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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 73-year-old Japanese woman visited our department complaining of a nodule on the scalp which had appeared four years previously&#46; Physical examination revealed a 12-mm semi-pedunculated black nodule on the left side of the head &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Dermoscopic examination showed large blue-gray ovoid nest-like structures&#44; irregularly dilated vessels&#44; and erosions&#46; Histopathological examination showed a nodular tumor extending from the epidermis into the mid-dermis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The tumor was composed of small round cells that had a high nucleocytoplasmic ratio&#44; with small pores&#44; which are features of sweat duct differentiation features of poroid differentiation into small ductal structures &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; There were no histopathological features suggestive of basal cell carcinoma &#40;BCC&#41;&#46; Some of the tumor cells contained melanin granules&#44; and an increased number of melanocytes&#44; confirmed by HMB-45 staining and MART-1 staining&#44; was observed within the nests&#46; Also&#44; many melanophages were observed in the stroma&#46; After making a diagnosis by punch biopsy&#44; the nodule was removed under local anesthesia&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Eccrine poroma is a benign adnexal tumor mainly composed of poroid cells and often present as a reddish nodule&#46; While eccrine poroma does not appear to have a bias for occurrence between races&#44; pigmented variants of eccrine poroma often develop in non-white races&#46; Pigmented eccrine poroma have been reported especially from Japan&#44; and according to a clinicopathological analysis in Japan&#44; among the 421 cases with pathological diagnosis of poroid cell neoplasms&#44; 114 cases &#40;27&#46;1&#37;&#41; had melanin pigment in the tumor cells&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">As shown in the present case&#44; pigmented eccrine poroma on the scalp can clinically mimic BCC&#46; Previous studies have shown that pigmented eccrine poroma has dermoscopic findings of arborizing vessels and blue-gray ovoid nests&#44; and pigmented eccrine poroma on the face was clinically similar to BCC&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In the present case&#44; the gross pathology are similar to those of BCC&#46; In addition&#44; since there were no dermoscopic findings of seborrheic keratosis or malignant melanoma&#44; and the scalp is one of the most frequent areas where BCC occurs&#44; the lesion was suspected to be BCC until the biopsy&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Minagawa and Koga found in their case series study that the most frequent dermoscopic structures in pigmented eccrine poromas were vascular structures such as arborizing vessels&#44; hairpin vessels&#44; and polymorphous vessels&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However&#44; the dermoscopic characteristics of other skin tumors such as globule-like structures and comedo-like openings were also found in pigmented eccrine poromas&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> One possible reason why pigmented eccrine poroma shows similar dermoscopic findings to BCC and&#47;or seborrheic keratosis is that&#44; as both of these tumors are classified into appendage tumors&#44; their rough structures are similar&#44; and they are distinguished only by pathological findings that cannot be observed by dermoscopy&#46; Although Bombonato et al&#46; suggested that reflectance confocal microscopy may be useful for diagnosing pigmented eccrine poroma&#44; biopsy is still essential for the diagnosis in order to avoid misdiagnosis and overtreatment&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In conclusion&#44; considering the lack of established specific dermoscopic criteria for pigmented eccrine poroma&#44; pigmented eccrine poroma on the scalp should be biopsied for histopathologic confirmation of the diagnosis&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec1005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect1005">Authors&#8217; contributions</span><p id="par1025" class="elsevierStylePara elsevierViewall">Masato Ishikawa&#58; Designed the study&#59; performed the research and contributed to analysis and interpretation of data&#59; wrote the initial draft of the manuscript&#59; read and approved the final version of the manuscript&#46;</p><p id="par1020" class="elsevierStylePara elsevierViewall">Mikio Ohtsuka&#58; Performed the research and contributed to analysis and interpretation of data&#59; read and approved the final version of the manuscript&#46;</p><p id="par2020" class="elsevierStylePara elsevierViewall">Toshiyuki Yamamoto&#58; Designed the study&#59; assisted in the preparation of the manuscript&#59; read and approved the final version of the manuscript&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Case Letter
Pigmented poroma on the scalp clinically mimicking basal cell carcinoma
Masato Ishikawa
Autor para correspondência
ishimasa@fmu.ac.jp

Corresponding author.
, Mikio Ohtsuka, Toshiyuki Yamamoto
Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A clinical appearance of semi-pedunculated black nodule on the left side of the head&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 73-year-old Japanese woman visited our department complaining of a nodule on the scalp which had appeared four years previously&#46; Physical examination revealed a 12-mm semi-pedunculated black nodule on the left side of the head &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Dermoscopic examination showed large blue-gray ovoid nest-like structures&#44; irregularly dilated vessels&#44; and erosions&#46; Histopathological examination showed a nodular tumor extending from the epidermis into the mid-dermis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The tumor was composed of small round cells that had a high nucleocytoplasmic ratio&#44; with small pores&#44; which are features of sweat duct differentiation features of poroid differentiation into small ductal structures &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; There were no histopathological features suggestive of basal cell carcinoma &#40;BCC&#41;&#46; Some of the tumor cells contained melanin granules&#44; and an increased number of melanocytes&#44; confirmed by HMB-45 staining and MART-1 staining&#44; was observed within the nests&#46; Also&#44; many melanophages were observed in the stroma&#46; After making a diagnosis by punch biopsy&#44; the nodule was removed under local anesthesia&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Eccrine poroma is a benign adnexal tumor mainly composed of poroid cells and often present as a reddish nodule&#46; While eccrine poroma does not appear to have a bias for occurrence between races&#44; pigmented variants of eccrine poroma often develop in non-white races&#46; Pigmented eccrine poroma have been reported especially from Japan&#44; and according to a clinicopathological analysis in Japan&#44; among the 421 cases with pathological diagnosis of poroid cell neoplasms&#44; 114 cases &#40;27&#46;1&#37;&#41; had melanin pigment in the tumor cells&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">As shown in the present case&#44; pigmented eccrine poroma on the scalp can clinically mimic BCC&#46; Previous studies have shown that pigmented eccrine poroma has dermoscopic findings of arborizing vessels and blue-gray ovoid nests&#44; and pigmented eccrine poroma on the face was clinically similar to BCC&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In the present case&#44; the gross pathology are similar to those of BCC&#46; In addition&#44; since there were no dermoscopic findings of seborrheic keratosis or malignant melanoma&#44; and the scalp is one of the most frequent areas where BCC occurs&#44; the lesion was suspected to be BCC until the biopsy&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Minagawa and Koga found in their case series study that the most frequent dermoscopic structures in pigmented eccrine poromas were vascular structures such as arborizing vessels&#44; hairpin vessels&#44; and polymorphous vessels&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However&#44; the dermoscopic characteristics of other skin tumors such as globule-like structures and comedo-like openings were also found in pigmented eccrine poromas&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> One possible reason why pigmented eccrine poroma shows similar dermoscopic findings to BCC and&#47;or seborrheic keratosis is that&#44; as both of these tumors are classified into appendage tumors&#44; their rough structures are similar&#44; and they are distinguished only by pathological findings that cannot be observed by dermoscopy&#46; Although Bombonato et al&#46; suggested that reflectance confocal microscopy may be useful for diagnosing pigmented eccrine poroma&#44; biopsy is still essential for the diagnosis in order to avoid misdiagnosis and overtreatment&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In conclusion&#44; considering the lack of established specific dermoscopic criteria for pigmented eccrine poroma&#44; pigmented eccrine poroma on the scalp should be biopsied for histopathologic confirmation of the diagnosis&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec1005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect1005">Authors&#8217; contributions</span><p id="par1025" class="elsevierStylePara elsevierViewall">Masato Ishikawa&#58; Designed the study&#59; performed the research and contributed to analysis and interpretation of data&#59; wrote the initial draft of the manuscript&#59; read and approved the final version of the manuscript&#46;</p><p id="par1020" class="elsevierStylePara elsevierViewall">Mikio Ohtsuka&#58; Performed the research and contributed to analysis and interpretation of data&#59; read and approved the final version of the manuscript&#46;</p><p id="par2020" class="elsevierStylePara elsevierViewall">Toshiyuki Yamamoto&#58; Designed the study&#59; assisted in the preparation of the manuscript&#59; read and approved the final version of the manuscript&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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