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Dermoscopy case of the month
In vivo characterization of recurrent dermatofibrosarcoma protuberans by dermoscopy and reflectance confocal microscopy

https://doi.org/10.1016/j.jaad.2016.03.005Get rights and content

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Clinical presentation

A 54-year-old woman presented with a 3- × 4-cm asymptomatic brown plaque overlying a linear scar, resulting from the removal of a cystlike lesion on the abdomen a year earlier. No histologic examination was performed (Fig 1, A).

Dermoscopic appearance

The dermoscopic examination showed central linear white and pink areas surrounded by structureless light-brown areas with focal pigmented reticular lines. No vascular pattern were seen. We performed an incisional biopsy of the pink area (Fig 1, B).

In vivo reflectance confocal microscopic appearance

At the epidermal level we observed normal stratum granulosum and spinosum that resembled a honeycomb pattern with dark nuclei surrounded by bright-white cytoplasm.

The dermoepidermal junction displayed a focal loss of normal “edged papillae” (dark, round areas surrounded by bright rings of the basal layer cells) (Fig 2) with bright elongated cells in the papillary dermis corresponding to spindled tumor cells (Fig 2, B).

Histologic diagnosis

Histopathological examination revealed oval to spindle-shaped cells arranged in a storiform pattern in the dermis (Fig 3, A). Immunohistochemistry was positive for CD34 cells (Fig 3, B), which had reached the overlying epidermis. Dermatofibrosarcoma protuberans was diagnosed.

Key message

Dermatofibrosarcoma protuberans may be very difficult to identify on the basis of clinical and dermoscopic features, in particular in the presence of scars. Because of the variability in the dermoscopic patterns,

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Funding sources: None.

Conflicts of interest: None declared.

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