eISSN: 2299-0046
ISSN: 1642-395X
Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii
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vol. 36
Letter to the Editor

Atypical fibroxanthoma mimicking amelanotic melanoma in dermoscopy

Adam W. Cichewicz
Agnieszka Białecka
Kaja Męcińska-Jundziłł
Urszula Adamska
Izabela Neska-Długosz
Dariusz Grzanka
Rafał Czajkowski

Chair of Dermatology, Sexually Transmitted Diseases and Immunodermatology, Faculty of Medicine in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
Department of Clinical Pathomorphology, Faculty of Medicine in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
Adv Dermatol Allergol 2019; XXXVI (4): 492-494
Online publish date: 2019/08/30
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The differential diagnostics of non-pigmented nodular dermatological lesions pose a challenge even for an experienced dermatologist. We present the case of a female patient qualified for urgent excision of a skin tumour located in the nasal apex area, for which dermoscopy suggested the diagnosis of amelanotic melanoma.
The 64-year-old female patient was admitted to the Dermatology Department for surgical treatment of a tumour located in the skin of the nasal apex. The patient reported the occurrence of the lesion 6 months before. Dermoscopic examination performed by an experienced dermatologist confirmed existence of the lesion in the form of a well-bordered, cohesive, pink skin tumour, with a diameter of 8 mm. The examination demonstrated presence of single, irregular, dot and linear type blood vessels. Exfoliation and white structureless areas were observed on the surface of the lesion. Residues of the regular pigment network were visible on the circumference of the lesion (Figure 1). Considering absence of a pathological vascularisation, white structureless areas, residues of the pigment network, and a pink colour of the tumour, amelanotic melanoma was suspected [1, 2]. The tumour was surgically excised and skin defect was closed with a full thickness skin graft from the left preauricular area. The excised skin fragment with the lifted nodule was fixed in 10% buffered formalin and sent to the Department of Pathology. Microscopically, the tumour was well circumscribed, dome shaped skin nodule composed of atypical spindle cells arranged in a fascicular and haphazard pattern (Figure 2 A). There was no grenz zone of uninvolved dermis seen between the tumour and epidermis. Frequent mitotic figures were present. Atypical spindled cells were polymorphic, some of them had prominent nucleoli, other had large, hyperchromatic nuclei (Figures 2 B, C). The immunohistochemistry stains were viewed under a light microscope. There was no expression of S100, melan A and HMB45. Also there was no expression of desmin, CK5/6 and CD34 in tumour cells. The expression of vimentin and CD68 was present (Figures 2 D, E). Ki67 index was approximately 20% (Figure 2 F). According to microscopic and immunohistochemical manifestation of the entity, atypical fibroxanthoma was diagnosed.
Atypical fibroxanthoma (AFX) is a rare and rapidly growing skin tumour. It belongs to rare mesenchymal tumours [3]. Its name comes from the characteristic histopathological presentation of...

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