Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Quiz
2020:86:6;743-746
doi: 10.4103/ijdvl.IJDVL_21_18
PMID: 31089007

Pigmented papule on the volar aspect of left middle finger

Qian-Nan Jia, Kai Fang, Tao Qu
 Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China

Correspondence Address:
Tao Qu
No. 1, Shuaifuyuan, Dongcheng District, Beijing
China
Published: 09-May-2019
How to cite this article:
Jia QN, Fang K, Qu T. Pigmented papule on the volar aspect of left middle finger. Indian J Dermatol Venereol Leprol 2020;86:743-746
Copyright: (C)2020 Indian Journal of Dermatology, Venereology, and Leprology

Clinical History

A 43-year-old woman presented to Peking Union Medical College Hospital, Beijing, China with a black, firm papule on the volar aspect of the left middle finger, present since 2 years. Physical examination revealed a pigmented, elevated, verrucous papule of size 2mm [Figure - 1]. Systemic examination findings were unremarkable. Histopathology revealed proliferation of basaloid cells extending from the basal epidermis into the dermis [Figure - 2]a. The cuboidal tumor cells were characterized by scant eosinophilic cytoplasm and small monomorphous nuclei [Figure - 2]b. The tumor grew downward in broad anastomosing bands, with highly fibrovascularized stroma [Figure - 2]b. Parakeratosis and crust were present in the overlying epidermis. Dendritic melanocytes and abundant melanin deposition were also observed throughout the tumor. There was no evidence of peripheral palisading of nuclei or mucinous stroma. Immunohistochemical staining with carcinoembryonic antigen and epithelial membrane antigen highlighted the eccrine ductal lumina [Figure - 2]c and [Figure - 2]d. Immunohistochemical staining with Melan-A was positive in dendritic melanocytes [Figure - 2]e. The patient underwent surgical excision and there was no recurrence in the 9-month follow-up period.

Figure 1: Pigmented, elevated, verrucous papule on the left middle finger

What is Your Diagnosis?

Answer

Pigmented eccrine poroma.

Discussion

Eccrine poroma is an adnexal tumor of the terminal eccrine duct. It usually presents as a skin-colored or reddish papule, plaque, or nodule. Eccrine poroma can form anywhere where eccrine glands are present and is most commonly located on the acral sites. However, the rare pigmented variant has a predilection for the non-acral sites. We searched PubMed (1986–2016) for reports of the pigmented variant and reviewed the sixteen available cases. Only 3 (18.8%) cases were located in palmoplantar areas [Table - 1]. The average age of patients was 59 years (ranging from 30 to 86 years). The male-to-female ratio was 0.45, showing a higher prevalence in female patients; while eccrine poroma has no gender predilection. Moreover, this case is exceptional for its location and maybe clinically confused with cutaneous melanoma. Other differential diagnoses include pigmented basal cell carcinoma, verruca vulgaris, seborrheic keratosis and hidradenoma.

Table 1: Summary of reports of pigmented eccrine poroma (1986-2016)

Histopathology is the gold standard for the diagnosis of pigmented eccrine poroma. The characteristics of this tumor are monomorphic basaloid cells with poroid differentiation and a highly fibrovascularized stroma. It is also characterized by the presence of melanin and proliferation of melanocytes. Verruca vulgaris exhibits digitate epidermal hyperplasia and koilocytosis in granular layer and dilated capillaries in papillae. Cutaneous melanoma is poorly circumscribed and is characterized by nests of atypical melanocytes with pleomorphic nuclei and mitotic figures. Basaloid cells are also present in seborrheic keratosis and basal cell carcinoma. In contrast to eccrine poroma, seborrheic keratosis may present horn cysts without ductal differentiation. In basal cell carcinoma, basaloid cells form nests with characteristic peripheral palisading and retraction artifacts. Hidradenoma is characterized by larger cells and nuclei without broad-based connection to the epidermis or the granulation tissue-like stroma.

Compared with the nonpigmented eccrine poroma of the palms, this pigmented case had evident proliferation of melanocytes [Figure - 2]e and [Figure - 2]f. Given the low density of melanocytes in palmoplantar region, there are several hypotheses of melanocyte proliferation. Melanocytes may be activated by endothelin-1, which promotes proliferation, survival, and migration of melanocytes.[1] Another hypothesis supports the migration of melanocytes from nearby epidermis or hair follicles to the lesion.[2]

Pigmented variant is extremely rare on the palmoplantar region, which is the most common site of eccrine poroma. Meanwhile, the presence of melanin and melanocytes do not always produce clinically visible pigmentation.[3] There are some explanations of these remarkable phenomena. One is that palmoplantar fibroblasts express high levels of dickkopf1, which inhibits growth and survival of melanocytes and production of melanin.[4] Another one is that fibronectin, which promotes melanocyte proliferation, differentiation, and migration, is expressed in lower levels in palmoplantar region.[5] This may suggest that melanocytes proliferate and survive poorly in acral sites, thus explaining the unusual occurrence of pigmented eccrine poroma in acral sites.

As a benign tumor, therapeutic options in the management of eccrine poroma include shaving, electrosurgical destruction and surgical excision. However, in consideration of the possible malignant transformation and recurrence, complete surgical excision is advocated.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References
1.
Chiu HH, Chen PH, Wu CS, Chen GS, Tsai KB, Wen CH, et al. Origin of poroid hidradenoma and pigmentation mechanism of eccrine poroma: Critical analysis of an unique presentation. J Eur Acad Dermatol Venereol 2009;23:597-9.
[Google Scholar]
2.
Ohata U, Hara H, Suzuki H. Pigmented eccrine poroma occurring on the scalp: Derivation of melanocytes in the tumor. Am J Dermatopathol 2006;28:138-41.
[Google Scholar]
3.
Betti R, Bombonato C, Cerri A, Moneghini L, Abramo P, Menni S, et al. Clinically and/or histologically pigmented poromas in Caucasian patients. G Ital Dermatol Venereol 2014;149:341-6.
[Google Scholar]
4.
Yamaguchi Y, Passeron T, Watabe H, Yasumoto K, Rouzaud F, Hoashi T, et al. The effects of dickkopf 1 on gene expression and Wnt signaling by melanocytes: Mechanisms underlying its suppression of melanocyte function and proliferation. J Invest Dermatol 2007;127:1217-25.
[Google Scholar]
5.
Yasuda M, Miyachi Y, Ishikawa O, Takahashi K. Spatial expressions of fibronectin and integrins by human and rodent dermal fibroblasts. Br J Dermatol 2006;155:522-31.
[Google Scholar]

Fulltext Views
643

PDF downloads
131
Show Sections