Acrochordons are generally assumed to be benign and might not be submitted for pathologic analysis. One study of 1335 clinically diagnosed acrochordons found only 5 malignant tumors.1 Both squamous cell carcinoma and basal cell carcinoma have been reported in acrochordon-like lesions.1,2 We report herein a case of acrochordon-like melanoma metastasis.
Figure 1. Clinical (inset) and dermoscopic images. Clinical image shows the hyperpigmented pedunculated metastatic melanoma lesion of the axillary vault to be similar in appearance to a pigmented acrochordon. Dermoscopic image of the pigmented saccular lesion without obvious vasculature (Canon Rebel SXi camera; 3Gen DermLite FOTO Dermatoscope with 30-mm polarized lens) (original magnification ×8).
Figure 2. Microscopic images. A, Reflectance confocal microscopy (RCM) demonstrates multiple dense and sparse dermal nests (arrow) B, Dense nest of atypical melanocytes (arrow) is seen on RCM in close proximity to horizontally oriented blood vessels (arrowheads). C and D, Histopathologic examination reveals multiple discohesive nests of severely atypical melanocytes with epidermal sparing (C) and closely interposed neovascularization of a tumor nest (D) (hematoxylin-eosin, original magnifications ×4 [C] and ×40 [D])
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Reflectance Confocal Microscopy
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