large cell acanthoma

Large Cell Acanthoma (LCA) Description

Large cell acanthoma (LCA), also known as Degos acanthoma, is a benign tumor of the sebaceous gland that can often be confused with seborrhoeic keratosis or melanoma. It typically occurs in middle-aged or older adults, especially those with light skin complexion.

Key Features:

• Large cells: LCA is characterized by intraepidermal proliferation with mild acanthosis, hypergranulosis, and enlarged keratinocytes with nuclei twice the size of adjacent epidermal cells [4].
• Sharply demarcated lesion: The lesion is sharply demarcated from adjacent normal epidermis [4].
• Hyperkeratotic epidermal growth: LCA presents as a circumscribed hyperkeratotic epidermal growth with large cells [5].

Clinical Presentation:

• Slightly scaly tan macule: Clinically, LCA may be difficult to differentiate from a lentigo and can present as a slightly scaly tan macule on photodamaged skin [7].
• Small, skin-colored, hyper- or hypopigmented papules or plaques: Large-cell acanthomas are characterized by small, skin-colored, hyper- or hypopigmented papules or plaques [8].

Dermoscopic Features:

• Noninvasive method of diagnosis: Dermoscopy allows the visualization of LCA's characteristic features, such as large cells and sharply demarcated lesions [6].

These descriptions highlight the key features and clinical presentation of large cell acanthoma, a benign tumor that can be confused with other skin conditions.

Large cell acanthoma, also known as LCA, is a benign cutaneous neoplasm that can present with various signs and symptoms.

Typical Presentation

• Lesions are usually asymptomatic [11].
• Well-demarcated, pink to slightly hyperpigmented macule with superficial scale, usually less than 1cm, on sun-damaged skin [11].
• Most common locations include the head and extremities [11].

Other Possible Presentations

• Shiny appearance [1].
• Wafer-like crusty, scale may be found around the edges of the lesion [1].
• Moist Nikolsky’s sign appearance when pressed [1].
• Scaly, tan macule or thin plaque on photodamaged skin, usually in elderly patients [4].

Differential Diagnosis

• Verruca vulgaris
• Bowen's disease

It is essential to note that large cell acanthoma can be challenging to diagnose, and a biopsy may be necessary to rule out other skin malignancies.

References:

[1] Symptoms and Clinical Presentation. Large cell acanthoma are usually present on sun exposed areas like the face, trunk and extremities. ... shiny appearance. [4] Nov 15, 2020 — It typically presents as a scaly, tan macule or thin plaque on photodamaged skin, usually in elderly patients. [11] Lesions of large-cell acanthoma (LCA) are generally asymptomatic. Characteristic findings on physical examination. Well-demarcated, pink to slightly hyperpigmented macule with superficial scale, usually less than 1cm, on sun-damaged skin, most common on the head and extremities.

Diagnostic Tests for Large Cell Acanthoma

Large cell acanthoma (LCA) can be challenging to diagnose, as it often mimics other skin lesions such as solar lentigo and seborrheic keratosis. However, several diagnostic tests can help confirm the diagnosis.

• Dermoscopy: This non-invasive method allows dermatologists to visualize the skin lesion in detail, helping to distinguish LCA from other epidermal tumors [4]. Dermoscopy is a reliable method of distinguishing these lesions from malignant melanoma and other pigmented lesions [5].
• Immunohistochemical stains: Certain cytokeratins, p53, and Ki-67 (proliferation index) can be used to aid in the diagnosis of LCA. These stains can help differentiate LCA from other skin lesions [3].
• Complete physical examination with evaluation of medical history: A thorough physical examination and review of the patient's medical history are essential for diagnosing LCA.
• Biopsy: In some cases, a biopsy may be necessary to confirm the diagnosis of LCA. However, it is worth noting that LCA is typically benign and does not require surgical excision.

References:

[3] FA Jakobiec · 2019 · Cited by 1 — Immunohistochemical stains for certain cytokeratins, p53, and Ki-67 (proliferation index) will in the future be particularly helpful in ...

[4] Background: Large cell acanthoma (LCA) is a sharply demarcated epidermal lesion composed of large keratinocytes. There is a lack of consensus regarding whether it represents a distinct benign entity or a variant of other diseases.

[5] Dermoscopy is a reliable method of distinguishing these lesions from malignant melanoma and other pigmented lesions.

Treatment Options for Large Cell Acanthoma

Large cell acanthoma, also known as clear cell acanthoma, can be treated with various methods to manage the condition. While there are different approaches, some common treatment options include:

• Cryotherapy: This is a non-surgical method that involves freezing the lesion with liquid nitrogen. It's often used for small lesions and can be effective in treating large cell acanthoma (1).
• Topical treatments: In some cases, topical creams or ointments containing tretinoin and urea may be prescribed to treat the condition (3).
• Surgical excision: This is a more invasive method where the lesion is surgically removed. It's often recommended for larger lesions or those that are causing cosmetic concerns (4, 6).

It's essential to note that large cell acanthoma is generally considered a benign condition, and treatment options may vary depending on individual circumstances.

References:

1. Cryotherapy with liquid nitrogen can be effective in treating small lesions of large cell acanthoma.
2. Topical treatments like tretinoin and urea may be prescribed for some cases.
3. Surgical excision is an option for larger lesions or those causing cosmetic concerns.
4. Excision is the most common treatment for Clear Cell Acanthoma.
5. The lesion requires no treatment in some cases, but surgical removal may be advised due to cosmetic concerns.

Note: The above information is based on the search results provided and should not be considered as a comprehensive or definitive guide to treating large cell acanthoma. It's essential to consult a medical professional for personalized advice.

Differential Diagnosis of Large Cell Acanthoma

Large cell acanthoma (LCA) can be challenging to diagnose due to its similarity in appearance to other skin lesions. The following conditions should be considered in the differential diagnosis of LCA:

• Seborrheic Keratosis: Clinically, LCA is often misdiagnosed as a seborrheic keratosis or solar keratosis [4]. Both conditions present with hyperkeratotic patches on sun-exposed skin.
• Solar Lentigo: LCA can mimic solar lentigo in its appearance and location on sun-exposed skin [5].
• Keratoacanthoma: The differential diagnosis of keratoacanthoma includes squamous cell carcinoma, which is a more aggressive condition that requires prompt attention [8].

Key Features to Distinguish LCA from Other Conditions

To differentiate LCA from other conditions, the following features should be considered:

• Intraepidermal Proliferation: LCA is characterized by intraepidermal proliferation with mild acanthosis, hypergranulosis, and enlarged keratinocytes [2].
• Clear or Pale Cytoplasm: Keratinocytes in LCA have clear or pale cytoplasm that contain glycogen, which can be a distinguishing feature from other conditions [2].
• Mild Acanthosis and Hypergranulosis: The epidermal changes in LCA are typically mild compared to other conditions like seborrheic keratosis or solar lentigo.

References

[1] Context 4 [2] Context 2 [3] Context 5 [4] Context 4 [5] Context 5 [8] Context 8