Friday, April 01, 2016

Unusual Tumor in a 53 yo Man

53-year-old man who was seen for a general skin examination.  He has Crohn's disease and has been on 6-MP for the past 8-10 years.  His gastroenterologist said because of this he should have a skin examination. 

O/E:  The patient has type II skin.  He has a 6 mm in diameter pink papule on the calf of the left leg.  Dermoscopically, this lesion has a dotted vascular pattern.
IMPRESSION:  Lesion left calf.  Etiology unclear.  

Plan:  Excisional biopsy was obtained. 

Inflammatory Bowel Disease Treatment and Non-melanoma Skin Cancer: Jacqueline F De Luca, MD, Yun Sun Lee, MD, and Douglas Johnson, MD, Hawaii J Med Public Health. 2012.7:324–325.

Abstract:Immunosuppressant medications for Inflammatory Bowel Disease can help with both symptoms and disease progression. However, like immunosuppressants used in transplant patients, they are now suspect of contributing to nonmelenoma skin cancer (NMSC). Presented is a case of a 57-year-old Jewish man with Crohn's Disease who was diagnosed with a total of 84 NMSCs. We hope to elucidate the risk of immunosuppressants, particularly the thiopurines, on the development of NMSC.



  1. Consider Tufted Angioma; Bacillary angiomatosis
    Al-Za’abi AM, Ghazarian D, Greenberg GR, Shaw JC. Eruptive tufted angiomas in a patient with Crohn's disease. J Clin Pathol. 2005;58:214–6.

  2. Has somewhat of a "string of pearls" configuration suggestive of a clear cell acanthoma. I haven't seen any correlations with this and Crohn's disease or with immunosuppression, but the age and morphology would be consistent.

  3. Clear cell acanthoma with string of pearls seems to fit .
    Patrick Kenny

  4. Yoon Cohen wrote: This looks like "clear cell acanthoma" by looking at the dermoscopic image.


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