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Dermoscopic Structure of Invasive Squamous Cell Carcinoma of the Nose: Considering the Search for Keratin Plugs
Ghita Sqalli Houssini1,*, Meryem Soughi1, Zakia Douhi1, Sara Elloudi1, Hannane Baybay1, Touria Bouhafa2 and Fatima Zahra Mernissi1
1Department of Dermatology, University Hospital Hassan II, Fez, Morocco
²Radiotherapy department, University Hospital Hassan II, Fez, Morocco
Received Date: 03/11/2023; Published Date: 12/04/2024
*Corresponding author: Dr. Sqalli Houssini Ghita, Department of Dermatology, University Hospital Hassan II, Fez, Morocco
Keywords: Keratin; Plugs; Dermoscopy; Keratoacanthoma; Squamous cell; Carcinoma
Dermoscopic features of squamous cell carcinoma have been extensively studied to differentiate it from other skin tumors, notably Bowen's disease and keratoacanthoma [1-2]. Certain structures can be found in common in invasive squamous cell carcinoma, and also reported in keratoacanthoma, recognized for its benign evolution.We describe the case of a 13-year-old adolescent with no notable medical history, who has presented with an ulcerated and rapidly growing tumor on the tip of her nose for the past 5 months. External biopsy results suggested a mature infiltrating squamous cell carcinoma. She was referred to us by the radiotherapists for dermatological consultation. Clinical examination revealed a 3 cm tumor on the nose with an infiltrated base, featuring a central crater-like area filled with yellowish keratin. Dermoscopy revealed a crater-like ulceration, miliaria-like crusts, polymorphic vascularity, and signs of keratinization: keratin plugs, an amorphous white area without structure, and white circles around hair follicles.In fact, in our patient's case, the clinical and dermoscopic presentation posed confusion with keratoacanthoma due to the crater-like appearance of the ulceration and the presence of keratin plugs, which can be present in both keratinocytic tumors, but they appear to be more frequent in keratoacanthoma [1-2]. So, the uniqueness of our case lies firstly in the young age of the patient who developed an infiltrating squamous cell carcinoma, the crater-like appearance of the lesion, and the follicular plugs. Aside from the mixed background (white and red), polymorphic vascularity, and amorphous central keratin within the ulceration, keratin plugs and white circles can also be found in an invasive squamous cell carcinoma displaying a crater-like aspect on the nose. In conclusion, a crateriform tumor in a young adult with dermoscopic findings of keratin plugs does not always indicate a keratoacanthoma. Therefore, biopsy is always necessary to rule out invasive squamous cell carcinoma despite the young age.
Figure 1: Clinical image of a crateriform tumor on the nose.
Figure 2: Dermoscopy performed on the periphery of the crater-shaped tumour, showing keratin plugs, white areas without structures, a central ulceration and keratin.
Author Contributions: All the authors contributed to the completion of this work concerning its correction and revision
Conflicts of interest: The authors do not declare any conflict of interest.
Grant information: The authors received no specific funding for this work.
Consent: The examination of this patient was conducted according to the Declaration of Helsinki principles.
References
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- Cliff Rosendahl, MBBS; Alan Cameron, MBBS; Giuseppe Argenziano, MD. Dermoscopy of squamous cell carcinoma and keratoacanthoma. Arch Dermatol, 2012; 148(12): 1386-1392.
