Clinical features

•Uncommon “tumor” which presents as an erythematous or brown dome-shaped papule/plaque 1-4 cm diameter with puncta that frequently bleed with mild trauma

•Peripheral scale

•Predilection for the lower leg but has been described at a wide variety of sites

•Middle-aged or elderly

•M=F

•Very rarely, multiple lesions

•Polypoid variant

•Giant variant

•Pigmented variant

•Eruptive (Blaschkoid) variant

Histological features

•Most probably a localized inflammatory lesion rather than a true neoplasm

•Parakeratotic scale with neutrophils

•Sharply demarcated acanthosis/psoriasiform hyperplasia; bland epithelium

•Fusion of rete ridges

•Cytoplasmic pallor or clear cell change; spongiosis sometimes present

•Characteristic intraepidermal adnexal epithelial sparing

•Dendritic melanocytes sometimes present

•Vascular dilatation in the dermal papillae and a perivascular sometimes neutrophil-rich infiltrate

•EMA+ve, CEA –ve

•PAS +ve, DPAS -ve

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