Pyogenic granuloma and nodular Kaposi’s sarcoma: dermoscopic clues for the differential diagnosis

Pyogenic granuloma and nodular Kaposi’s sarcoma: dermoscopic clues for the differential diagnosis

Background/aim: Pyogenic granuloma (PG)-like nodular Kaposi’s sarcoma (KS) has been previously demonstrated in several studies.However, to the best of our knowledge, no original study investigating the dermoscopic differential diagnosis of PG and KS exists in therelevant literature. In this study we aimed to identify dermoscopic findings providing useful clues to differential diagnosis between thetwo entities.Materials and methods: Patients with histopathologically confirmed PG or nodular KS were included in the study. Demographic,clinical, dermoscopic, and histopathological findings of the cases were retrospectively reviewed.Results: The most common finding observed in PG was red structureless areas (80.00%), followed by intersecting thick white lines(56.66%), ulceration (36.66%), and collarette scale (33.33%). The most common findings detected in nodular KS were polychromaticstructures (56.66%) and red (46.66%) and white (13.33%) structureless areas, respectively.Conclusion: Intersecting thick white lines seem to be the strongest dermoscopic clue to PG. Striate surface scaling (n = 6) was a novelfinding identified for PG. Here we also described a new vascular pattern (widespread vessels composing a network) for nodular KS.

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  • 1. Plachouri KM, Georgiou S. Therapeutic approaches to pyogenic granuloma: an updated review. International Journal of Dermatology 2019; 58 (6): 642-648. doi: 10.1111/ijd.14268
  • 2. Curtiss P, Strazzulla LC, Friedman-Kien AE. An update on Kaposi’s sarcoma: epidemiology, pathogenesis and treatment. Dermatologic Therapy 2016; 6 (4): 465-470. doi: 10.1007/ s13555-016-0152-3
  • 3. Scott PL, Motaparthi K, Krishnan B, Hsu S. Pyogenic granuloma-like Kaposi sarcoma: a diagnostic pitfall. Dermatology Online Journal 2012; 18 (3): 4.
  • 4. Zaballos P, Carulla M, Ozdemir F, Zalaudek I, Bañuls J et al. Dermoscopy of pyogenic granuloma: a morphological study. British Journal of Dermatology 2010; 163 (6): 1229-1237. doi: 10.1111/j.1365-2133.2010.10040.x
  • 5. Requena L, Sangueza OP. Cutaneous vascular proliferation. Part II. Hyperplasias and benign neoplasms. Journal of the American Academy of Dermatology 1997; 37 (6): 887-919. doi: 10.1016/s0190-9622(97)70065-3
  • 6. Elmets CA, Ceilley RI. Amelanotic melanoma presenting as a pyogenic granuloma. Cutis 1980; 25 (2): 164-167.
  • 7. Rowe L. Granuloma pyogenicum. AMA Archives of Dermatology 1958; 78 (3): 341-347. doi: 10.1001/ archderm.1958.01560090055013
  • 8. Zalaudek I, Argenziano G, Kerl H, Soyer HP, HofmannWellenhof R. Amelanotic/hypomelanotic melanoma – is dermoscopy useful for diagnosis? Journal of the German Society of Dermatology 2003; 1 (5): 369-373. doi: 10.1046/j.1610- 0387.2003.02042.x
  • 9. Schmidt BM, Holmes CM. Classic solitary Kaposi sarcoma of the foot in an immunocompetent patient: a case report. Wounds 2016; 28 (9): 35-40.
  • 10. Mohanty G, Mohanty R, Satpathy A. Simultaneous occurrence of pyogenic granuloma at multiple sites associated with bone loss: report of a rare case. Journal of Indian Society of Periodontology 2018; 22 (2): 174-177. doi: 10.4103/jisp. jisp_367_17
  • 11. Hu SC, Ke CL, Lee CH, Wu CS, Chen GS et al. Dermoscopy of Kaposi’s sarcoma: areas exhibiting the multicoloured ‘rainbow pattern’. Journal of the European Academy of Dermatology and Venereology 2009; 23 (10): 1128-1132. doi: 10.1111/j.1468- 3083.2009.03239.x
  • 12. Kittler H, Rosendahl C, Cameron A, Tschandl P. Dermatoscopy. An Algorithmic Method Based on Pattern Analysis. 1st ed. Vienna, Austria: Facultas Verlags and Buchhandels AG; 2011.
  • 13. Zaballos P, Llambrich A, Cuellar F, Puig S, Malvehy J. Dermoscopic findings in pyogenic granuloma. British Journal of Dermatology 2006; 154 (6): 1108-1111. doi: 10.1111/j.1365- 2133.2006.07193.x
  • 14. Kelati A, Mernissi FZ. The rainbow pattern in dermoscopy: a zoom on nonkaposi sarcoma skin diseases. Biomedical Journal 2018; 41 (3): 209-210. doi: 10.1016/j.bj.2018.04.004
  • 15. Uzunçakmak TK, Ozkanli S, Karadağ AS. Dermoscopic rainbow pattern in blue nevus. Dermatology Practical & Conceptual 2017; 7 (3): 60-62. doi: 10.5826/dpc.0703a13
  • 16. Cheng ST, Ke CL, Lee CH, Wu CS, Chen GS et al. Rainbow pattern in Kaposi’s sarcoma under polarized dermoscopy: a dermoscopic pathological study. British Journal of Dermatology 2009; 160 (4): 801-809. doi: 10.1111/j.1365- 2133.2008.08940.x
  • 17. Vazquez-Lopez F, Garcia-Garcia B, Rajadhyaksha M, Marghoob AA. Dermoscopic rainbow pattern in non-Kaposi sarcoma lesions. British Journal of Dermatology 2009; 161 (2): 474-475. doi: 10.1111/j.1365-2133.2009.09225.x
  • 18. Demirel BG, Koca R, Tekin NS, Kandemir NO, Gün BD et al. Classic Kaposi’s sarcoma: the clinical, demographic and treatment characteristics of seventy-four patients. Turkish Archives of Dermatology and Venereology 2016; 50 (4): 136- 140. doi: 10.4274/turkderm.35336