[http://dermatology.cdlib.org/144/tumors/axillary_syringoma/2.jpg Syringoma (dermatology.cdlib.org)].<ref>{{Cite journal  | last1 = Nosrati | first1 = N. | last2 = Coleman | first2 = NM. | last3 = Hsu | first3 = S. | title = Axillary syringomas. | journal = Dermatol Online J | volume = 14 | issue = 4 | pages = 13 | month =  | year = 2008 | doi =  | PMID = 18627735 |URL = http://dermatology.cdlib.org/144/tumors/axillary_syringoma/hsu.html}}</ref>


==Cutaneous B-cell lymphoma==
==Chondroid syringoma==
*Abbreviated CBCL.
*Used to be called ''mixed tumour of skin''.<ref name=pmid19693940>{{Cite journal  | last1 = Kumar | first1 = B. | title = Chondroid syringoma diagnosed by fine needle aspiration cytology. | journal = Diagn Cytopathol | volume = 38 | issue = 1 | pages = 38-40 | month = Jan | year = 2010 | doi = 10.1002/dc.21159 | PMID = 19693940 }}</ref>


===General===
===General===
*CBCL is less common than cutaneous T-cell lymphoma (CTCL).<ref>URL: [http://emedicine.medscape.com/article/1099540-overview http://emedicine.medscape.com/article/1099540-overview]. Accessed on: 24 August 2010.</ref>
*Mixed apocrine & eccrine tumour of skin, usually in the head & neck<ref name=pmid19693940/>, especially nose and cheek.<ref name=pmid19633639/>
*May be in major and minor salivary glands.<ref name=pmid19633639>{{Cite journal  | last1 = Rauso | first1 = R. | last2 = Santagata | first2 = M. | last3 = Tartaro | first3 = G. | last4 = Filipi | first4 = M. | last5 = Colella | first5 = G. | title = Chondroid syringoma: a rare tumor of orofacial region. | journal = Minerva Stomatol | volume = 58 | issue = 7-8 | pages = 383-8 | month =  | year =  | doi =  | PMID = 19633639 }}</ref>


===Microscopic===
===Microscopic===
Features:
Features:
*Dermal lymphoid infiltrate.
*Mix tumour with:<ref name=pmid19693940/>
*"Grenz zone" - space between the epidermis and the dermal infiltrate - '''key feature'''.
*#Epithelial component:
*#*Nests of cells with:
*#**Moderate dull eosinophilic cytoplasm.
*#**Round/ovoid nuclei with nucleoli.
*#Mesenchymal component - '''key feature''':
*#*[[Chondromyxoid stroma]].
 
Images:
*[https://www.dermnetnz.org/topics/apocrine-mixed-tumour-pathology Chondroid syringoma  (DermnetNZ)].


===IHC===
==Dermal cylindroma==
*B cell and T cell markers.
{{Main|Dermal cylindroma}}


==Cutaneous T-cell lymphoma==
==Keratoacanthoma==
*Abbreviated CTCL.
{{Main|Keratoacanthoma}}


==Sebaceous adenoma==
===General===
===General===
*''Mycosis fungoides'' - is a subtype (???).
*Seen in [[Muir-Torre syndrome]] - a variant of [[Lynch syndrome]] (hereditary non-polyposis colon cancer).
*CTCL is more common than cutaneous B-cell lymphoma (CBCL).<ref>URL: [http://emedicine.medscape.com/article/1099540-overview http://emedicine.medscape.com/article/1099540-overview]. Accessed on: 24 August 2010.</ref><ref>URL: [http://emedicine.medscape.com/article/1098342-overview http://emedicine.medscape.com/article/1098342-overview]. Accessed on: 24 August 2010.</ref>
 
Notes:
*Sebaceous lesions (from benign to malignant): [[sebaceous hyperplasia]], sebaceous adenoma, sebaceoma, [[sebaceous carcinoma]].


===Microscopic===
===Microscopic===
*Atypical lymphocytes:
Features:
**Have folded "cerebriform" nuclei; ''Sezary-Lutzner cells''.<ref name=Ref_Klatt385>{{Ref Klatt|385}}</ref>
*Abnormal sebaceous glands (pale fluffy cytoplasm):
*Grouping:
**Increased basal epithelium.
**Nests in the epidermis - known as "Pautrier microabscesses".
**Multiple dilated glands - opening to the surface.
**Single lymphocytes in epidermis; "lymphocyte exocytosis".<ref>URL: [http://www.mdconsult.com/das/book/body/199872830-2/0/1709/I4-u1.0-B978-0-443-06694-8..50117-2--f2.fig http://www.mdconsult.com/das/book/body/199872830-2/0/1709/I4-u1.0-B978-0-443-06694-8..50117-2--f2.fig]. Accessed on: 6 May 2010.</ref>
**Short linear arrays of lymphocytes along the basal layer of the epidermis; "epidermotropism".<ref name=Ref_Klatt385>{{Ref Klatt|385}}</ref>


Images:
====Images====
*[http://commons.wikimedia.org/wiki/File:Cutaneous_T-cell_lymphoma_-_very_high_mag.jpg CTCL - very high mag. (WC)].
<gallery>
*[http://commons.wikimedia.org/wiki/File:Cutaneous_T-cell_lymphoma_-_intermed_mag.jpg CTCL - intermed. mag. (WC)].
Image:Sebaceous_adenoma_-_low_mag.jpg | Sebaceous adenoma - low mag. (WC/Nephron)
*[http://www.jci.org/articles/view/24826/figure/2 CTCL (jci.org)].
Image:Sebaceous_adenoma_-_high_mag.jpg | Sebaceous adenoma - high mag. (WC/Nephron)
*[http://www.mdconsult.com/das/book/body/199872830-2/0/1709/I4-u1.0-B978-0-443-06694-8..50117-2--f2.fig CTCL (mdconsult.com)].
</gallery>
www:
*[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=587283984 Sebaceous adenoma (jhmi.edu)].


===IHC===
==Trichilemmoma==
Features:
*May be spelled ''tricholemmoma''.
*CD4 +ve.<ref>{{Ref PBoD8|1185}}</ref>
{{Main|Trichilemmoma}}


==Merkel cell carcinoma==
==Poroma==
===General===
{{Main|Poroma}}
Features:<ref name=pmid20418670>{{Cite journal  | last1 = Calder | first1 = KB. | last2 = Smoller | first2 = BR. | title = New insights into merkel cell carcinoma. | journal = Adv Anat Pathol | volume = 17 | issue = 3 | pages = 155-61 | month = May | year = 2010 | doi = 10.1097/PAP.0b013e3181d97836 | PMID = 20418670 }}</ref>
*Rare.
*Aggressive course/poor prognosis.
*Neuroendocrine-like.<ref name=pmid19395876>{{Cite journal  | last1 = Pulitzer | first1 = MP. | last2 = Amin | first2 = BD. | last3 = Busam | first3 = KJ. | title = Merkel cell carcinoma: review. | journal = Adv Anat Pathol | volume = 16 | issue = 3 | pages = 135-44 | month = May | year = 2009 | doi = 10.1097/PAP.0b013e3181a12f5a | PMID = 19395876 }}
</ref>


Etiology:
==Nodular hidradenoma==
*Polyomavirus (?).<ref name=pmid20418670/>
*[[AKA]] ''eccrine acrospiroma''.<ref name=pmid18319032>{{Cite journal  | last1 = Punia | first1 = RP. | last2 = Garg | first2 = S. | last3 = Bal | first3 = A. | last4 = Mohan | first4 = H. | title = Pigmented nodular hidradenoma masquerading as nodular malignant melanoma. | journal = Dermatol Online J | volume = 14 | issue = 1 | pages = 15 | month =  | year = 2008 | doi =  | PMID = 18319032 |URL = http://dermatology.cdlib.org/141/case_presentations/hidradenoma/punia.html }}</ref>
*Immunocompromised/immunosuppressed (e.g. organ transplant recipients).
{{Main|Nodular hidradenoma}}


===Microscopic===
==Trichoblastoma==
Features:<ref name=Ref_WMSP491>{{Ref WMSP|491}}</ref>
{{Main|Trichoblastoma}}
*Nests or sheets or trabeculae.
*Scant cytoplasm.
*Nuclear moulding.
*Multiple small nucleoli.
*Usually mitotically active.
 
Image:
*[http://www.ispub.com/ispub/ijd/volume_5_number_2_8/concurrent_merkel_cell_carcinoma_and_bowen_s_disease_of_the_thigh/bowen-fig3.jpg Merkel cell carcinoma (ispub.com)].
*[http://commons.wikimedia.org/wiki/File:Merkelcellcarcinoma_Tag.jpg Merkel cell carcinoma - nested pattern (WC)].


===IHC===
==Trichofolliculoma==
*CK7 -ve, CK20 +ve
{{Main|Trichofolliculoma}}


==Eccrine carcinoma==
==Apocrine carcinoma of the skin==
===General===
===General===
*Arises from the proximal sweat duct.
*Rare.<ref name=pmid7678545>{{Cite journal  | last1 = Paties | first1 = C. | last2 = Taccagni | first2 = GL. | last3 = Papotti | first3 = M. | last4 = Valente | first4 = G. | last5 = Zangrandi | first5 = A. | last6 = Aloi | first6 = F. | title = Apocrine carcinoma of the skin. A clinicopathologic, immunocytochemical, and ultrastructural study. | journal = Cancer | volume = 71 | issue = 2 | pages = 375-81 | month = Jan | year = 1993 | doi =  | PMID = 7678545 }}</ref>
*Usually very good prognosis.<ref name=pmid7678545/>


===Microscopic===
===Microscopic===
Features:
Features:<ref name=pmid7678545/>
*Pleomorphic nuclei with nucleoli.
*Nests.
*Duct-like structures - '''key feature'''.
*Apocrine snouts - "decapitation secretion"
*Extends from dermis into epidermis (follows path of a benign sweat duct).
 
DDx:
*[[Paget disease of the breast]]/[[Extramammary Paget disease]].


Notes:
====Images====
*May resemble [[Extramammary Paget's disease]]/[[Paget's disease of the breast]].
<gallery>
Image:Apocrine_carcinoma_-_intermed_mag.jpg | Apocrine carcinoma - intermed. mag. (WC/Nephron)
Images:  
Image:Apocrine_carcinoma_-_high_mag.jpg | Apocrine carcinoma - high mag. (WC/Nephron)
*[http://commons.wikimedia.org/wiki/File:Eccrine_carcinoma_intermed_mag.jpg Eccrine carcinoma - intermed. mag. (WC)].
</gallery>
*[http://commons.wikimedia.org/wiki/File:Eccrine_carcinoma_high_mag.jpg Eccrine carcinoma - high mag. (WC)].
===Stains===
Features:<ref name=pmid7678545/>
*PAS +ve.
*PASD +ve.


==Kaposi sarcoma==
===IHC===
:See ''[[Kaposi sarcoma]]''.
*[[GCDFP-15]] (gross cystic disease fluid protein-15) +ve.<ref name=pmid7678545/>


=Intermediate=
==Dermatomyofibroma==
==Atypical fibroxanthoma==
:Should ''not'' be confused with [[dermatofibroma]].
*Abbreviated ''AFX''.
*Abbreviated ''DMF''.
===General===
===General===
*Typically head & neck region.<ref>URL: [http://emedicine.medscape.com/article/1056204-overview http://emedicine.medscape.com/article/1056204-overview]. Accessed on 2 September 2011.</ref>
*Uncommon.
*Thought to be related to [[pleomorphic undifferentiated sarcoma]].<ref>{{Cite journal  | last1 = Withers | first1 = AH. | last2 = Brougham | first2 = ND. | last3 = Barber | first3 = RM. | last4 = Tan | first4 = ST. | title = Atypical fibroxanthoma and malignant fibrous histiocytoma. | journal = J Plast Reconstr Aesthet Surg | volume =  | issue =  | pages =  | month = Jun | year = 2011 | doi = 10.1016/j.bjps.2011.05.004 | PMID = 21664889 }}</ref>
 
Clinical:
*Rapid growth.
*Elderly.
*Good prognosis.<ref name=pmid20526171>{{Cite journal  | last1 = Beer | first1 = TW. | last2 = Drury | first2 = P. | last3 = Heenan | first3 = PJ. | title = Atypical fibroxanthoma: a histological and immunohistochemical review of 171 cases. | journal = Am J Dermatopathol | volume = 32 | issue = 6 | pages = 533-40 | month = Aug | year = 2010 | doi = 10.1097/DAD.0b013e3181c80b97 | PMID = 20526171 }}</ref>


===Microscopic===
===Microscopic===
Features:<ref name=Ref_Derm521>{{Ref Derm|521}}</ref>
Features:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
*Dermal lesion - '''key point'''.
*Poorly formed fasicles parallel to the skin surface, usu. restricted to the superficial dermis.
*Marked nuclear atypia.
*Moderate cellular density - less cellular than [[DFSP]].
*Mitoses.
*Eosinophilic cytoplasm.
*Mulitnucleated cells.
*Foamy cytoplasm - '''key feature'''.


DDx:
DDx:
*[[Melanoma]].
*[[DFSP]].
*[[Pleomorphic undifferentiated sarcoma]] (MFH).
*[[Dermatofibroma]].
*[[Leiomyosarcoma]].
*Sarcomatoid [[squamous carcinoma]].


Image:
Images:
*[http://dermatology.cdlib.org/141/case_reports/afx/1.jpg AFX (cdlib.org)].<ref pmid18319023>{{Cite journal  | last1 = Vandergriff | first1 = TW. | last2 = Reed | first2 = JA. | last3 = Orengo | first3 = IF. | title = An unusual presentation of atypical fibroxanthoma. | journal = Dermatol Online J | volume = 14 | issue = 1 | pages = 6 | month =  | year = 2008 | doi =  | PMID = 18319023 }}</ref>
*[http://www.dermpedia.org/node/8822 DMF - low mag. (dermpedia.org)].
*[http://www.dermpedia.org/node/8824 DMF - high mag. (dermpedia.org)].


===IHC===
===IHC===
Features:<ref name=Ref_Derm521>{{Ref Derm|521}}</ref>
Features:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
*S100 -ve (done to r/o melanoma).
*CD10 +ve.
*34betaE12 -ve, p63 -ve (done to exclude SCC).
*Vimentin +ve.
*Desmin -ve (done to r/o leiomyosarcoma).


=Benign=
Others:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
==Eccrine poroma==
*CD34 -ve.
*[[AKA]] ''nodular hidradenoma''. (???)
*Factor XIIIa -ve.
*S-100 -ve.


==Papillary eccrine adenoma==
*Abbreviated ''[[PEA]]''.
===General===
===General===
*Benign tumour arising from the distal sweat duct.
*Uncommon.
*Erythematous - gross.
*Benign.<ref name=pmid857729>{{Cite journal  | last1 = Rulon | first1 = DB. | last2 = Helwig | first2 = EB. | title = Papillary eccrine adenoma. | journal = Arch Dermatol | volume = 113 | issue = 5 | pages = 596-8 | month = May | year = 1977 | doi =  | PMID = 857729 }}</ref>
 
Treatment:
*Excision.<ref>URL: [http://archderm.jamanetwork.com/article.aspx?articleid=541159 http://archderm.jamanetwork.com/article.aspx?articleid=541159]. Accessed on: 10 December 2012.</ref>
===Gross===
*Central location.
 
Note:
*The ''digital papillary adenoma'' is considered malignant; the AFIP says these are best classified as ''adenocarcinomas'', i.e. ''[[digital papillary adenocarcinoma]]''.<ref name=pmid10843279>{{Cite journal  | last1 = Duke | first1 = WH. | last2 = Sherrod | first2 = TT. | last3 = Lupton | first3 = GP. | title = Aggressive digital papillary adenocarcinoma (aggressive digital papillary adenoma and adenocarcinoma revisited). | journal = Am J Surg Pathol | volume = 24 | issue = 6 | pages = 775-84 | month = Jun | year = 2000 | doi =  | PMID = 10843279 }}</ref>


===Microscopic===
===Microscopic===
Features:<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)70190-5 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)70190-5]. Accessed on: 2 July 2010.</ref>
Features:<ref name=pmid17642667>{{Cite journal  | last1 = Laxmisha | first1 = C. | last2 = Thappa | first2 = DM. | last3 = Jayanthi | first3 = S. | title = Papillary eccrine adenoma. | journal = Indian J Dermatol Venereol Leprol | volume = 70 | issue = 6 | pages = 370-2 | month =  | year =  | doi =  | PMID = 17642667 | URL = http://www.ijdvl.com/article.asp?issn=0378-6323;year=2004;volume=70;issue=6;spage=370;epage=372;aulast=Laxmisha }}</ref><ref name=pmid9793207/>
*Broad sheets of basaloid cells containing ductal structures - '''key feature'''.
*Well-circumscribed lesions consisting of multiple cystic spaces lined by a bilayered epithelium with:
*Biphasic stroma:
**Papillary projections into the lumen.
*#Edematous stroma.
**Amorphous eosinophilic material in the cystic spaces.
*#Sclerotic stroma.
**Surrounded by a fibrous stroma.<ref name=pmid9508346>{{Cite journal  | last1 = Mizuoka | first1 = H. | last2 = Senzaki | first2 = H. | last3 = Shikata | first3 = N. | last4 = Uemura | first4 = Y. | last5 = Tsubura | first5 = A. | title = Papillary eccrine adenoma: immunohistochemical study and literature review. | journal = J Cutan Pathol | volume = 25 | issue = 1 | pages = 59-64 | month = Jan | year = 1998 | doi =  | PMID = 9508346 }}</ref>
*Moderate nuclear pleomorphism.
 
*+/-Occasional mitoses.
Note:
*May appear to have more than two cell layers.
 
DDx:
*[[Digital papillary adenocarcinoma]] - location important.
*[[Tubular apocrine adenoma]] (tubulopapillary hidradenoma<ref name=pmid1566975>{{Cite journal  | last1 = Fox | first1 = SB. | last2 = Cotton | first2 = DW. | title = Tubular apocrine adenoma and papillary eccrine adenoma. Entities or unity? | journal = Am J Dermatopathol | volume = 14 | issue = 2 | pages = 149-54 | month = Apr | year = 1992 | doi =  | PMID = 1566975 }}</ref>) - a related tumour.<ref name=pmid8238787>{{Cite journal  | last1 = Ishiko | first1 = A. | last2 = Shimizu | first2 = H. | last3 = Inamoto | first3 = N. | last4 = Nakmura | first4 = K. | title = Is tubular apocrine adenoma a distinct clinical entity? | journal = Am J Dermatopathol | volume = 15 | issue = 5 | pages = 482-7 | month = Oct | year = 1993 | doi =  | PMID = 8238787 }}</ref>


Notes:
Image:
*Area above gland appears crusted.
*[http://www.ijdvl.com/viewimage.asp?img=ijdvl_2004_70_6_370_13482_2.jpg PEA - crappy image (ijdvl.com)].<ref name=pmid17642667/>


==Trichoepithelioma==
===IHC===
===General===
Outer layer of epithelium:<ref name=pmid9508346/>
*Benign.
*SMA-alpha +ve.  
**Maligant counterpart of trichoepithelioma: [[trichilemmal carcinoma]].  
*Keratin 14 +ve.  
*May be familial:  
Inner layer of epithelium:<ref name=pmid9508346/>
**Multiple familial trichoepithelioma.<ref name=pmid15289313>{{Cite journal  | last1 = Salhi | first1 = A. | last2 = Bornholdt | first2 = D. | last3 = Oeffner | first3 = F. | last4 = Malik | first4 = S. | last5 = Heid | first5 = E. | last6 = Happle | first6 = R. | last7 = Grzeschik | first7 = KH. | title = Multiple familial trichoepithelioma caused by mutations in the cylindromatosis tumor suppressor gene. | journal = Cancer Res | volume = 64 | issue = 15 | pages = 5113-7 | month = Aug | year = 2004 | doi = 10.1158/0008-5472.CAN-04-0307 | PMID = 15289313 }}</ref>
*Keratin 8 +ve.
**Brooke-Spiegler syndrome.


===Microscopic===
Other stains:<ref name=pmid9793207>{{Cite journal  | last1 = Guccion | first1 = JG. | last2 = Patterson | first2 = RH. | last3 = Nayar | first3 = R. | last4 = Saini | first4 = NB. | title = Papillary eccrine adenoma: an ultrastructural and immunohistochemical study. | journal = Ultrastruct Pathol | volume = 22 | issue = 3 | pages = 263-9 | month =  | year =  | doi =  | PMID = 9793207 }}</ref>
Features:<ref>URL: [http://emedicine.medscape.com/article/1060049-workup#a0723 http://emedicine.medscape.com/article/1060049-workup#a0723]. Accessed on: 31 August 2011.</ref>
*Vimentin +ve.
*Well-circumscribed cell nest in the superficial dermis.  
*CEA +ve.
*Surrounding by a fibrous stroma.  
*[[EMA]] +ve.
*Basaloid cells with [[peripheral pallisading]].
*S-100 +ve.
*+/-Surround keratin-filled cysts.
*Fibroblasts-like cell aggregate, similar to a follicular papillae (papillary-mesenchymal body).  


Notes:
===Sign out===
*Very rarely an artifical cleft - as in [[basal cell carcinoma]].
<pre>
SKIN LESION, LEFT PARIETAL SCALP, BIOPSY:
- PAPILLARY ECCRINE ADENOMA.
</pre>


Variants:
====Micro====
*Desmoplastic.
The sections show a well-circumscribed multi-locular superficial dermal lesion with a bilayered epithelium and intracystic papillary projections. The cystic spaces contain amorphous eosinophilic material. The cystic component is surrounded by a dense fibrous stroma with a mixed inflammatory infiltrate, consisting primary of plasma cells and lymphocytes.


DDx:
There is no significant nuclear atypia and no mitotic activity is appreciated. The overlying epidermis matures appropriately. A granular layer is present.
*[[Basal cell carcinoma]].


=See also=
=See also=
Michael
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