Nagrani Nicole, Jaimes Natalia, Oliviero Margaret C, Rabinovitz Harold S
Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Skin and Cancer Associates, Plantation, FL, USA.
Dermatol Pract Concept. 2018 Jul 31;8(3):180-183. doi: 10.5826/dpc.0803a06. eCollection 2018 Jul.
Lichen planus-like keratosis (LPLK) is an involuting cutaneous lesion often presenting between the fifth and seventh decades of life. These lesions typically appear abruptly as a solitary macule, papule, or plaque that continuously evolves as it undergoes regression. Clinical and dermoscopic features of LPLK can mimic both benign and malignant lesions, often prompting biopsy for accurate diagnosis. We describe a case of LPLK developing in a patient with a history of multiple skin cancers, including melanoma. Dermoscopy revealed peripheral granules and a central area with pinkish-brown pigmentation and a disorganized pattern with shiny white structures and rosettes. Handheld reflectance confocal microscopy (RCM) showed a typical honeycomb pattern with millia-like cysts and comedo-like openings, and lacked pagetoid and dendritic cells. Based on the benign features seen with RCM, the lesion was followed until complete regression was observed. In conclusion, we describe a case of LPLK with clinically and dermoscopically indeterminate features that was successfully monitored with RCM. We intend to highlight the utility of RCM as a diagnostic aid in equivocal lesions in order to prevent unnecessary excisional procedures.
扁平苔藓样角化病（LPLK）是一种常出现在50至70岁之间的消退性皮肤病变。这些病变通常突然出现为单个斑疹、丘疹或斑块，在消退过程中会持续演变。LPLK的临床和皮肤镜特征可模仿良性和恶性病变，常常需要进行活检以准确诊断。我们描述了一例LPLK发生在一名有多种皮肤癌病史（包括黑色素瘤）的患者身上。皮肤镜检查发现外周颗粒以及中央区域呈粉棕色色素沉着，并有杂乱的模式，伴有闪亮的白色结构和玫瑰花结。手持反射式共聚焦显微镜（RCM）显示出典型的蜂巢状模式，伴有粟丘疹样囊肿和粉刺样开口，且缺乏派杰样细胞和树突状细胞。基于RCM所见的良性特征，对该病变进行了随访，直至观察到完全消退。总之，我们描述了一例具有临床和皮肤镜检查特征不明确的LPLK病例，通过RCM成功进行了监测。我们旨在强调RCM作为诊断辅助手段在可疑病变中的作用，以避免不必要的切除手术。
