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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.
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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.

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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).

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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).

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