Observation | Dermatol Pract Concept 2016;6(3):9 47 DERMATOLOGY PRACTICAL & CONCEPTUAL www.derm101.com Case presentation A 72-year-old man with a history of melanoma in situ pre- sented for his regular follow-up visit. The routine clinical examination revealed a pinkish-red nodule on the lower back. The nodule was not present in the previous visit held six months earlier (Figures 1, A and B). The dermoscopic examination revealed a nonpigmented lesion characterized by a polymorphous vascular pattern, consisting of dotted and short curved linear vessels on a red- pinkish background. The latter unspecific pattern did not allow a definite diagnosis, prompting us to excise the nodule (Figure 2). On low power examination the lesion was well circum- scribed and involved the reticular dermis (Figure 3A). At higher magnification, the extensive myxoid change was evi- dent; cellularity was inconspicuous and vascularity consisted of small, thin-walled vessels (Figure 3B). The findings were diagnostic of superficial angiomyxoma. Conclusions SA was initially described by Carney et al. in 1985 in asso- ciation with Carney’s complex syndrome, a rare autosomal dominant disorder characterized by neoplasia involving the heart, central nervous system, and endocrine organs. In 1998 Allen et al. reported several cases of SA without evidence of Carney’s complex. In 1999 Calonje et al. reported the clinico- pathological and immunohistochemical features of SA as an independent disease [1,5]. In 2014 Green et al. reported the Superficial angiomyxoma of the skin Alvaro Abarzúa-Araya1 Aimillios Lallas2 Simonetta Piana3 Caterina Longo2 Elvira Moscarella2, Giuseppe Argenziano4 1 Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile 2 Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy 3 Pathology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy 4 Dermatology Unit, Second University of Naples, Naples, Italy Key words: superficial angiomyxoma, angiomyxoma, cutaneous tumor, dermoscopy Citation: Abarzúa-Araya A, Lallas A, Piana S, Longo C, Moscarella E, Argenziano G. Superficial angiomyxoma of the skin. Dermatol Pract Concept 2016;6(3):9. doi: 10.5826/dpc.0603a09 Received: March 13, 2016; Accepted: May 2, 2016; Published: July 31, 2016 Copyright: ©2016 Abarzúa-Araya et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: None. Competing interests: The authors have no conflicts of interest to disclose. All authors have contributed significantly to this publication. Corresponding author: Aimillios Lallas, MD, Skin Cancer Unit, Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42100, Reggio Emilia, Italy. Tel. 00390522295611; Fax. 00390697625822. E-mail: emlallas@gmail.com Superficial angiomyxomas (SA) of the skin are rare benign cutaneous tumors of soft tissue composed of prominent myxoid matrix and numerous blood vessels. SA are more common in males [1] and they are usually located on the trunk but can also appear on the lower limbs, head, neck and genitalia [2,3]. Treatment is surgical, the total excision is curative, but local recurrence is possible [4]. Herein we present a 72-year-old patient with a history of melanoma in situ, with a new lesion on the lower back. ABSTRACT 48 Observation | Dermatol Pract Concept 2016;6(3):9 dermoscopic features of SA for the first time and described “the red planet sign”—a red, translucent, globular exophytic lesion with arborizing vessels that looks like a blood moon during recent lunar eclipses [6]. In contrast, in our case, the patient presented with a pinkish-red nodule on the lower back, not a polypoid lesion. Additionally, dermoscopy did not show the red planet sign, thus we believe that this sign may be highly unspecific or anecdotic. We did not perform an echocardiogram or other tests because our patient lacked skin pigmentation, mucosal lesion, other cutaneous tumors or family history of myxomas. Although Spitz nevus and amelanotic melanoma come first in the list of differential diagnoses of nonpigmented nodular lesions displaying predominantly dotted vessels under dermoscopy, several other less common tumors might exhibit a similar pattern. Our case suggests that SA should be added in this list. However, since these dermoscopic findings are highly unspecific, a nodule dermoscopically characterized by predominantly dotted vessels should be promptly excised to rule out melanoma. Figure 1. Superficial angiomyxoma. Clinical images. [Copyright: ©2016 Abarzúa-Araya et al.] A B Figure 2. Superficial angiomyxoma. Dermoscopic image. [Copy- right: ©2016 Abarzúa-Araya et al.] Figure 3A & B. Superficial angiomyxoma. Histologic images. [Copy- right: ©2016 Abarzúa-Araya et al.] A B Observation | Dermatol Pract Concept 2016;6(3):9 49 4. Diniz G, Temir G, Ortac R. Angiomyxoma: always myxoid, some- times aggressive. Turk Patoloji Derg. 2012;28(2):162-4. PMID: 22627635. DOI: 10.5146/tjpath.2012.01116. 5. Calonje E, Guerin D, McCormick D, Fletcher CD. Superficial an- giomyxoma: clinicopatologic analysis of a series of a distinctive but poorly recognized cutaneous tumors with tendency for recurrence. Am J Surg Pathol. 1999;23(8):910-7. PMID: 10435560. 6. Green M, Logemann N, Sulit DJ. Myxoid stroma and delicate vasculature of a superficial angiomyxoma give rise to the red planet sign. Dermatol Online J. 2014;20(9). PMID: 25244175. References 1. Lee CC, Chen YL, Liau JY, Chen CA, Cheng WF. Superficial angiomyxoma on the vulva of an adolescent. Taiwan J Obstet Gynecol. 2014;53(1):104-6. PMID: 24767658. DOI: 10.1016/j. tjog.2013.08.001. 2. Rodríguez-Vásquez M, García-Arpa M, Delgado M, et al. Angio- mixoma superficial. Actas Dermosifiliogr. 2005;96(5):311-4. PMID: 16476394 3. Nakamura M, Tokura Y. Superficial angiomyxoma on the scrotum of a child. Pediatr Dermatol. 2011;28(2):200-1. PMID: 21504453. DOI: 10.1111/j.1525-1470.2011.01389.x.