Indian Dermatology Online Journal

: 2015  |  Volume : 6  |  Issue : 4  |  Page : 284--285

A solitary auricular polyp

Michael J McFall1, John R Griffin2, Dirk M Elston2,  
1 Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
2 Ackerman Academy of Dermatopathology, New York, USA

Correspondence Address:
Michael J McFall
142 North Clark Drive, Apartment 3, West Hollywood, CA 90048

How to cite this article:
McFall MJ, Griffin JR, Elston DM. A solitary auricular polyp.Indian Dermatol Online J 2015;6:284-285

How to cite this URL:
McFall MJ, Griffin JR, Elston DM. A solitary auricular polyp. Indian Dermatol Online J [serial online] 2015 [cited 2021 Jan 23 ];6:284-285
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Full Text

A 73-year-old man presented to his dermatologist with a 1 cm, polypoid, left auricular lesion of 1-year duration. His past medical history was significant for prostatic adenocarcinoma.

A biopsy was obtained, and immunohistochemical staining for Melan-A was performed [Figure 1] and [Figure 2].{Figure 1}{Figure 2}

The most likely diagnosis is:

Congenital pattern nevus with pseudovascular spacesEpithelioid angiosarcomaGlomangiomaMetastatic melanoma associated with an angiokeratomaLobular capillary hemangioma (pyogenic granuloma).


Metastatic melanoma associated with an angiokeratoma


The histological sections demonstrated dilated and focally thrombosed vascular spaces within the superficial dermis. The overlying epidermis showed focal atrophy, but was otherwise unremarkable. Adjacent to and within the vascular lumens, atypical epithelioid cells arranged in nests and sheets were noted, without definitive maturation or dispersion [Figure 1]a and b]. Furthermore, conspicuous nucleoli and rare mitoses were appreciated in the epithelioid cell proliferation [Figure 2]a]. Immunohistochemical stains for S-100 and Melan-A [Figure 2]b] highlighted the tumor.

Albeit rare, published case reports and small series have described the co-occurrence of cutaneous melanoma and other neoplasms (epithelial, mesenchymal, and hematopoietic). Concomitant melanoma and malignant (basal cell carcinoma [BCC], squamous cell carcinoma, chronic lymphocytic leukemia, leiomyosarcoma, Paget's disease, atypical fibroxanthoma, and Merkel cell carcinoma) [1],[2],[3],[4],[5],[6],[7] as well as benign tumors (seborrheic keratosis) [8] have been documented with BCC reported most often. To further clarify the confusing terminology used to describe these unique lesions, several authors have proposed a standardized nomenclature with four general subcategories including: combination, collision, biphenotypic, and colonization tumors.[9],[10],[11],[12] However, due in large part to the relative paucity of cases, the biology and therefore clinical relevance of these lesions is not well-understood.

In the current case, given the clinical history of a solitary lesion, the possibility of a primary melanoma was considered. However, the absence of an in-situ lesion, focal sheet-like growth with poor maturation in a predominantly intravascular location, and relatively monomorphic atypical cytology of the nevoid/epithelioid population suggest a metastasis. As the distinction between primary cutaneous and metastatic melanoma has significant prognostic and therapeutic implications, criteria incorporating both architectural and cytologic features have been proposed in an attempt to elucidate this quandary. [13] The presence of an intraepidermal (in-situ) and/or benign nevic component, relative absence of lymphovascular invasion, polymorphous cytology, and fewer mitoses favor a primary lesion. In contrast, a dermal and/or subcutaneous infiltrate, extensive lymphovascular invasion, monomorphous population, and numerous mitoses favor a metastasis. Ultimately, however, the correlation of clinical and radiologic findings, as was suggested in our case, is critical in arriving at an accurate diagnosis.


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