Letters to the Editor

Indian Journal of Dermatology, Venereology, and Leprology | May-June 2015 | Vol 81 | Issue 3308

explained by Koebner’s phenomenon. A hypertrophic scar pathologically is composed of compactly arranged and parallel bundles of thickened collagen with fibroblasts. The pathology is primarily dermal, but may be accompanied by some epidermal hyperplasia at times. The currently recognised pathomechanisms of Koebner phenomenon fail to clarify if the phenomenon may occur in a 7-month-old scar. We assume that there may be a phenomenon of ‘Koebner recall’ where development of isomorphic pathologic lesions occurs at the sites of previous trauma probably in predisposed individuals. There may be immunological, vascular or other factors that may be at work even in a dermis with fibroblastic hyperplasia, which are yet to be defined as the causes of this interesting clinical manifestation. Lahiri et al. had described the occurrence of vitiligo[2] and lichen planus[3] along stretch marks. Koebner’s phenomenon seen in recent and old scars in pemphigus, which manifest primarily as epidermal disease, has also been described previously.[4]

Kinjal D. Rambhia, Siddhi B. Chikhalkar, Kinjal D. Rambhia, Siddhi B. Chikhalkar, Uday S. KhopkarUday S. Khopkar

Department of Dermatology, Seth GS Medical College and KEM Hospital, Parel, Mumbai,

Maharashtra, India

Address for correspondence:Address for correspondence: Dr. Kinjal Deepak Rambhia,Department of Dermatology, Seth GS Medical College and

KEM Hospital,Parel, Mumbai, Maharashtra, India. E-mail: kinjal_rambhia@hotmail.com

REFERENCESREFERENCES

1. Thappa DM. The isomorphic phenomenon of Koebner. Indian J Dermatol Venereol Leprol 2004;70:187-9.

2. Lahiri K, Sengupta SR. Vitiligo developing on striae: An

Figure 4: Jet black tattoo pigment unassociated with the lichenoid infi ltrate seen deeper in the dermis. (H and E, ×400)

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isomorphic phenomenon? Indian J Dermatol 1996;41:70-1.3. Lahiri K, Malakar S. Lichen planus developing along striae

gravidarum. Indian J Dermatol 2004;49:156-7.4. Cerottini JP, Burren R, Panizzon RG. Pemphigus vulgaris

occurring simultaneously on a recent and an old surgical scar due to a Koebner’s phenomenon. Eur J Dermatol 2000;10:546-7.

Clinical and dermoscopic Clinical and dermoscopic features of eccrine poromafeatures of eccrine poroma

Sir,A healthy 44-year-old male patient presented with a 3-year history of a slow growing lesion on the sole [Figure 1]. Occasional bleeding and mild local pain under pressure were the only symptoms. Dermoscopy showed a pink homogeneous area and an ivory halo around the entire lesion. Multiple round-to-oval reddish structures surrounded by a white halo and dotted vessels were also seen. An incisional biopsy confirmed the clinical diagnosis of eccrine poroma (EP). The lesion was completely excised.

Sweat gland tumors represent approximately 1% of primary skin lesions. Eccrine poroma is a benign sweat gland neoplasm that accounts for roughly 10% of sweat gland tumors.[1] Clinically, the tumour appears as a single slow-growing, asymptomatic, soft, well-circumscribed papule, plaque, or nodule, pink-to-red in color, with a surface ranging from smooth to verrucous, with occasional ulceration and/or scaling.[1,2] Eccrine poroma commonly develops at the distal extremities, such as the soles, palms, and fingers. However, multiple lesions, pigmented variants, and other anatomical sites of localization, including the head and neck, may also occur.[2]

Dermoscopy of eccrine poroma is characterized by a vascular pattern, which may be polymorphous. Glomerular, hairpin vessels and linear irregular vessels, surrounded by a white to pink halo, may be observed. Reddish-white globule-like structures

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Letters to the Editor

309Indian Journal of Dermatology, Venereology, and Leprology | May-June 2015 | Vol 81 | Issue 3

Address for correspondence:Address for correspondence: Dr. Bruno Simão dos Santos,Dermatologic clinic, Rua Miguel de Frias,

40, Niterói - Rio de Janeiro, Brazil. E-mail: b.simao@ymail.com

REFERENCESREFERENCES

1. Moore TO, Orman HL, Orman SK, Helm KF. Poromas of the head and neck. J Am Acad Dermatol 2001;44:48-52.

2. Ferrari A, Buccini P, Silipo V, De Simone P, Mariani G, Marenda S, et al. Eccrine poroma: A clinical-dermoscopic study of seven cases. Acta Derm Venereol 2009;89:160-4.

3. Kuo HW, Ohara K. Pigmented eccrine poroma: A report of two cases and study with dermatoscopy. Dermatol Surg 2003;29:1076-9.

4. Minagawa A, Koga H. Dermoscopy of pigmented poromas. Dermatology 2010;221:78-83.

5. Lallas A, Moscarella E, Argenziano G, Longo C, Apalla Z, Ferrara G, et al. Dermoscopy of uncommon skin tumours. Australas J Dermatol 2014;55:53-62.

6. Altamura D, Piccolo D, Lozzi GP, Peris K. Eccrine poroma in an unusual site: A clinical and dermoscopic simulator of amelanotic melanoma. J Am Acad Dermatol 2005;53:539-41.

Figure 1: (a and b) Reddish papule with a scaly surface and a clear-cut keratotic border, located on the sole. (c) Polarized light dermoscopy with immersion fl uid showing a pink homogeneous area and an ivory halo around the entire lesion. Multiple round-to-oval reddish structures surrounded by a white halo and dotted vessels may also be seen (original magnifi cation, ×10)

a b

c

are occasionally seen, mimicking the red lacunae typical of vascular lesions, such as hemangioma or pyogenic granuloma. Milky-red areas, commonly found in melanoma, may also be present.[2] Pigmented globule-like structures, comedo-like openings, as well as blue-gray ovoid nests, arborizing vessels, and maple leaf-like structures similar to those of pigmented basal cell carcinomas are also described in pigmented variants of eccrine poroma.[3,4] The dermoscopic findings described in previous reports of eccrine poroma have been summarized by Lallas et al.[5]

Eccrine poroma may exhibit polymorphic features that can make diagnosis difficult. The clinical and dermoscopic differential diagnoses include, among others, pyogenic granuloma, hemangioma, seborrheic keratosis, melanocytic nevus, amelanotic melanoma, and basal cell carcinoma.[6]

Bruno Simão dos SantosBruno Simão dos SantosDermatologic clinic, Rua Miguel de Frias, 40,

Niterói - Rio de Janeiro, Brazil

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Recurrent cutaneous Recurrent cutaneous leiomyosarcoma of the inner leiomyosarcoma of the inner thighthigh

Sir,A 55-year-old African male from Senegal presented with a large nodular lesion on the inner surface of the left thigh [Figure 1]. The lesion had first appeared 8 years ago, had been interpreted as a keloid and excised twice once 6 years ago and again 3 years ago in Senegal without any histological examination. Clinically, the lesion measured 45 × 55 mm, was hard in consistency, moved easily over the deep subcutaneous planes, and seemed to comprise of separate, coalescing nodules. The overlying epidermis was adherent. Bilateral inguinal lymph nodes were palpable but normal. Patient reported feeling a stabbing pain in the nodule. Complete blood examination, human immunodeficiency virus antibodies, hepatitis markers, and human herpesvirus 8 polymerase chain reaction (PCR) from blood showed no abnormalities.

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