Case Letter
Basaloid follicular hamartoma following Blaschko’s lines
Gabriela Martins de Queiroz
, Tayla Cristina Lopes, Maria Clara Dantas Valle Soares, Carlos Bruno Fernandes Lima
Corresponding author
Universidade Potiguar, Natal, RN, Brazil
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Hypopigmented lesions appeared at 15 days of life on the facial region, and evolved in the first year of life to hyperchromic lesions, spreading to the cervical region and trunk. The lesions have been stable and asymptomatic since that time. The mother denied comorbidities or associated symptoms. The patient does not have any family history of similar lesions, neoplasms, or autoimmune diseases.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">On dermoscopy, the lesions were non-specific with a homogeneous brownish color and with structures similar to follicular crypts or openings (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathological examination (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) showed a well-circunscribed, basaloid, epithelioid cell proliferation in the superficial dermis, forming strands and islets in a radial pattern. Thus, a diagnosis of multiple basaloid follicular hamartomas was made.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Basaloid follicular hamartoma (BFH) consists of the proliferation of multifocal basaloid cells, with frequent connection to the epidermis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> BFH lesions may present as papules, nodules, or plaques, which may be skin-colored or hyperchromic. The cells are folliculocentric and restricted to the superficial dermis. The hair follicles are distorted, with branching strands from basaloid cells.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> The present case showed a distribution of basaloid cells in strands and islets with a radial pattern in the superficial dermis, which clinically followed the embryological lines.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The main differential diagnosis of BFH is basal cell carcinoma (BCC). Both consist histopathologically of basaloid strands of cells in a fibrous stroma, but the BCC is not folliculocentric and can be seen in the interfollicular dermis.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Acquired BFH can show a linear pattern, following the lines of Blaschko - occurring due to mosaicism - or in a generalized form - commonly associated with autoimmune diseases.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In the case described herein, BFH clones were distributed along the Blaschko lines, representing ectodermal development patterns, which is a rare distribution. When a somatic mutation or chromosomal nondisjunction occurs during embryogenesis, affecting an epidermal progenitor cell, the affected offspring cells proliferate and migrate along the lines of Blaschko.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Currently, there is no standard treatment for BFH. Correct identification prevents patients from undergoing unnecessary surgery and also allows periodic monitoring to detect malignant transformations. Lesions that increase in size or change in appearance should be biopsied whenever detected. If associated with an autoimmune disease, treatment of the comorbidity may lead to the regression of the associated skin lesions.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In summary, BFH is a rare type of benign skin tumor, with different presentations, which can be congenital or acquired. Its main differential diagnosis is basal cell carcinoma, and histopathology should be performed for differentiation. There is yet no standard treatment for this condition and, in most cases, it is not necessary.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0055" class="elsevierStylePara elsevierViewall">Gabriela Martins de Queiroz: Collection, analysis, and interpretation of data; design, planning, drafting and writing of the manuscript; critical review of the literature; critical review of the manuscript; approval of the final version of the manuscript.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Tayla Cristina Lopes: Collection, analysis, and interpretation of data; design, planning, drafting and writing of the manuscript; critical review of the literature; critical review of the manuscript; approval of the final version of the manuscript.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Maria Clara Dantas Valle Soares: Analysis and interpretation of data; drafting and writing of the manuscript; critical review of the literature; critical review of the manuscript; approval of the final version of the manuscript.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Carlos Bruno Fernandes Lima: Analysis and interpretation of data, design and planning of the manuscript; critical review of the literature; critical review of the manuscript; approval of the final version of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-08-28" "fechaAceptado" => "2020-10-23" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Hospital Infantil Varela Santiago, Natal, RN, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2197 "Ancho" => 1675 "Tamanyo" => 349042 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hyperpigmented unilateral linear papular lesions; some are verrucous, on the face and neck..</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2230 "Ancho" => 1675 "Tamanyo" => 389336 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy showing brownish, crypt-like structures.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1628 "Ancho" => 2175 "Tamanyo" => 960831 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Proliferation of basaloid epithelioid cells in strands and islets showing a radial pattern (Hematoxylin & eosin, ×200).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumours of the skin appendages" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. 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| 2024 November | 23 | 8 | 31 |
| 2024 October | 134 | 61 | 195 |
| 2024 September | 157 | 96 | 253 |
| 2024 August | 199 | 114 | 313 |
| 2024 July | 153 | 109 | 262 |
| 2024 June | 115 | 100 | 215 |
| 2024 May | 97 | 79 | 176 |
| 2024 April | 111 | 100 | 211 |
| 2024 March | 96 | 70 | 166 |
| 2024 February | 114 | 87 | 201 |
| 2024 January | 78 | 69 | 147 |
| 2023 December | 73 | 67 | 140 |
| 2023 November | 124 | 87 | 211 |
| 2023 October | 104 | 73 | 177 |
| 2023 September | 115 | 77 | 192 |
| 2023 August | 99 | 33 | 132 |
| 2023 July | 96 | 37 | 133 |
| 2023 June | 76 | 61 | 137 |
| 2023 May | 62 | 24 | 86 |
| 2023 April | 40 | 16 | 56 |
| 2023 March | 61 | 42 | 103 |
| 2023 February | 49 | 42 | 91 |
| 2023 January | 69 | 52 | 121 |
| 2022 December | 79 | 49 | 128 |
| 2022 November | 114 | 95 | 209 |
| 2022 October | 101 | 80 | 181 |
| 2022 September | 24 | 25 | 49 |
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