We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Observation |

An Unusual 2-Tone Epidermal Cyst Dermoscopy, Confocal Microscopy, and Histopathologic Correlations

Francesco Lacarrubba, MD1; Anna Elisa Verzì, MD1; Aurora Tedeschi, MD1; Rosario Caltabiano, MD2; Giuseppe Micali, MD1
[+] Author Affiliations
1Dermatology Clinic, University of Catania, Catania, Italy
2Department G.F. Ingrassia, Section of Anatomic Pathology, University of Catania, Catania, Italy
JAMA Dermatol. 2015;151(12):1386-1388. doi:10.1001/jamadermatol.2015.2505.
Text Size: A A A
Published online


This case report describes an unusual, clinically 2-tone epidermal cyst that displayed an irregular blue color under dermoscopy, reflectant platelike structures under confocal microscopy, and cholesterol clefts histopathologically.

Noninvasive techniques such as dermoscopy and reflectant confocal microscopy (RCM) may enhance the diagnosis in some unusual nodules, as illustrated by the present case.

Article InformationCorresponding Author: Giuseppe Micali, MD, Dermatology Clinic, University of Catania, AOU Policlinico-Vittorio Emanuele, Via Santa Sofia, 78-95123, Catania, Italy (cldermct@gmail.com).

Published Online: September 9, 2015. doi:10.1001/jamadermatol.2015.2505.

Conflict of Interest Disclosure: None reported.

Figures in this Article

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Figure 1.
Clinical and Dermoscopic Views of Epidermal Cyst

A, In the clinical image, a well-demarcated, 2-tone nodule of about 0.5 × 1 cm is apparent on the right thigh. B, Under dermoscopy (original magnification ×10, polarized light), the 2 well-defined areas can be seen, one of a homogeneous yellowish color, the other an irregular blue; within the bluish area, a circular, keratin-filled pore is evident (arrowhead).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Reflectance Confocal Microscopy (RCM) Visualization and Pathologic Analysis of Epidermal Cyst

A, Under RCM, highly reflectant, geometrical, platelike structures with notched corners are apparent. B, Histopathologically, a squamous epithelial lining contains an intact granular cell layer and cholesterol clefts (arrowheads) (hematoxylin-eosin, original magnification ×100).

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles