Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 243  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
E-CORRESPONDENCE
Year : 2013  |  Volume : 58  |  Issue : 2  |  Page : 162
A case of multiple facial clear cell acanthomas successfully treated by cryotherapy


Department of Dermatology, Kobe University Graduate School of Medicine, Kobe, Japan

Date of Web Publication5-Mar-2013

Correspondence Address:
Masahiro Oka
Department of Dermatology, Kobe University Graduate School of Medicine, Kobe
Japan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.108122

Rights and Permissions



How to cite this article:
Hatakeyama M, Oka M, Fukunaga A, Kunisada M, Funasaka Y, Nishigori C. A case of multiple facial clear cell acanthomas successfully treated by cryotherapy. Indian J Dermatol 2013;58:162

How to cite this URL:
Hatakeyama M, Oka M, Fukunaga A, Kunisada M, Funasaka Y, Nishigori C. A case of multiple facial clear cell acanthomas successfully treated by cryotherapy. Indian J Dermatol [serial online] 2013 [cited 2019 Jun 19];58:162. Available from: http://www.e-ijd.org/text.asp?2013/58/2/162/108122


Sir,

Clear cell acanthoma (CCA) is a benign epidermal tumor characterized histologically by clear, glycogen-containing epidermal cells. [1] Typically, CCA presents as a slowly growing, well-demarcated, pink to brown, dome-shaped nodule or plaque. [1] We present herein a rare case of multiple CCAs that developed on the face and showed almost complete resolution after cryotherapy.

A 52-year-old woman visited the Department of Dermatology at Kobe University Hospital complaining of a group of papules and plaques on her right lateral cheek. Initially, there was a solitary papule that had remained unchanged for few decades. When the patient was 51-years-old, the lesion abruptly and rapidly grew, and was associated with the formation of several papules and plaques over a period of 10 months. On examination, there were four, light brown to light red, slightly elevated, firm papules and plaques measuring 2 mm × 2 mm × 1 mm, 2.5 mm × 2.5 mm × 1 mm, 18 mm × 10 mm × 3 mm and 34 mm × 18 mm × 3 mm, on the lateral side of her right cheek in close proximity [Figure 1]a. The surfaces of the two plaques were slightly scaly and moist. An intralesional skin biopsy was taken from the biggest plaque. The epidermis showed marked irregular acanthosis, elongation of rete ridges and had tumor cells with slightly enlarged nuclei and pale cytoplasm with no atypia [Figure 2]a and b. The corneal layer of the epidermis showed parakeratosis and was infiltrated with many erythrocytes and neutrophils [Figure 2]c. Neutrophilic exocytosis and focal spongiosis were present in the epidermis. The pale cells in the epidermis were periodic acid-Sciff (PAS)-positive [Figure 2]d and diastase-sensitive [Figure 2]e. The papillary dermis showed proliferating capillaries and scattered inflammatory infiltrates, including neutrophils and eosinophils. From these findings, we made the diagnosis of multiple CCA and commenced treatment with cryotherapy using liquid nitrogen. Cryotherapy was carried out once every week. Within 3 months, the skin lesions resolved almost completely, leaving slight pigmentation and erythema [Figure 1]b. Over the next 3 months, there was no sign of recurrence.

The CCA in our patient was histologically typical but unusual in its location, size and number. CCA appears usually in the lower limbs and infrequently on the face. [1] It is usually approximately 1-2 cm in diameter, but a variant named giant CCA has been reported. [1] In our case, one of the lesions measuring 34 mm × 18 mm × 3 mm may be classified as a giant CCA. In the majority of CCA cases, the lesion is solitary and multiple lesions are extremely rare. [1] Trau, et al.[2] summarized 12 cases of CCA with multiple lesions and showed that all the multiple lesions were located on the lower limbs. Our patient is the first case of multiple facial CCAs with a giant lesion. Various treatments of CCA have been reported, including surgical excision, [1] curettage, [1] electrofulgulation [1] and carbon dioxide laser. [3] Although CCA is a benign tumor, CCA does not show spontaneous regression. [1] We believe that cryotherapy is an effective method in the treatment of CCA, as reported previously. [4],[5]
Figure 1: Clinical appearance of clear cell acanthoma before and after 12 times of cryotherapy. (a) The patient had several papules and plaques on her right lateral cheek before therapy. (b) After 12 times of cryotherapy, the lesions resolved almost completely, leaving a slight pigmentation and erythema

Click here to view
Figure 2: Histopathological findings. (a) The epidermis shows marked acanthosis and elongation of rete ridges (H and E, original magnification, × 10). (b) The epidermis is composed of clear cells without atypia (H and E, original magnification, × 100). (c) The corneal layer of the epidermis shows parakeratosis and is infiltrated with many erythrocytes and neutrophils (H and E, original magnification × 100). (d and e) The pale cells in the epidermis are (d) PAS-positive and (e) diastase-sensitive

Click here to view


 
   References Top

1.Silver SG, Ho VC. Benign epithelial tumors. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, editors. Fitzpatrick's Dermatology in General Medicine. 6 th ed. New York: McGraw-Hill; 2003. p. 777.  Back to cited text no. 1
    
2.Trau H, Fisher BK, Schewach-Millet M. Multiple clear cell acanthomas. Arch Dermatol 1980;116:433-4.  Back to cited text no. 2
[PUBMED]    
3.Chi CC, Wang SH, Huang HS. Clear cell acanthoma successfully treated with a carbon dioxide laser. Dermatol Surg 2005;31:1355-8.  Back to cited text no. 3
[PUBMED]    
4.Kavanagh GM, Marshman G, Burton JL. Multiple clear cell acanthomas treated by cryotherapy. Australas J Dermatol 1995;36:33-4.  Back to cited text no. 4
[PUBMED]    
5.Betti R, Bruscagin C, Inselvini E, Palvarini M, Crosti C. Successful cryotherapic treatment and overview of multiple clear cell acanthoma. Dermatol Surg 1995;21:342-4.  Back to cited text no. 5
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (1,984 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed1689    
    Printed23    
    Emailed0    
    PDF Downloaded35    
    Comments [Add]    

Recommend this journal