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Histopathology revealed a well-circumscribed&#44; multinodular&#44; asymmetrically pigmented dermal tumor&#44; with no connection to the overlying epidermis&#46; It was composed of basaloid cells with scant cytoplasm and distinct nucleoli&#44; showing moderate pleomorphism and 10 mitoses per 10 high-power fields&#46; Occasional aggregates of shadow cells were also observed&#46; Heavily pigmented dendritic melanocytes without atypia were scattered among basaloid cells&#44; forming small clusters&#46; There was no necrosis or calcification in the tumor &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Basaloid cells were positive for cytokeratin AE1&#47;AE3&#44; cytokeratin 5&#47;6&#44; and beta-catenin&#44; and the melanocytic component was highlighted by HMB-45 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; These findings were consistent with the diagnosis of melanocytic matricoma&#46; There is no evidence of local recurrence or metastasis 26 months after excision&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Melanocytic matricoma typically presents as a sharply demarcated&#44; small &#40;generally smaller than 1&#8239;cm&#41; unevenly pigmented papule or nodule&#44; arising on sun-damaged skin of elderly individuals&#44; with a male predominance&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> Histologically&#44; it is a well-circumscribed nodular or multinodular dermal biphasic neoplasm&#44; composed of epithelial cells with matrical differentiation and melanocytes&#46; The epithelial component consists of basaloid matrical and supramatrical cells&#44; which are mild to moderately pleomorphic and mitotically active&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Small aggregates of eosinophilic shadow cells can also be present&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Dendritic melanocytes without atypia are scattered among epithelial cells and show strong pigmentation&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The epithelial component shows positivity for cytokeratin and beta-catenin&#44; whereas dendritic melanocytes are highlighted by HMB-45&#44; S-100 and Melan-A&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Cases with atypical histologic features have been reported&#44; such as melanocytic atypia&#44; epidermal connection&#44; calcification&#44; granulomatous inflammation&#44; epidermal consumption&#44; or cystic degeneration&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> None of these features were present in the present case&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Clinical differential diagnosis of this entity includes malignant melanoma&#44; pigmented Basal Cell Carcinoma &#40;BCC&#41;&#44; and hemangioma&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Histopathological differential diagnosis includes tumors with matrical differentiation&#44; such as pilomatricoma with melanocytic hyperplasia&#44; malignant pilomatricoma&#44; matricoma&#44; BCC with matrical differentiation<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and&#44; most challengingly&#44; malignant melanocytic matricoma&#44; an extremely rare tumor with only 8 reported cases&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Proposed criteria for differentiating benign and malignant melanocytic matricoma remain controversial<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5</span></a>&#59; recurrence&#44; metastasis&#44; necrosis&#44; ulceration&#44; an infiltrative growth pattern with pushing borders&#44; and marked cytological atypia would suggest malignancy&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5</span></a> but according to some authors&#44; a high mitotic rate would not constitute a reliable criterion of aggressive behavior&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Despite being considered a benign tumor&#44; 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contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">I&#241;igo Aranguren-L&#243;pez&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Sara Ibarbia-Oruezabal&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Nerea Segu&#233;s-Merino&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Case Letter
Melanocytic matricoma: a rare tumor that can mimic melanoma
Iñigo Aranguren-Lópeza,
Corresponding author
i_arlo_4@hotmail.com

Corresponding author.
, Sara Ibarbia-Oruezabala, Nerea Segués-Merinob
a Department of Dermatology, Hospital Universitario Donostia, San Sebastián, Spain
b Department of Pathology, Hospital Universitario Donostia, San Sebastián, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Melanocytic matricoma is a rare benign cutaneous adnexal tumor that recapitulates the early anagen hair follicle&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It was first described in 1999&#44; and to date&#44; there are approximately 20 published cases in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 60-year-old man with HIV under antiretroviral therapy presented with a 2-month history of a rapidly growing papule affecting his left preauricular area&#46; Physical examination showed a well-defined 6&#8239;mm papule with an uneven coloration ranging from pink to grey &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Complete surgical excision of the tumor was performed&#46; Histopathology revealed a well-circumscribed&#44; multinodular&#44; asymmetrically pigmented dermal tumor&#44; with no connection to the overlying epidermis&#46; It was composed of basaloid cells with scant cytoplasm and distinct nucleoli&#44; showing moderate pleomorphism and 10 mitoses per 10 high-power fields&#46; Occasional aggregates of shadow cells were also observed&#46; Heavily pigmented dendritic melanocytes without atypia were scattered among basaloid cells&#44; forming small clusters&#46; There was no necrosis or calcification in the tumor &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Basaloid cells were positive for cytokeratin AE1&#47;AE3&#44; cytokeratin 5&#47;6&#44; and beta-catenin&#44; and the melanocytic component was highlighted by HMB-45 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; These findings were consistent with the diagnosis of melanocytic matricoma&#46; There is no evidence of local recurrence or metastasis 26 months after excision&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Melanocytic matricoma typically presents as a sharply demarcated&#44; small &#40;generally smaller than 1&#8239;cm&#41; unevenly pigmented papule or nodule&#44; arising on sun-damaged skin of elderly individuals&#44; with a male predominance&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> Histologically&#44; it is a well-circumscribed nodular or multinodular dermal biphasic neoplasm&#44; composed of epithelial cells with matrical differentiation and melanocytes&#46; The epithelial component consists of basaloid matrical and supramatrical cells&#44; which are mild to moderately pleomorphic and mitotically active&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Small aggregates of eosinophilic shadow cells can also be present&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Dendritic melanocytes without atypia are scattered among epithelial cells and show strong pigmentation&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The epithelial component shows positivity for cytokeratin and beta-catenin&#44; whereas dendritic melanocytes are highlighted by HMB-45&#44; S-100 and Melan-A&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Cases with atypical histologic features have been reported&#44; such as melanocytic atypia&#44; epidermal connection&#44; calcification&#44; granulomatous inflammation&#44; epidermal consumption&#44; or cystic degeneration&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> None of these features were present in the present case&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Clinical differential diagnosis of this entity includes malignant melanoma&#44; pigmented Basal Cell Carcinoma &#40;BCC&#41;&#44; and hemangioma&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Histopathological differential diagnosis includes tumors with matrical differentiation&#44; such as pilomatricoma with melanocytic hyperplasia&#44; malignant pilomatricoma&#44; matricoma&#44; BCC with matrical differentiation<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and&#44; most challengingly&#44; malignant melanocytic matricoma&#44; an extremely rare tumor with only 8 reported cases&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Proposed criteria for differentiating benign and malignant melanocytic matricoma remain controversial<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5</span></a>&#59; recurrence&#44; metastasis&#44; necrosis&#44; ulceration&#44; an infiltrative growth pattern with pushing borders&#44; and marked cytological atypia would suggest malignancy&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5</span></a> but according to some authors&#44; a high mitotic rate would not constitute a reliable criterion of aggressive behavior&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Despite being considered a benign tumor&#44; the clinical behavior of melanocytic matricoma remains unknown because of the few reported cases and the lack of long-term follow-up&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4&#44;5</span></a> Therefore&#44; complete surgical excision and periodic re-examinations are recommended&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5</span></a> Dermatologists and dermatopathologists should be aware of this rare entity when facing a pigmented lesion with a dual epithelial&#47;melanocytic component to avoid misdiagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">I&#241;igo Aranguren-L&#243;pez&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Sara Ibarbia-Oruezabal&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Nerea Segu&#233;s-Merino&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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ISSN: 03650596
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Idiomas
Anais Brasileiros de Dermatologia
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