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Dermatopathology, Volume 12, Issue 2 (June 2025) – 6 articles

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14 pages, 7504 KiB

Open AccessArticle

Cutaneous Metastases—Histological Particularities of Multifaceted Entities

by Andreea Cătălina Tinca, Bianca Andreea Lazar, Andreea Raluca Cozac-Szőke, Georgian Nicolae Radu, Simina Petra Simion, Diana Maria Chiorean, Irina Bianca Kosovski, Adrian Horațiu Sabău, Raluca Niculescu, Iuliu Gabriel Cocuz, Raluca-Diana Hagău, Emoke Andrea Szasz, Sabin Gligore Turdean and Ovidiu Simion Cotoi

Dermatopathology 2025, 12(2), 14; https://doi.org/10.3390/dermatopathology12020014 - 25 Apr 2025

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Abstract

Cutaneous metastases from internal organ cancers are diagnosed in approximately 0.2% of skin biopsies. This diagnosis can be the first sign of a previously undiagnosed malignancy with an internal organ origin. We conducted a retrospective study that included all cases of cutaneous metastases diagnosed in our hospital. A total of 25 patients were identified (14 females and 11 males). The average age of the patients included was 62.3. The most common primary cancer site was the lung for male patients, while for female patients it was the breast. In seven of our cases, cutaneous metastases were the first sign of an internal organ cancer. Common sites for cutaneous metastases in our study involved the anterior thoracic wall, the abdomen, and the scalp. Our study aims to highlight the importance of recognizing the histopathology of metastatic tumors and differentiating them from primary skin neoplasms. Immunohistochemistry is a mandatory tool for differential diagnosis in all cases, especially for patients who do not have a history of neoplasia. Full article

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15 pages, 1682 KiB

Open AccessReview

A Scoping Review on Melasma Treatments and Their Histopathologic Correlates

by Aurore D. Zhang, Michelle Lazar, Emiliya Akhundova, Candice E. Brem, Eric J. Beltrami and Neelam A. Vashi

Dermatopathology 2025, 12(2), 13; https://doi.org/10.3390/dermatopathology12020013 - 11 Apr 2025

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Abstract

Melasma is an incredibly common dyschromic disorder, mostly impacting women with skin of color. There are three variants of melasma based on the depth of pathologic involvement: epidermal, mixed, and dermal. While there are many treatments for melasma, there is a paucity of research on melasma treatments and their dermatopathological correlates. A scoping review was conducted of all human trials on melasma with histopathologic analysis, including 37 trials in the final analysis. Most studies were conducted on women with a Fitzpatrick skin type of III or greater. Strong histologic evidence supports the utilization of retinols/retinoids for epidermal melasma and microneedling for dermal melasma. There is a paucity of trials conducted on melasma utilizing histologic correlates, and fewer still that are comprehensive to include analyses on quality of life. Full article

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11 pages, 5246 KiB

Open AccessCase Report

Congenital Melanocytic Nevus with Neurocristic Cutaneous Hamartoma: A Case Report

by Dina El-Rayes, Katlin Wilson, Sheilagh Maguiness, Daniel Miller, Gerardo Cazzato and Alessio Giubellino

Dermatopathology 2025, 12(2), 12; https://doi.org/10.3390/dermatopathology12020012 - 10 Apr 2025

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Abstract

Congenital melanocytic nevi (CMN) are benign tumors present at birth or arising in the first few months of life. A small subset of these nevi present with mild atypical features and heterogeneous differentiation, including Schwannian differentiation. We present a case of a 3-week-old with a 7 cm red/purple scalp nodule consistent with CMN with mild atypical heterogeneous areas. On histology, there were dermal nests of spindle cells in a fibrillar matrix, with increased vessels and clusters of small round melanocytes interspersed between collagen bundles and around adnexal structures. The lesion also exhibited rare pagetoid ascent of melanocytes as single cells and nests. Overall, these features were consistent with a CMN with nodular proliferative neurocristic cutaneous hamartoma (NCH) with a component of a compound mild atypical melanocytic proliferation. Next generation sequencing (NGS) identified a novel SH2B1::BRAF fusion. This case highlights the diagnostic challenges of heterogeneous differentiation within CMN in young children. Full article

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33 pages, 5157 KiB

Open AccessSystematic Review

Dermatomyositis-like Eruptions, Hydroxyurea-Associated Squamous Dysplasia, and Nonmelanoma Skin Cancer: A Case Report and Systematic Review

by Giorgia Di Marco, Gianmarco Diego Bigotto, Eleonora Cossar, Nathalie Rizzo, Stefania Guida and Franco Rongioletti

Dermatopathology 2025, 12(2), 11; https://doi.org/10.3390/dermatopathology12020011 - 30 Mar 2025

Viewed by 326

Abstract

Hydroxyurea (HU), a cornerstone treatment for myeloproliferative disorders, is associated with a wide range of cutaneous side effects, from xerosis and hyperpigmentation to more severe conditions like dermatomyositis-like eruptions (DM-LE) and nonmelanoma skin cancers (NMSC), particularly squamous cell carcinoma (SCC). In this review, we present a unique case of HU-induced DM-LE with histological evidence of keratinocyte dysplasia and p53 overexpression, followed by a systematic analysis of similar cases. Our findings reveal that the clinical presentation of DM-LE, while typically considered benign, shares clinical and histological features with hydroxyurea-associated squamous dysplasia (HUSD), a precancerous condition that may progress to SCC in chronically exposed patients. Key insights include the characteristic histopathological findings of DM-LE, the role of chronic HU therapy and UV-induced damage in promoting p53 overexpression, and the overlap between DM-LE and HUSD. Regular dermatologic monitoring, patient education on photoprotection, and the careful assessment of skin lesions in long-term HU users are essential for the early detection and prevention of malignancies. This review underscores the importance of distinguishing between DM-LE, HUSD, and SCC to optimize management and minimize risks associated with HU therapy. Full article

(This article belongs to the Section Clinico-Pathological Correlation in Dermatopathology)

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7 pages, 1514 KiB

Open AccessCase Report

Uncommon Collision Tumors: Dermoscopic and Histopathological Features of Basal Cell Carcinoma Overlying Dermatofibroma

by Amal Makansi, Charlotta Enerbäck, Maria Madentzoglou, Georgios Kravvas and Sandra Jerkovic Gulin

Dermatopathology 2025, 12(2), 10; https://doi.org/10.3390/dermatopathology12020010 - 25 Mar 2025

Viewed by 698

Abstract

Dermatofibromas (DFs) represent prevalent benign fibrohistiocytic tumors, typically manifesting as solitary lesions. In the majority of cases, the clinical presentation and dermoscopic and histopathological features of DFs adhere to a characteristic profile. However, DFs may exhibit atypical clinical presentations and, more commonly, histologic attributes, posing challenges in differential diagnosis. Both DFs and basal cell carcinomas (BCCs) are frequently encountered cutaneous lesions, each characterized by distinct clinical and dermoscopic features and microscopic morphology. The simultaneous occurrence of these two entities within the same lesion is rare. DFs have been documented to form collision tumors in conjunction with a spectrum of benign and malignant lesions, encompassing not only BCC but also balloon cell nevus, squamous cell carcinoma (SCC), and melanoma. Alterations in the epidermis overlaying a DF range from simple hyperplasia to the proliferation of basaloid cells. Accurate diagnosis, leading to the complete excision of the lesion, is contingent upon the recognition of dermoscopic criteria, precluding misinterpretation as a benign lesion. We present two cases of collision tumors comprising DF and BCC. This case report underscores the paramount importance of dermoscopy and adherence to dermoscopic criteria in the assessment of collision lesions and the diagnostic process related to cutaneous malignancies. Full article

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10 pages, 11966 KiB

Open AccessReview

Postherpetic Pseudolymphomatous Angiosarcoma Concealed Within Milia en Plaque: Expanding the Spectrum of Wolf Isotopic Response with a Literature Review

by Marina Corral-Forteza, Noelia Pérez-Muñoz and Maria-Teresa Fernández-Figueras

Dermatopathology 2025, 12(2), 9; https://doi.org/10.3390/dermatopathology12020009 - 22 Mar 2025

Viewed by 303

Abstract

The Wolf isotopic response (WIR) refers to the development of cutaneous lesions in areas of previously healed but unrelated skin disease. While most are observed in healed herpes zoster, WIR has been reported in various other contexts. Affected areas are believed to exhibit immune dysregulation, lymphatic dysfunction, and altered neuromediator activity, increasing susceptibility to inflammatory, neoplastic, and infectious conditions. This phenomenon aligns with the broader concept of the “immunocompromised district”, which also encompasses the Koebner phenomenon and its reverse. Herein, we present the case of a 96-year-old woman who developed multiple cysts and comedones at the site of a resolved herpes zoster. Due to persistent and refractory inflammation, curettage was performed, and histopathological examination revealed angiosarcoma with a pseudolymphomatous reaction interspersed among the cysts. The coexistence of multiple types of WIR is rare but not unprecedented, highlighting the importance of recognizing the diverse pathologic conditions that can arise in such settings. In this review, we explore the historical evolution of terminology used to describe lesions in vulnerable skin areas and related phenomena. We also provide an updated overview of current pathogenic theories and present a comprehensive compilation of postherpetic reactions reported to date. Full article

(This article belongs to the Section Clinico-Pathological Correlation in Dermatopathology)

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