The diagnosis of rare skin lesions in ear, nose, and throat: the clues lie in clinical examination
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20231090Keywords:
Pilomatricoma, Keratoacanthoma, Dufourmental flapAbstract
Here we present 2 case reports of 2 relatively rare skin lesion that can be encountered in ENT practice, and touch upon the basic clinical evaluation that is mostly overlooked in favour of investigations to reach a diagnosis, since in many cases, investigations fail to give a clear result. The first case is a pilomatricoma, which can be tricky differential diagnosis to reach in the preoperative phase, with the lesion not having any clear differentiating characteristics on imaging. But the answer to a preoperative diagnosis might lie in the “Tent Sign”, bluish discoloration of the skin, or calcium extrusion from the lesion. The second case is a keratoacanthoma, which, waiting long enough should regress on its own. But as watchful waiting is not a feasible line of management, the distinct crateriform pattern should be looked for in lesions on sun exposed areas, and if present, instead of just an incisional biopsy or wedge biopsy, complete surgical excision with clear margins and intact architecture should be planned.
References
Lan MY, Lan MC, Ho CY, Li WY, Lin CZ. Pilomatricoma of the head and neck: a retrospective review of 179 cases. Arch Otolaryngol Head Neck Surg. 2003;129(12):1327-30.
O’Connor N, Patel M, Umar T, Macpherson DW, Ethunandan M. Head and neck pilomatricoma: an analysis of 201 cases. Bri J Oral Maxillofacial Surg. 2011;49(5):354-8.
Kwiek B, Schwartz RA. Keratoacanthoma (KA): An update and review. J Am Academy Dermatol. 2016;74(6):1220-33.
Malherbe A, Chenantais J. Note sur l’e´pithe´lioma calcifie´des glandes se´bace´es. Prog Med. 1880;8:826-37.
Dubreuilh W, Cazenave E. De l’epithelioma calcifie: etude histologique. Ann Dermatol Syphilol. 1922;3:257-68.
FORBIS R, Helwig EB. Pilomatrixoma (calcifying epithelioma). Arch Dermatol. 1961;83(4):606-18.
Jones PG, Campbell PE. PILOMATRIXOMA: A not uncommon Hamartoma of Infancy and Childhood. J Paediatr Child Heal. 1969;5(3):162-6.
Arnold Jr HL. Letter: pilomatrixoma. Arch Dermatol. 1977;113:1303.
Moehlenbeck FW. Pilomatrixoma (calcifying epithelioma): a statistical study. Arch Dermatol. 1973;108(4):532-4.
Julian CG, Bowers PW. A clinical review of 209 pilomatricomas. J Am Academy Dermatol. 1998;39(2):191-5.
Kumaran N, Azmy A, Carachi R, Raine PA, Macfarlane JH, Howatson AG. Pilomatrixoma—accuracy of clinical diagnosis. J Pediatr Surg. 2006;41(10):1755-8.
Graham JL, Merwin CF. The tent sign of pilomatricoma. Cutis. 1978;22(5):577-80.
Wang J, Cobb CJ, Martin SE, Venegas R, Wu N, Greaves TS. Pilomatrixoma: clinicopathologic study of 51 cases with emphasis on cytologic features. Diagnostic Cytopathol. 2002 Sep;27(3):167-72.
Borges AF. The rhombic flap. Plastic Reconstructive Surg. 1981;67(4):458-66.
Kang AS, Kang KS. Rhomboid flap: Indications, applications, techniques and results. A comprehensive review. Ann Med Sur. 2021;68:102544.
Ooshima M, Kochi M, Morioka D, Miyamoto T, Tsuda T, Kadomatsu K. Bipedicled mini VY advancement flap for skin defect of the face. Modern Plastic Surg. 2018;8(02):15.
Li ZR, Jiang Y, Zhang JY, Su YW, Hu JZ. Modified OT advancement flap for reconstruction of skin defects. Int J Clin Experimental Pathol. 2017;10(9):9158.
Aydin OE, Tan O, Algan S, Kuduban SD, Cinal H, Barin EZ. Versatile use of rhomboid flaps for closure of skin defects. Eurasian J Med. 2011;43(1):1.
Hutchinson J. Morbid growths and tumors: 1: the ‘‘crateriform ulcer of the face’’ a form of acute epithelial cancer. Trans Pathol Soc London. 1889;40:275-81.
Musso L, Gordon H. Spontaneous Resolution of a Molluscum Sebaceum. Proceedings of Royal Society Med. 1950;43(11):838-9.
Rook A, Whimster I. Keratoacanthoma–a thirty year retrospect. Brit J Dermatol. 1979;100(1):41-7.
Gleich T, Chiticariu E, Huber M, Hohl D. Keratoacanthoma: a distinct entity? Experimental Dermatol. 2016;25(2):85-91.
Schwartz RA. Keratoacanthoma: a clinico-pathologic enigma. Dermatol Surg. 2004;30(2 Pt 2):326-33.
Ko CJ. Keratoacanthoma: facts and controversies. Clin Dermatol. 2010;28(3):254-61.
Tisack A, Fotouhi A, Fidai C, Friedman BJ, Ozog D, Veenstra J. A clinical and biological review of keratoacanthoma. Brit J Dermatol. 2021;185(3):487-98.
