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E-CORRESPONDENCE |
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| Year : 2013 | Volume
: 58
| Issue : 2 | Page : 162 |
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| A case of multiple facial clear cell acanthomas successfully treated by cryotherapy |
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Mayumi Hatakeyama, Masahiro Oka, Atsushi Fukunaga, Makoto Kunisada, Yoko Funasaka, Chikako Nishigori
Department of Dermatology, Kobe University Graduate School of Medicine, Kobe, Japan
| Date of Web Publication | 5-Mar-2013 |
Correspondence Address:
Masahiro Oka
Department of Dermatology, Kobe University Graduate School of Medicine, Kobe
Japan
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-5154.108122
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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 2023 Jun 5];58:162. Available from: https://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
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 | 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
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 References | |  |
| 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. 
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| 2. | Trau H, Fisher BK, Schewach-Millet M. Multiple clear cell acanthomas. Arch Dermatol 1980;116:433-4.
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| 3. | Chi CC, Wang SH, Huang HS. Clear cell acanthoma successfully treated with a carbon dioxide laser. Dermatol Surg 2005;31:1355-8.
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| 4. | Kavanagh GM, Marshman G, Burton JL. Multiple clear cell acanthomas treated by cryotherapy. Australas J Dermatol 1995;36:33-4.
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| 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.
[PUBMED] |
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