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Record W4288925967 · doi:10.1016/j.jdcr.2022.07.028

Pigmented squamous cell carcinoma in situ with amyloid deposition mimicking melanoma

2022· article· en· W4288925967 on OpenAlexaff
Taylor E. Woo, Karen Naert, Justin Chia

Bibliographic record

VenueJAAD Case Reports · 2022
Typearticle
Languageen
FieldMedicine
TopicCutaneous Melanoma Detection and Management
Canadian institutionsUniversity of Calgary
Fundersnot available
KeywordsMedicineMelanomaPathologyIn situBasal cellDermatologyCarcinoma in situCancer researchCarcinomaChemistry

Abstract

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Clinical presentationA 68-year-old female presented with an 18-months history of an incidentally noticed asymptomatic lesion on the right buttock. There was no personal or family history of skin cancer, no tanning booth use, and minimal sun exposure. On examination, there was a 12 × 5 mm brown-black plaque with irregular borders (Fig 1).Dermatoscopic appearanceContact polarized dermatoscopic examination revealed a multicomponent pattern composed of gray and brown dots and structureless zones (Fig 2).Fig 2Contact polarized dermatoscopic image showing a multicomponent pattern composed of gray and brown dots and structureless zones.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Histologic diagnosisHistology demonstrated full-thickness epidermal atypia and presence of eosinophilic globules in the papillary dermis (Fig 3). A crystal violet stain was positive in some globules compatible with amyloid (Fig 4).Key messagePigmented squamous cell carcinoma in situ (SCCis) is an uncommon variant of SCCis. It most commonly presents as progressively enlarging papules/plaques, typically in photoexposed areas. Pigmented SCCis is often seen in dark skin phototypes and may clinically mimic melanoma, pigmented basal cell carcinoma, and seborrheic keratosis. Dermatoscopy may aid in diagnosis and can reveal multicomponent pattern, atypical glomerular vascular structures, absence of a pigment network or pseudonetwork, diffuse pigmentation or blotches, hypopigmented structureless areas, or brown or gray dots in a linear fashion.1Cameron A. Rosendahl C. Tschandl P. Riedl E. Kittler H. Dermatoscopy of pigmented Bowen's disease.J Am Acad Dermatol. 2010; 62: 597-604https://doi.org/10.1016/j.jaad.2009.06.008Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar Histologically, pigmented SCCis shows full-thickness epidermal keratinocyte atypia, dyskeratosis, nuclear pleomorphism, and apoptosis. Amyloid has been observed in these cutaneous neoplasms.2Baykal C. Hurdogan O. Babuna Kobaner G. Ekinci A.P. Buyukbabani N. Secondary localized cutaneous amyloidosis is not rare in Bowen's disease and bowenoid papulosis.Turk Patoloji Derg. 2022; 38: 54-59https://doi.org/10.5146/tjpath.2021.01530Crossref PubMed Scopus (1) Google Scholar Treatment involves surgical excision, electrodessication and curettage, photodynamic therapy, and topical chemotherapeutic agents. In our case, the lesion was treated with surgical excision.Fig 3Routine histology demonstrating full-thickness epidermal atypia and eosinophilic globules in the papillary dermis (hematoxylin and eosin stain; 10× magnification).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig 4Crystal violet stain showing amyloid deposits in the papillary dermis (20× magnification).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Clinical presentationA 68-year-old female presented with an 18-months history of an incidentally noticed asymptomatic lesion on the right buttock. There was no personal or family history of skin cancer, no tanning booth use, and minimal sun exposure. On examination, there was a 12 × 5 mm brown-black plaque with irregular borders (Fig 1). A 68-year-old female presented with an 18-months history of an incidentally noticed asymptomatic lesion on the right buttock. There was no personal or family history of skin cancer, no tanning booth use, and minimal sun exposure. On examination, there was a 12 × 5 mm brown-black plaque with irregular borders (Fig 1). Dermatoscopic appearanceContact polarized dermatoscopic examination revealed a multicomponent pattern composed of gray and brown dots and structureless zones (Fig 2). Contact polarized dermatoscopic examination revealed a multicomponent pattern composed of gray and brown dots and structureless zones (Fig 2). Histologic diagnosisHistology demonstrated full-thickness epidermal atypia and presence of eosinophilic globules in the papillary dermis (Fig 3). A crystal violet stain was positive in some globules compatible with amyloid (Fig 4).Key messagePigmented squamous cell carcinoma in situ (SCCis) is an uncommon variant of SCCis. It most commonly presents as progressively enlarging papules/plaques, typically in photoexposed areas. Pigmented SCCis is often seen in dark skin phototypes and may clinically mimic melanoma, pigmented basal cell carcinoma, and seborrheic keratosis. Dermatoscopy may aid in diagnosis and can reveal multicomponent pattern, atypical glomerular vascular structures, absence of a pigment network or pseudonetwork, diffuse pigmentation or blotches, hypopigmented structureless areas, or brown or gray dots in a linear fashion.1Cameron A. Rosendahl C. Tschandl P. Riedl E. Kittler H. Dermatoscopy of pigmented Bowen's disease.J Am Acad Dermatol. 2010; 62: 597-604https://doi.org/10.1016/j.jaad.2009.06.008Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar Histologically, pigmented SCCis shows full-thickness epidermal keratinocyte atypia, dyskeratosis, nuclear pleomorphism, and apoptosis. Amyloid has been observed in these cutaneous neoplasms.2Baykal C. Hurdogan O. Babuna Kobaner G. Ekinci A.P. Buyukbabani N. Secondary localized cutaneous amyloidosis is not rare in Bowen's disease and bowenoid papulosis.Turk Patoloji Derg. 2022; 38: 54-59https://doi.org/10.5146/tjpath.2021.01530Crossref PubMed Scopus (1) Google Scholar Treatment involves surgical excision, electrodessication and curettage, photodynamic therapy, and topical chemotherapeutic agents. In our case, the lesion was treated with surgical excision.Fig 4Crystal violet stain showing amyloid deposits in the papillary dermis (20× magnification).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Histology demonstrated full-thickness epidermal atypia and presence of eosinophilic globules in the papillary dermis (Fig 3). A crystal violet stain was positive in some globules compatible with amyloid (Fig 4).Key messagePigmented squamous cell carcinoma in situ (SCCis) is an uncommon variant of SCCis. It most commonly presents as progressively enlarging papules/plaques, typically in photoexposed areas. Pigmented SCCis is often seen in dark skin phototypes and may clinically mimic melanoma, pigmented basal cell carcinoma, and seborrheic keratosis. Dermatoscopy may aid in diagnosis and can reveal multicomponent pattern, atypical glomerular vascular structures, absence of a pigment network or pseudonetwork, diffuse pigmentation or blotches, hypopigmented structureless areas, or brown or gray dots in a linear fashion.1Cameron A. Rosendahl C. Tschandl P. Riedl E. Kittler H. Dermatoscopy of pigmented Bowen's disease.J Am Acad Dermatol. 2010; 62: 597-604https://doi.org/10.1016/j.jaad.2009.06.008Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar Histologically, pigmented SCCis shows full-thickness epidermal keratinocyte atypia, dyskeratosis, nuclear pleomorphism, and apoptosis. Amyloid has been observed in these cutaneous neoplasms.2Baykal C. Hurdogan O. Babuna Kobaner G. Ekinci A.P. Buyukbabani N. Secondary localized cutaneous amyloidosis is not rare in Bowen's disease and bowenoid papulosis.Turk Patoloji Derg. 2022; 38: 54-59https://doi.org/10.5146/tjpath.2021.01530Crossref PubMed Scopus (1) Google Scholar Treatment involves surgical excision, electrodessication and curettage, photodynamic therapy, and topical chemotherapeutic agents. In our case, the lesion was treated with surgical excision. Pigmented squamous cell carcinoma in situ (SCCis) is an uncommon variant of SCCis. It most commonly presents as progressively enlarging papules/plaques, typically in photoexposed areas. Pigmented SCCis is often seen in dark skin phototypes and may clinically mimic melanoma, pigmented basal cell carcinoma, and seborrheic keratosis. Dermatoscopy may aid in diagnosis and can reveal multicomponent pattern, atypical glomerular vascular structures, absence of a pigment network or pseudonetwork, diffuse pigmentation or blotches, hypopigmented structureless areas, or brown or gray dots in a linear fashion.1Cameron A. Rosendahl C. Tschandl P. Riedl E. Kittler H. Dermatoscopy of pigmented Bowen's disease.J Am Acad Dermatol. 2010; 62: 597-604https://doi.org/10.1016/j.jaad.2009.06.008Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar Histologically, pigmented SCCis shows full-thickness epidermal keratinocyte atypia, dyskeratosis, nuclear pleomorphism, and apoptosis. Amyloid has been observed in these cutaneous neoplasms.2Baykal C. Hurdogan O. Babuna Kobaner G. Ekinci A.P. Buyukbabani N. Secondary localized cutaneous amyloidosis is not rare in Bowen's disease and bowenoid papulosis.Turk Patoloji Derg. 2022; 38: 54-59https://doi.org/10.5146/tjpath.2021.01530Crossref PubMed Scopus (1) Google Scholar Treatment involves surgical excision, electrodessication and curettage, photodynamic therapy, and topical chemotherapeutic agents. In our case, the lesion was treated with surgical excision. Pigmented squamous cell carcinoma in situ (SCCis) is an uncommon variant of SCCis. It most commonly presents as progressively enlarging papules/plaques, typically in photoexposed areas. Pigmented SCCis is often seen in dark skin phototypes and may clinically mimic melanoma, pigmented basal cell carcinoma, and seborrheic keratosis. Dermatoscopy may aid in diagnosis and can reveal multicomponent pattern, atypical glomerular vascular structures, absence of a pigment network or pseudonetwork, diffuse pigmentation or blotches, hypopigmented structureless areas, or brown or gray dots in a linear fashion.1Cameron A. Rosendahl C. Tschandl P. Riedl E. Kittler H. Dermatoscopy of pigmented Bowen's disease.J Am Acad Dermatol. 2010; 62: 597-604https://doi.org/10.1016/j.jaad.2009.06.008Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar Histologically, pigmented SCCis shows full-thickness epidermal keratinocyte atypia, dyskeratosis, nuclear pleomorphism, and apoptosis. Amyloid has been observed in these cutaneous neoplasms.2Baykal C. Hurdogan O. Babuna Kobaner G. Ekinci A.P. Buyukbabani N. Secondary localized cutaneous amyloidosis is not rare in Bowen's disease and bowenoid papulosis.Turk Patoloji Derg. 2022; 38: 54-59https://doi.org/10.5146/tjpath.2021.01530Crossref PubMed Scopus (1) Google Scholar Treatment involves surgical excision, electrodessication and curettage, photodynamic therapy, and topical chemotherapeutic agents. In our case, the lesion was treated with surgical excision. None disclosed.

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How this classification was reachedexpand

Full frame distilled prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.

metaresearch head score (Codex)0.000
metaresearch head score (Gemma)0.000
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Case report · Consensus signal: Case report
GenreCandidate signal: Empirical · Consensus signal: Empirical
Teacher disagreement score0.016
Threshold uncertainty score0.660

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0000.000
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0000.000
Bibliometrics0.0000.000
Science and technology studies0.0000.000
Scholarly communication0.0000.000
Open science0.0000.000
Research integrity0.0000.000
Insufficient payload (model declined to judge)0.0000.000

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.009
GPT teacher head0.220
Teacher spread0.211 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one teacher head, not a consensus.

The models applied no category: nothing in the taxonomy fit this work.
Study designCase report
Domainnot available
GenreEmpirical

How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".

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Published2022
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