Sebaceoma on the scalp simulating a malignant pigmented neoplasia

The correct identification of pigmented nodular lesions of the scalp is often challenging. Despite the importance of clinical patterns and dermoscopy, important adjuvant tools that are usually helpful, their interpretation sometimes is not clear-cut. Here, the authors discuss a case of sebaceoma mimicking a malignant pigmented neoplasia, with conclusive histopathology.

KEYWORDS
Adenoma; Dermoscopy; Histology; Melanoma; Neoplasms; Sebaceous gland neoplasms; Sebaceous glands; Skin neoplasms; Trichoscopy

Authorship

Bárbara Catojo Poggi ^** Corresponding author. E-mail:baby_poggi@hotmail.com (B.C. Poggi).

Department of Dermatology, Hospital Naval Marcílio Dias, Rio de Janeiro, RJ, BrazilHospital Naval Marcílio DiasBrazilRio de Janeiro, RJ, BrazilDepartment of Dermatology, Hospital Naval Marcílio Dias, Rio de Janeiro, RJ, Brazil

http://orcid.org/0000-0002-3841-7114

Daniel Fernandes Melo

Postgraduate Program in Medical Sciences, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, BrazilUniversidade do Estado do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilPostgraduate Program in Medical Sciences, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

http://orcid.org/0000-0002-8807-2556

Juliana Marques da Costa

Clinic of Oncologic Dermatology and Dermatoscopy, Department of Dermatology, Hospital Naval Marcílio Dia, Rio de Janeiro, RJ, BrazilHospital Naval Marcílio DiaBrazilRio de Janeiro, RJ, BrazilClinic of Oncologic Dermatology and Dermatoscopy, Department of Dermatology, Hospital Naval Marcílio Dia, Rio de Janeiro, RJ, Brazil

http://orcid.org/0000-0003-0401-1068

Maria Auxiliadora Jeunon Sousa

ID - Investigação em Dermatologia, Rio de Janeiro, RJ, BrazilInvestigação em DermatologiaBrazilRio de Janeiro, RJ, BrazilID - Investigação em Dermatologia, Rio de Janeiro, RJ, Brazil

http://orcid.org/0000-0002-1549-1477

* Corresponding author. E-mail:baby_poggi@hotmail.com (B.C. Poggi).

Conflicts of interest

The authors declare no conflicts of interest.

Author's contribution

Bárbara Catojo Poggi: Elaboration and writing of the manuscript; obtaining, analyzing and interpreting the data.

Daniel Fernandes Melo: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; intellectual participation in propaedeutic and/or therapeutic conduct of the cases studied; critical review of the manuscript.

Juliana Marques da Costa: Approval of the final version of the manuscript; elaboration and writing of the manuscript; intellectual participation in propaedeutic and/or therapeutic conduct of the cases studied; critical review of the manuscript.

Maria Auxiliadora Jeunon Sousa: Approval of the final version of the manuscript; elaboration and writing of the manuscript; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of t.he cases studied; critical review of the literature; critical review of the manuscript.

SCIMAGO INSTITUTIONS RANKINGS

ID - Investigação em Dermatologia, Rio de Janeiro, RJ, BrazilInvestigação em DermatologiaBrazilRio de Janeiro, RJ, BrazilID - Investigação em Dermatologia, Rio de Janeiro, RJ, Brazil

Figures

Figures (5)

Thumbnail

Figure 1
Blackened nodule upon erythematous base with central crust at the apex of the scalp.

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Figure 2
Hematic crust and peripheral red-milky area with poorly defined globules on dermoscopy.

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Figure 3
Pathological features of sebaceoma. Regularly contoured epithelial neoplasia arranged in “v” with the apex pointing toward the depth. There is acanthosis on the left and predominance of dermal masses on the right, conferring intrinsic asymmetry, an unusual characteristic for this type of proliferation. The masses have regular shapes and sizes, are predominantly rounded or oval, and are immersed in collagenized stroma. In this panoramic magnification, it is already possible to perceive clusters of epithelial cells of pale cytoplasm permeating the masses; this is representative of mature sebocytes (hematoxylin and eosin, ×20).

Thumbnail

Figure 4
Pathological features of sebaceoma. Detail of epithelial massive arranged in the dermis. The predominance of vesicle-like epithelial cells and scarce cytoplasm (immature sebocytes) can be noted, which are less permeated by pale cytoplasm cells, containing lipid vacuoles, some with indented nuclei (mature sebocytes), randomly arranged and associated with ducts. There is absence of palisade in the periphery of the masses (hematoxylin and eosin, ×200).

Thumbnail

Figure 5
Immunohistochemical staining of the skin biopsy: positivity in the immunohistochemical reaction with the anti-EMA antibody in a cytoplasmic reticular pattern around the lipid vacuoles (original magnification of ×400).

Figure 1 Blackened nodule upon erythematous base with central crust at the apex of the scalp.

Figure 2 Hematic crust and peripheral red-milky area with poorly defined globules on dermoscopy.

Figure 3 Pathological features of sebaceoma. Regularly contoured epithelial neoplasia arranged in “v” with the apex pointing toward the depth. There is acanthosis on the left and predominance of dermal masses on the right, conferring intrinsic asymmetry, an unusual characteristic for this type of proliferation. The masses have regular shapes and sizes, are predominantly rounded or oval, and are immersed in collagenized stroma. In this panoramic magnification, it is already possible to perceive clusters of epithelial cells of pale cytoplasm permeating the masses; this is representative of mature sebocytes (hematoxylin and eosin, ×20).

Figure 4 Pathological features of sebaceoma. Detail of epithelial massive arranged in the dermis. The predominance of vesicle-like epithelial cells and scarce cytoplasm (immature sebocytes) can be noted, which are less permeated by pale cytoplasm cells, containing lipid vacuoles, some with indented nuclei (mature sebocytes), randomly arranged and associated with ducts. There is absence of palisade in the periphery of the masses (hematoxylin and eosin, ×200).

Figure 5 Immunohistochemical staining of the skin biopsy: positivity in the immunohistochemical reaction with the anti-EMA antibody in a cytoplasmic reticular pattern around the lipid vacuoles (original magnification of ×400).

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Sebaceoma on the scalp simulating a malignant pigmented neoplasia

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[1] * Corresponding author. E-mail:baby_poggi@hotmail.com (B.C. Poggi).