Brown Papules Research Articles

A Middle-Aged Female with Multiple Brownish Plaques and Nodules: A Case Report of Multiple Cutaneous Reticulohistiocytomas

Non-Langerhans-Cell histiocytosis spectrum of disorders includes multicentric reticulohistiocytosis (MR) and multiple cutaneous reticulohistiocytomas (MCR), which are very uncommon granulomatous conditions. In reticulohistiocytoma, the most common sites of involvement are extensor surfaces, particularly the hands and forearms and the classical lesions are characterised by firm brown or yellow papules, nodules and plaques. As MCR is a very rare granulomatous condition, we report here a middle-aged female a case of MCR and we highlight the significance of considering reticulohistiocytoma in the differential diagnoses of chronic and persistent brownish plaques or nodules on skin.

Dermoscopy Of The Month: Dermoscopic Finding of Pigment Network in Lesions of Eruptive Syringoma

Abstract Syringoma is a benign adnexal tumor derived from intraepidermal eccrine ducts. The usual presentation of syringoma is a small smooth skin-colored, yellowish or brownish papule with flattened or rounded top. Eruptive syringoma is a rarely reported form, where lesions are numerous and occur in successive crops. A case of a 57-year-old Caucasian male with a twenty four-year history of multiple asymptomatic, erythematous and brownish papules, predominantly over the anterior aspect of the trunk is presented. All lesions appeared after prolonged sun exposures within a few days and persisted without further changes afterwards. Contact non-polarized dermoscopy showed a fine light brown, regular pigment network on a light pink background, being the same in all lesions. History of the disease, clinical finding and dermoscopy were inconclusive, and biopsy was performed. Histopathology revealed signs of syringoma. Dermoscopic finding was thought to be intriguing and therefore is discussed in this paper.

Indeterminate Cell Histiocytosis – Case Report and Review of Literature

Abstract Introduction. Indeterminate cell histiocytosis is a rare proliferative disorder of indeterminate dendritic cells, reported in only 50 case reports so far. It is clinically presented as yellow, red or brown papules and nodules that appear in otherwise healthy adult individuals. Indeterminate cells are distinct dendritic cells of the skin that have ultrastructural similarities to the epidermal Langerhans cells but do not contain the characteristic Birbeck’s granules and they are also langerin-negative, unlike LCH. Indeterminate cell histiocytosis is an exceptional entity with variable clinical, histopathologic or immunohistochemical findings, sharing morphologic and immunophenotypic features with both Langerhans- and non-Langerhans cell histiocytoses. Case Report. We present a case of indeterminate histiocytosis in a 77-year-old man with 3-year history of asymptomatic, multiple reddish and brown papules and nodules over the entire body, including the oral mucosa. Skin biopsy was done, and histopathological analysis with immunohistochemistry was performed. The positive ICH staining of cells for CD68, CD1a, and S-100 enabled us to diagnose ICH in our patient. Also, BRAF V600E mutation was detected in tumor tissue. The treatment was started with methotrexate that was effective for 6 months, but due to the disease recurrence, further therapy with thalidomide was advised, without effect. Conclusion. Indeterminate histiocytosis is a rare disease, therefore no standardized treatment has been established and the treatment options are limited.

Dermoscopy of Sarcoidosis: A Useful Clue to Diagnosis.

Dermsocopy of Sarcoidosis: A Useful Clue to Diagnosis A 28-year-old male presented with a 1-year history of multiple, raised, reddish lesions over the right eye and right forearm. There was no other significant history. On examination, multiple, discrete, shiny, reddish brown papules were present over the right eye and the anteromedial aspect of the right forearm. Few lesions over the forearm were grouped together forming a small plaque [Figure 1]. Diascopy of the lesions showed apple jelly color. A clinical diagnosis of papular sarcoidosis was made. Dermoscopy (DermLite II hybrid m; 3Gen; polarized mode, ×10 magnification) revealed multiple linear and branching vessels over translucent yellowish-orange globular structures. Scar-like depigmented areas were also seen [Figure 2]. Histology was done and showed multiple well-defined granulomas in the dermis consisting of epithelioid cells, histiocytes, few multinucleated giant cells, and lymphocytes, which was consistent with sarcoidosis [Figure 3a and b]. The dermoscopy findings in our case are in line with those previously described by Pellicano et al. in their study.[1] The dermsocopic finding of various granulomatous disorders are summarized in Table 1.Figure 1: Multiple, discrete, reddish-brown infiltrated papules over the anteromedial aspect of the forearmFigure 2: (a) Multiple linear and branching vessels (seen as arrows) over translucent yellowish-orange globular structures (seen as star). (b) Multiple arborizing vessels (blue arrow) overlying translucent reddish orange background (star) with scar-like depigmented areas (black arrow) (Polarized mode, ×10)Figure 3: (a) Multiple well-defined granulomas seen in the dermis having epithelioid histiocytes, multinucleated giant cells, and few lymphocytes (H and E, 10×). (b) Closer view showing epithelioid cell granuloma with histiocytes, epithelioid cells, and scattered lymphocytes (H and E, 40×)Table 1: Dermoscopic findings of granulomatous disordersFinancial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Pseudomyogenic hemangioendothelioma: a little-known tumor

Pseudomyogenic hemangioendothelioma (PHE) is a rare indolent vascular tumor that typically has a multifocal presentation and involves multiple tissue planes. This report describes a 34-year-old man with multiple infiltrated brown papules and plaques on his left leg that had evolved for 6 months. The skin biopsy revealed a dermal and subcutaneous neoplasm composed of fascicles of spindle cells with atypia and epithelioid cells with prominent nucleoli and abundant eosinophilic cytoplasm. There was no evidence of necrosis, and the mitotic rate was low. There was strong reactivity with cytokeratin AE1/AE3, ERG, and FLI1, multifocal reactivity with smooth muscle actin, and focal reactivity with CD31. There was no expression of keratin MNF116, CAM5.2, CD34, CAMTA1, S100-protein, epithelial membrane antigen, melan-A, HMB-45, factor XIIIa, HHV8, or CD10. The nuclei of neoplastic cells showed intact expression of INI1. The clinical, histological, and immunophenotypical aspects were consistent with a diagnosis of PHE. A lower limb CT scan showed lesions in the skin, muscle, and bone planes. The patient was sent to an oncology center, where he maintains regular clinical and imagiological follow-up.

Angiolymphoid hyperplasia with eosinophilia: report of nine cases.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign vascular proliferation characterized by dermal or subcutaneous red or brown papules or nodules, most commonly on the head and neck. The aim of this study was to review the epidemiological and clinical characteristics of ALHE, focusing particularly on the histological and therapeutic features. We performed a retrospective study of all cases of ALHE diagnosed in our dermatology and pathology departments between 2004 and 2015. Over 12 years, we collected nine cases of ALHE (0.75 case/year). There were four men and five women. The mean age was 43 years. Lesions presented as erythematous or violaceous papules or nodules in all cases, multiple in five cases, and localized on the head in eight cases or other sites in four cases. The diagnosis of ALHE was clinically suspected in only two cases. The histopathological findings showed an ill-circumscribed, intradermal slightly lobular proliferation of capillary-sized vessels around several central vessels. In all cases, the blood vessels were lined by large endothelial cells. An inflammatory infiltrate around the vessels was formed mainly of lymphocytes and eosinophils with isolated plasma cells and histiocytes. Surgery was the most common treatment in our series. Other local or general treatment has also been used with varying responses. Angiolymphoid hyperplasia with eosinophilia is a rare epithelioid vascular tumor with a challenging clinical and histological diagnosis. Despite its benign nature, ALHE causes a therapeutic dilemma.

Sudden eruption of multiple Meyerson naevi

<p>We present a case of a young patient presenting with a six-month history of multiple squamous pink and light brown papules surrounded by symmetrical eczema on the trunk. Dermoscopy revealed light brown structureless and avascular lesions with an erythematous scaly halo. The patient denied the presence of naevi on the sites of the newly emerging changes. Histopathology revealed acanthotic epidermis and linear clusters of morphologically normal naevi cells in the upper dermis, infiltration of lymphocytes, plasma cells, eosinophils and mild spongiosis in the dermis. Topical betamethasone/gentamicin ointment twice daily for 10 days was prescribed. The erythematous scaly area around lesions completely disappeared on the follow-up visit after six months. This is a unique case of a sudden appearance of newly formed multiple benign dermal naevi with Meyerson phenomenon—the sudden eruption of multiple Meyerson naevi.</p>

Penile eruptive syringoma.

A 23-year-old man presented with a six-year history of asymptomatic papular lesions on the penis. He had no history of sexually transmitted disease and reported having sought dermatologic care because he was beginning a relationship and his new girlfriend wanted to be certain that he did not have a contagious disease. Clinical examination showed multiple yellow-colored papules, 1-3 mm in size, along the dorsum and sides of the penis. Similar lesions were not present elsewhere on the body. Punch biopsies of two lesions were performed and on microscopic examination a diagnosis of syringoma was made. The patient refused treatment once the lesions were asymptomatic. Syringoma exclusively located to the penis is an extraordinary rare dermatological condition. These lesions appear as one or multiple asymptomatic papules measuring from 1 to 3 mm in diameter. Penile syringomas usually present as multiple, flesh-coloured or brownish papules on the penile shaft at puberty or in early adult life.

A young boy with brownish papules and plaque

A young boy with brownish papules and plaque

Juvenile Xanthogranuloma of Middle Ear and External Auditory Canal: A Rare Case Report

Juvenile xanthogranuloma (JXG) is a benign self-limiting non langerhans cell histiocytic lesion of unknown etiology and pathogenesis. It commonly affects infants and adolescents only 15% cases reported from the adult population. It characteristically appears as yellow to brown solitary papule, affecting the skin of head, neck and trunk region. Extra cutaneous JXG are reported from various sites including central nervous system, gastrointestinal system, kidney, larynx, tongue with single case report from tympanic membrane and external auditory canal. We describe a very rare case of adult JXG occurring as multiple papules from the external auditory canal and granulations from middle ear, which presented as persistent otorrhea. We discuss the clinical presentation, imaging, pathological findings and review of literature for this case. To the best of our knowledge this is first reported case of JXG from the middle ear cavity.

Clinicopathological analysis of 10 cases of clear cell acanthoma

Objective To investigate clinicopathological features and differential diagnosis of clear cell acan-thoma (CCA). Methods Clinical and pathological data on 10 patients with CCA were retrospectively reviewed. Results CCA clinically manifested as widespread, well-circumscribed, hemispherical dark red to brown papules and nodules with ulcerative, hemorrhagic or desquamative surfaces. Most patients had no subjective symptoms. Nine patients had solitary lesions, and 1 patient had multiple lesions. It frequently occurred in the middle-aged or elderly. Histopathological examination showed thickened prickle cell layer, and the tumor was composed of large clear cells with pale-staining cytoplasm. Characteristic pathological findings were scattered neutrophils and nuclear dust in the epidermis. Periodic acid-Schiff (PAS) staining without diastase was positive in all the 10 patients. Immunohisto-chemical study revealed that tumor cells expressed epithelial membrane antigen (EMA) and keratin, but did not express carcinoembryonic antigen (CEA). Conclusions CCA has no obvious clinical characteristics, and is easily misdiagnosed as melanocytic or vascular tumors. However, CCA has typical histological changes, and histopathological examination is the gold standard for its diagnosis. Key words: Acanthoma; Pathology; Diagnosis; Immunohistochemistry; Clear cell acanthoma

Sebaceoma: a clinicopathological analysis of 31 cases

Objective To analyze clinicopathologic features of sebaceoma. Methods Clinical, pathologic and immunohistochemical findings from 31 cases of sebaceoma were retrospectively analyzed. The clinicopathologic features of sebaceoma were investigated. Results There were 9 males and 22 females. The patients′ age was 53.90 ± 15.40 years, and the clinical course was 9.41 ± 13.75 years. Sebaceoma predominantly affected the face. The common lesion of sebaceoma was red, yellowish-red, skin-colored or slight brown papules, with no subjective symptoms in most cases. Histopathologically, neoplasms had symmetric structures, and were located in the dermis. Epidermal involvements were found in 9 cases. The neoplasm cells were mainly composed of basaloid cells, a few mature sebocytes and some transition cells. The proportion of mature sebocyts was less than 1% in 26 cases, less than 20% in 2 cases, and 20%-40% in 3 cases. Mitoses were occasionally found in 5 cases. One patient was complicated by eccrine poroma. Varying amounts of ducts were found in all the patients. Immunohistochemical staining showed that epithelial membrane antigen was expressed on ducts and mature sebocytes in all the patients, while epithelial antigen was undetected in any of the patients. Carcinoembryonic antigen, androgen receptor and D2-40 were found in 20, 24 and 28 patients with sebaceoma, respectively. Conclusions The diagnosis of sebaceoma mainly depends on histopathological examination. Combined immunohistochemical detection of epithelial membrane antigen, androgen receptor and D2-40 is beneficial to its differential diagnosis. Key words: Sebaceoma; Carcinoembryonic antigen; Receptors, androgen; Epithelial membrane antigen; Epithelial antigen; D2-40

Juvenile Xanthogranuloma of the Hand: A Case Report

Introduction: Juvenile xanthogranuloma (JXG) is a non-Langerhans-cell histiocytosis, a group of histiocytic proliferative disorders, seen throughout the first two decades of life. Case Presentation: The studied case was a 14-year-old boy who presented a rapidly growing circumscribed brown papule on his left palm. The mass was surgically resected and histopathologic examination confirmed the diagnosis of JXG. Conclusions: Juvenile xanthogranuloma is a cutaneous fibrohistiocytic lesion, which is rarely reported on palms. It is recommended to excise any soft tissue masses in children due to their possible association with malignancy.

Treatment of Verrucous Epidermal Nevus by Radiofrequency Ablation: a Case Report

Abstract Verrucous epidermal nevi are noninflammatory, congenital, cutaneous hamartomas composed of keratinocytes, abnormal clone(s) of cells that reflect genetic mosaicism arising from different somatic mutations. Some of these mutations are well recognized, but some are still unidentified. Molecular techniques are used for identification and classification of molecular causes of certain epidermal nevi, whereas all verrucous epidermal nevi are divided into epidermolytic and non-epidermolytic types. They are typically present at birth, but may appear during childhood, even later. Their prevalence in adults ranges from 0.1 to 0.5%, equally affecting both sexes, and about 1 in 1000 newborns. Warty, brown papules without inflammation distinguish verrucous nevi from other epidermal nevi, while presence at birth and persistance distinguish verrucous epidermal nevi from linear viral warts. Epidermolytic and non-epidermolytic verrucous epidermal nevi are almost always hard to distinguish, except by histology. As a rule, verrucous epidermal nevi are asymptomatic, they have a benign course, except occasionally, and therapy is mostly used for cosmetic reasons. Simple excision is usually the treatment of choice. Topical agents are rarely curative, as well as surgery which is associated with relapses, unless both epidermis and the underlying dermis are removed or destroyed at the same time. We present a case of an otherwise healthy 21-year-old female patient, who presented with a solitary congenital verrucous cauliflower-like lesion in the right zygomatic region of the face. The lesion was present from birth. Due to its gradual growth during years, the lesion became a great esthetic and functional problem for this young patient. There was no family history of similar or any other tumorous skin lesions in the family. On examination, the patient had a solitar unilateral, well defined yellowish cauliflower-like verrucous lesion confined to the right malar side of the face. The lesion was distributed along the lines of Blaschko extending horizontally, from its wider 1.5 cm cauliflower-like part on the right zygomatic region, towards its tail-like 0.5 cm thick end on the preauricular region, in approximately 3 cm long tail-like manner without crossing the midline. Since the patient refused biopsy, no exact differentiation between epidermolytic and non-epidermolytic nevi was possible. The diagnosis of verrucous epidermal nevus was based on history and clinical presentation, as a diagnosis of exclusion. Due to the fact that patients with epidermolytic verrucous epidermal nevi are at risk of parenting a child with bullous ichthyosiform erythroderma, the patient was counseled on this risk, and on the possibility of first-trimester antenatal diagnosis. The lesion was successfully treated by radio-wave surgery.

A Teen Lesion of Confluent and Reticulated Papillomatosis ( CRP )

Confluent and reticulated papillomatosis (CRP) is also known as Gougerot-Carteaud syndrome; it is a rare skin disease typically affecting teenagers. CRP is characterized by small grayish blue hyperkeratotic papillomatosis located on the trunk 1 . Lesions typically begin as hyperkeratotic small papules (1-2 mm) which enlarge and coalesce (4-5 mm) to form grayish brown papules and plaques in a confluent pattern centrally (on the midline region) and with a reticular pattern peripherally. Commonly, it begins on the skin of the intermammary or epigastric region, spreading over a period of weeks or months to axillae, groin, face, neck, arms, trunk, cheeks, pubic area, interscapular region, shoulders, the proximal extremities, and forehead 1-4 . The mucus membranes are spared. Skin markings are sometimes exaggerated, especially in the neck and the axillae (dirty neck and axillae), where the skin may be thickened. Scraping of the lesions produces a fine powdery scale 1 .

An itching plaque

A 30-year-old woman presented to our hospital in Manacor, Mallorca, with a new lesion on the thorax that had appeared three to four months earlier, had gradually enlarged and was slightly itchy. The patient was otherwise healthy. Physical examination revealed a tender, brownish papule or plaque contacting the elastic band of the underwear under the right breast (Figure 1). The remaining physical exam showed no other relevant lesions. Dermoscopic examination showed an ill-defined redyellowish background with a small, pigmented, structureless area. Tiny, dotted and comma vessels were barely visible. Remarkable were numerous rounded or droplet-shaped, whitish structures spread all over the lesion (Figure 2). A 3 mm punch biopsy was obtained showing epidermal acanthosis and an intense superficial dermal inflammatory infiltrate. The infiltrate was composed by neutrophils, eosinophils and plasma cells, intermingled with bigger epithelioid cells, some of them containing tiny, round, basophilic structures in their cytoplasm (Figure 3). What is your diagnosis?

Degos Disease Associated with Behçet's Disease.

Dear Editor: Degos disease (DD) is a rare, thrombo-occlusive vasculopathy that primarily affect the skin, gastrointestinal tract, and central nervous system1. The cutaneous lesions present as characteristic papules with porcelain-white central atrophy and an erythematous raised border. Behcet's disease (BD) is a systemic vasculitis characterized clinically by recurrent oral aphthous and genital ulcers, cutaneous lesions, and iridocyclitis/posterior uveitis2. DD can be found as an apparent idiopathic disease or as a surrogate clinical finding in some connective tissue diseases. Here, we report a patient with cutaneous manifestation of DD, associated with mucocutaneous and systemic BD lesions. A 45-year-old woman had asymptomatic erythematous papules with central, porcelain-white colored umbilication on the trunk and both extremities for 20 years, and some of the lesions had healed to leave atrophic scars (Fig. 1A, B). She also had recurrent oral and genital ulcers for 20 years (Fig. 1C). She had been treated with prednisolone, dapsone, and colchicine for 2 years, but the cutaneous lesions did not improve with BD treatments. Fig. 1 (A, B) Erythematous to brownish papules with porcelainwhite central atrophy. (C) Recurrent oral aphthous ulcer. Histopathologic examination of a typical lesion showed a cell-poor, wedge-shaped area of dermal necrosis with vessel occlusion as well as dermal edema. Occluded vessels with thrombosis and vascular endothelial cell swelling were observed at the base of the wedge-shaped lesion, and the area was surrounded by lymphocytic infiltration (Fig. 2). Copious mucin deposition was visible in the dermis, which also showed positive staining for Alcian blue (data not shown). The laboratory findings for antinuclear antibody, lupus anticoagulant, anticardiolipin antibodies, and antiphospholipid antibodies were all negative. The results of the pathergy test were positive. The patient also had non-erosive asymmetric arthritis, and a 99m Tc-HDP 3-phase bone scan showed hot uptake. She had a scarring change on the retina due to recurrent chorioretinitis. Colonoscopy showed no specific findings for DD or BD. The patient was diagnosed with DD associated with BD. The cutaneous lesions, which were not responsive to BD treatment, improved after 4 months of treatment with aspirin and dipyridamole. Fig. 2 Histopathologic finding showing a wedge-shaped dermal infarct with a broad base toward the epidermis. An occluded dermal vessel is visible at the base of the dermal infarct area, and a lymphohistiocytic inflammatory infiltrate is visible at the lateral ... While the etiology of DD is unknown, evidence suggests a primary vaso-occlusive process. Vascular coagulopathy, endothelial cell damage, and an autoimmune process are considered the major pathogenic mechanisms3,4. In BD, an immune-mediated occlusive vasculitis is found in most sites of the active disease, and the endothelium appears to be the primary target5. The cutaneous lesions of the present patient were characteristic of DD and did not respond to BD treatments. This indicates that, while DD can be associated with BD, it is a distinct disease entity to BD. To the best of our knowledge, although Sweet's syndrome and pyoderma gangrenosum in BD have been reported in association with BD, our patient represents the first reported case of DD associated with BD. With the underlying vaso-occlusive process of both DD and BD, it is reasonable for an association between DD and BD to exist. Whether this patient had the same underlying mechanisms or the findings were coincidental is yet to be determined. We suggest that DD and BD are distinct disease entities but that DD can be associated with BD.

Infantile Scabies Masquerading as Langerhans Cell Histiocytosis.

Dear Editor: Scabies is a contagious skin infestation caused by Sarcoptes scabiei burrowing into the epidermis. Scabies can cause clinical eruptions and intense pruritus with nocturnal exacerbation1. The presence of typical skin lesions and nocturnal pruritus enable rapid diagnosis and treatment1. Clinical eruptions, including scabietic nodules and visible skin burrows, can be the pathognomonic lesions of scabies2. However, infants and young children may present with atypical skin nodules, vesicles, and pustules that tend to be more generalized. These atypical manifestations often can be confused with seborrheic dermatitis, eczematous dermatitis, impetigo, multiple arthropod bites, and Langerhans cell histiocytosis (LCH)3. Here, we report the case of a 6-month-old infant with scabies who was misdiagnosed with LCH on the basis of histopathologic findings and clinical manifestations. A 6-month-old girl presented with a 1-month history of erythematous to brownish papules and nodules on her trunk (Fig. 1A). The patient was initially treated with topical corticosteroid cream under a diagnosis of contact dermatitis. However, the lesions quickly spread to the patient's hands and feet, with scales and erythematous patches (Fig. 1B). Therefore, she underwent abdominal punch biopsy. Histopathologic findings showed cellular infiltrate within the upper dermis with a perivascular distribution consisting of histiocytes, lymphocytes, and eosinophils (Fig. 2A). The histiocytes in the upper dermis stained positive for CD1a and S-100 (Fig. 2B, C). Therefore, she was diagnosed with LCH on the basis of histopathologic findings and clinical manifestation. However, at that time, her mother complained of pruritus and presented with scabietic nodules on the interdigital web and periumbilical area. Dermoscopy-assisted skin scraping was performed on both the palm of the patient and periumbilical area of her mother, revealing mites and eggs in both lesions (Fig. 2D). Therefore, the patient's lesions were scabietic and not due to LCH. The patient was treated with 10% crotamiton cream and achieved complete remission after 1 week. After 1 month, the patient experienced relapse of the skin lesions on her hands and feet. Skin scraping was performed again and showed positive findings for scabies. The patient was re-treated with crotamiton 10% cream. At the last follow-up of 8 months, she was relapse free. Fig. 1 (A) The patient had several erythematous to brownish papules and nodules on her trunk on the initial visit. (B) Scales and erythematous patches on the palm of the patient after 1 month from the initial visit. Fig. 2 (A) The dermal infiltration was composed of Langerhans cells admixed with lymphocytes and eosinophils (H&E stain, ×200). (B, C) Immunophenotyping demonstrated the majority of the histiocytic cells to be S-100 (B, ×40) and CD1a ... Infantile scabies can have diverse skin manifestations, making it difficult to correctly diagnose on the basis of clinical findings alone. The histopathologic findings of scabies are also nonspecific and are insufficient for diagnosis; they include eczematous reactions in the epidermis and perivascular area, and inflammatory cell infiltrate in the dermis4. The infiltrate usually comprises numerous histiocytes positive on CD1a and S-100 staining. Therefore, these findings can be often misdiagnosed as LCH. Meanwhile, Langerhans cell hyperplasia has been reported to be present in scabies4. The presence of scattered CD30+ cells, which appears in scabies, can aid the differential diagnosis4. In addition, using electron microscopy to assess the presence or absence of Birbeck granules, which is the hallmark of LCH, can also aid diagnosis5. In conclusion, clinicians should be aware of confusing infantile scabies with LCH. Careful history taking including exposure to scabies and performing CD30 staining, electron microscopy, and dermoscopy will aid diagnosis.

Basaloid follicular hamartoma on the upper eyelid.

Basaloid follicular hamartoma on the upper eyelid.

Dermoscopy of a clonal (inverted type A) nevus in a child

A 9-year-old white female presented with a melanocytic nevus that her parents had noticed approximately 9 months earlier. The physical examination revealed a 7-mm, well demarcated, thin brown papule with an eccentric small focus of dark pigmentation on the right upper aspect of back (Fig 1).