Clinical and dermoscopic features of Fibroepithelioma of Pinkus: case series with an emphasis on hypopigmented to pink l
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ORIGINAL PAPER
Clinical and dermoscopic features of Fibroepithelioma of Pinkus: case series with an emphasis on hypopigmented to pink lines intersecting at acute angles Japbani K. Nanda1 · Nadeem Marghoob2 · Diana M. Forero Cuevas3 · Katherine R. Lee4 · Michelle Levy5 · Ofer Reiter1,6 · Klaus J. Busam7 · Ashfaq A. Marghoob1 Received: 22 June 2020 / Revised: 8 September 2020 / Accepted: 12 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Fibroepithelioma of Pinkus (FEP) is a subtype of basal cell carcinoma (BCC) that can clinically resemble intradermal nevi (IDN) and fibromas. We performed a retrospective review of consecutively biopsied lesions confirmed to be FEP on histopathology diagnosed from January 1, 2008 to April 8, 2019. Clinical (n = 48), contact non-polarized dermoscopy (NPD) (n = 44), and contact polarized dermoscopy (PD) (n = 22) images from 36 patients were reviewed. Mean age was 64.5 years (SD 15.1 years, range 24–86 years) at diagnosis of first FEP lesion. Most lesions were located on the torso (n = 28, 58.3%), followed by the lower extremity (n = 9, 18.8%). The most common differential diagnoses at the time of biopsy included BCC (n = 40) and nevus (other than IDN, n = 5). Clinically, FEP were pink (95.8%), scaly (66.7%) papules (77.1%) displaying disrupted skin markings (62.5%) and absence of hair follicles (87.5%). NPD revealed serpentine (97.7%), dotted (81.8%), or polymorphous vessels (86.4%), and hypopigmented to pink lines intersecting at acute angles (HPLA) (52.3%). PD demonstrated serpentine (95.5%), dotted (86.4%), or polymorphous vessels (81.8%), shiny white lines (50.0%), and HPLA (59.1%). Classic features of BCC such as arborizing vessels (n = 2), ulceration (n = 1), shiny white blotches and strands (n = 1), blue-gray ovoid nest (n = 1), and leaf-like areas (n = 1) were uncommon. FEP often presents as scaly, erythematous papules with disrupted skin markings and absence of hair follicles. Dermoscopy reveals polymorphous vessels with shiny white lines and HPLA. Keywords Fibroepithelioma of Pinkus · Dermoscopy · Basal cell carcinoma · Polymorphous vessels · Shiny white lines
Introduction * Ashfaq A. Marghoob [email protected] 1
Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
2
New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
3
Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
4
Department of Dermatology, Stony Brook University, Stony Brook, NY, USA
5
New York, NY, USA
6
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
7
Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Fibroepithelioma of Pinkus (FEP) is a relatively indolent subtype of basal cell carcinoma (BCC) that was first described by Herman Pinkus in 1953 [6, 12]. While some debate exists as to whether FEP is a bona fide BCC or a fenestrated variant of trichoblastoma [4, 7, 18, 19], cli
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