Clinical Challenge: Itchy Lesion on the Chest - MPR

Clinical Challenge: Itchy Lesion on the Chest

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A 66-year-old man is referred for evaluation of a growth on his chest that he first noted several months ago. He denies history of skin cancer. The lesion has not bled but can be itchy at times. Examination reveals a 1.8cm, hyperpigmented plaque with a pinkish-red border. Multiple keratoses and lentigines are noted elsewhere.

Benign lichenoid keratosis, also known as lichen planus-like keratosis, is a skin disorder that occurs most frequently in fair-skinned individuals aged 50 to 60 years.1  It presents as a single, discrete papule, patch, or plaque ranging from light pink to...

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Benign lichenoid keratosis, also known as lichen planus-like keratosis, is a skin disorder that occurs most frequently in fair-skinned individuals aged 50 to 60 years.1  It presents as a single, discrete papule, patch, or plaque ranging from light pink to brown in color.1 The lesion surface may be smooth, scaly, or verrucous, and patients may complain of mild pruritus.2 Benign lichenoid keratosis may result from an inflammatory reaction within a pre-existing lesion such as a solar lentigo, seborrheic keratosis, large cell acanthoma, or viral wart.2,3 Histologic examination demonstrates  hyperkeratosis, hypergranulosis, acanthosis, and band-like lymphocytic infiltrates at the dermal-epidermal junction.3 Varying degrees of granularity are noted on dermoscopy.4

 

Differential diagnosis includes squamous and basal cell carcinomas; biopsy may be prudent to rule out more serious pathology. Benign lichenoid keratosis may respond to cryotherapy or be removed via shave excision or curettage. The lesion is benign and has no malignant potential.5

Conor Knight, PA-S, is a student at Kings College, and Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

  1. 1. Abdulla FR, Mutasim DF. Multiple benign lichenoid keratosesJ Am Acad Dermatol. 2010;62(5):900-901.
  2. 2. Anderson B, Cappel J. Lichenoid keratosis (lichenoid keratosis, lichen planus-like keratosis). Dermatology Advisor website. https://www.dermatologyadvisor.com/dermatology/lichenoid-keratosis-lichenoid-keratosis-lichen-planus-like-keratosis/article/691264/. Published 2017. Accessed October 24, 2018.
  3. 3. Mhatre A, Nadkarni N, Patil S, Agarwal S. A case of benign lichenoid keratosis. Indian J Dermatopathol Diagn Dermatol. 2015;2(2):49-51.
  4. 4. Nagrani N, Jaimes N, Oliviero MC, Rabinovitz HS. Lichen planus-like keratosis: clinical applicability of in vivo reflectance confocal microscopy for an indeterminate cutaneous lesionDermatol Pract Concept. 2018;8(3):180-183.
  5. 5. Rosen T. Benign lichenoid keratoses mimicking squamous and basal cell carcinoma. Patient Care website. http://www.patientcareonline.com/skin-diseases/benign-lichenoid-keratoses-mimicking-squamous-and-basal-cell-carcinoma. Published November 1, 2012. Accessed October 24, 2018.