Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2022;12(2):e2022089 1

Dotted Vessels in a Reticular Arrangement
Florentina Silvia Delli1, Despina Noukari1, Zoe Apalla2, Aimilios Lallas3

1 State Hospital for Skin and Venereal Diseases Thessaloniki, Hippokratia Hospital, Thessaloniki, Greece

2 Second Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece 

3 First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece 

Citation: Delli FS, Noukari D, Apalla Z, Lallas A. Dotted vessels in a reticular arrangement. Dermatol Pract Concept. 
2022;12(2):e2022089. DOI: https://doi.org/10.5826/dpc.1202a89

Accepted: September 26, 2021; Published: April 2022

Copyright: ©2022 Delli et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Florentina Silvia Delli, Dermatologist, MD, PhD, State Hospital for Skin and Venereal Diseases Thessaloniki, 
Hippokratia Hospital, 124 Delfon Street, 546 43, Thessaloniki Greece. E-mail: delliflorentina@ymail.com

Case presentation

We report a case of a 56-year-old male patient who pre-

sented for evaluation of a tumor on his right lower back 

( Figure  1A). He reported that he observed the lesion for 

the first time 3 years earlier and, since then, it gradually in-

creased in size and was sporadically traumatized.

Dermoscopy revealed glomerular and dotted vessels with 

a reticular arrangement at the periphery of the lesion (white 

circles, Figure 1B), but also linear mixed and hairpin-like 

vessels (white arrows, Figure 1B) irregularly distributed in 

the center and eccentrically. White structureless areas were 

also focally present (Figure 1B). 

Although reticularly arranged dotted vessels are sugges-

tive of a clear cell acanthoma (CCA) (1), the uneven distri-

bution of vessels in the lesion and the co-existence of other 

morphologic vessel types did not allow a confident clinical 

diagnosis. Therefore, the lesion was excised with a clinical 

differential diagnosis including CCA, non-pigmented eccrine 

poroma (2), amelanotic melanoma and poorly differentiated 

squamous cell carcinoma.

Histopathology confirmed the diagnosis of CCA.

Teaching Point

Dotted vessels in a reticular arrangement (“string of pearls” 

in the metaphoric terminology) are strongly indicative 

of CCA. 

However, excisional biopsy and histopathological ex-

amination is mandatory for any nodular lesions that will 

express only in part the dermoscopic criteria for clear cell 

acanthoma.

References

1. Cunha DG, Kassuga-Roisman LEBP, Silveira LKCB, Macedo FC. 

Dermoscopic features of clear cell acanthoma. An Bras Dermatol. 

2018;93(3):449–450. DOI:10.1590/abd1806–4841.20186977. 

PMID: 29924237. PMCID: PMC6001098.

2. Chessa MA, Patrizi A, Baraldi C, Fanti PA, Barisani A, Vaccari S. 

 Dermoscopic-Histopathological Correlation of Eccrine Poroma: An 

Observational Study. Dermatol Pract Concept. 2019;9(4):283–291.  

DOI:10.5826/dpc.0904a07. PMID: 31723462. PMCID: 

PMC6830555.



2 Image Letter | Dermatol Pract Concept. 2022;12(2):e2022089

Figure 1. (A) Nodular and pink skin lesion measuring 23 mm on patient right lower back. (B) Glomerular and dotted vessels with a reticular 

arrangement at the periphery of the lesion (white circles), linear mixed and hairpin-like vessels (white arrows irregularly distributed in the 

center and eccentrically. White structureless areas were also focally present.