Dear Editor,
A 52-year-old male patient, phototype IV, with significant photodamage complained of a painful chest lesion, with a progressive increase in the 6 previous months. During the physical examination, he had an erythematous plaque measuring 4 × 8 cm, with yellowish crusts and violaceous borders on the left anterosuperior thorax region (Fig. 1). Dermoscopy was inconclusive due to the presence of nonspecific yellowish crusts on the lesion (Fig. 2).
After applying wet compresses with saline solution, the crusts were carefully removed. To avoid contact with the lesion surface, polarized light dermoscopy was performed, which demonstrated the presence of glomerular vessels, suggestive of Bowen's disease (BD) (Fig. 3).11 Braun RP, Rabinovitz HS, Oliviero M, Kopf AW, Saurat J-H. Dermoscopy of pigmented skin lesions. J Am Acad Dermatol. 2005;52:109-21. In view of this picture, an excisional biopsy was performed. Histopathological examination confirmed the diagnosis of BD.
Dermoscopy is important in the diagnosis of pigmented and non-pigmented lesions.11 Braun RP, Rabinovitz HS, Oliviero M, Kopf AW, Saurat J-H. Dermoscopy of pigmented skin lesions. J Am Acad Dermatol. 2005;52:109-21. In non-pigmented lesions, the vascular pattern can lead to the diagnosis, but in the reported case, it was not possible to achieve the diagnosis due to the presence of crusts. The presence of yellowish crusts at dermoscopy has been previously described in 78.8% of 146 evaluated BD lesions, but it is not specific, and the presence of crusts alone is not a sufficient criterion for this diagnosis.22 Yang Y, Lin J, Fang S, Han S, Song Z. What’s new in dermoscopy of Bowen’s disease: two new dermoscopic signs and its differential diagnosis. Int J Dermatol. 2017;56:1022-5.,33 Shakya NM, LeAnder RW, Hinton KA, Stricklin SM, Rader RK, Hagerty J, et al. Discrimination of squamous cell carcinoma in situ from seborrheic keratosis by color analysis techniques requires information from scale, scale-crust and surrounding areas in dermoscopy images. Comput Biol Med. 2012;42:1165-9. In crusted lesions, the removal of the crusts may allow the observation of other dermoscopic structures that can help achieve the diagnosis. The removal of crusts should be performed with caution to avoid damage to the epithelium because this maneuver can allow the observation of other dermoscopic structures that make the diagnosis possible.
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Study conducted at the Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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Financial supportNone declared.
References
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1Braun RP, Rabinovitz HS, Oliviero M, Kopf AW, Saurat J-H. Dermoscopy of pigmented skin lesions. J Am Acad Dermatol. 2005;52:109-21.
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2Yang Y, Lin J, Fang S, Han S, Song Z. What’s new in dermoscopy of Bowen’s disease: two new dermoscopic signs and its differential diagnosis. Int J Dermatol. 2017;56:1022-5.
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3Shakya NM, LeAnder RW, Hinton KA, Stricklin SM, Rader RK, Hagerty J, et al. Discrimination of squamous cell carcinoma in situ from seborrheic keratosis by color analysis techniques requires information from scale, scale-crust and surrounding areas in dermoscopy images. Comput Biol Med. 2012;42:1165-9.
Publication Dates
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Publication in this collection
26 July 2021 -
Date of issue
May-Jun 2021
History
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Received
20 Nov 2019 -
Accepted
30 June 2020