Dermatology: Practical and Conceptual


Quiz  |  Dermatol Pract Concept 2017;7(1):3 19

DERMATOLOGY PRACTICAL & CONCEPTUAL
www.derm101.com

Report of Cases
Case 1: A man in his fifties with a history of Hodgkin lym-

phoma treated 20 years prior with the Stanford V protocol 

and mantle field radiation (total dose: 36 Gray) presented 

for skin examination. A 3 mm pedunculated pink papule was 

found on the right chest within the prior radiation field (Figure 

1A). The lesion was asymptomatic and of unknown duration. 

There was no history of change, bleeding, or itching. Polarized 

dermoscopy of the papule revealed irregular linear and looped 

branching vessels that terminated in a semicircular or circular 

fashion, also termed “cherry-blossom” vessels (Figure 2A).

Histopathologic examination revealed a pedunculated 

well-circumscribed nodular epithelial tumor composed of 

uniform cuboidal cells with round basophilic monomorphic 

nuclei. Multiple broad cords of the anatomizing tumor epi-

thelium connected to the overlying epidermis, surrounding 

characteristic sclerotic well-vascularized stroma (Figure 3A).

Case 2: A woman in her fifties with a history of basal cell 

carcinoma and B-cell acute lymphoblastic leukemia status 

post two allogenic hematopoietic stem cell transplants (total 

body irradiation induction dose of: 13.75 Gy) presented for 

skin examination. A new, asymptomatic 2 mm pedunculated 

pink papule was found on the presternal chest (Figure 1B). 

Polarized dermoscopy of the lesion revealed semicircular/

circular branching vessels originating from a common stem 

vessel (Figure 2B).

Histopathological examination revealed a polypoid epi-

thelial tumor comprised of broad downgrowths of cuboidal 

epithelium clearly demarcated from overlying epidermis 

amidst a background of hyalized/sclerotic highly vascular 

stroma. Small ducts with a pink cuticle were noted within 

epithelial bands (Figure 3B).

What is the diagnosis?

Isolated pink papule on the chest
Zachary Wolner1, Melissa P. Pulitzer2, Michael A. Marchetti1

1 Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

2 Dermatopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Citation: Wolner Z, Pulitzer MP, Marchetti MA. Isolated pink papule on the chest. Dermatol Pract Concept. 2017;7(1):3. DOI: https://doi.
org/10.5826/dpc.0701a03

Copyright: ©2017 Wolner 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.

Corresponding author: Michael A. Marchetti, MD, 16 East 60th Street, New York, NY 10022, USA. Tel. 646-888-6016. Email: marchetm@
mskcc.org

Figure 1. Non-pigmented eccrine poroma. A) Clinical image show-

ing a pink papule on the right upper chest. B) Clinical image show-

ing a pink papule on the presternal chest. [Copyright: ©2017 Wolner 

et al.]

A B

Figure 2. Non-pigmented eccrine poroma. Polarized, non-contact 

dermoscopy images of a pedunculated pink papule with irregular 

branching vessels that terminate in circular and semi-circular struc-

tures. A is from Case 1 and B is from Case 2. [Copyright: ©2017 

Wolner et al.]

A B

mailto:marchetm@mskcc.org
mailto:marchetm@mskcc.org


20 Quiz  |  Dermatol Pract Concept 2017;7(1):3

The dermoscopic features of nonpigmented eccrine poro-

mas are variable (Table 1). A “polymorphous” vascular 

pattern consisting of hairpin, glomerular, and irregular lin-

ear vessels in a single lesion has been frequently described 

[3,5-15]. The most common features include a structureless 

pink-white background (48%), hairpin (loop) vessels (47%), 

“frog-egg appearance” (39%), glomerular vessels (35%), red 

lacunae (27%), ulcers (24%), linear-irregular vessels (23%), 

and leaf-like or cherry-tree vessels (21%). The cases described 

herein showed irregular branching and looped vessels that 

terminated in semicircular or circular structures, which raised 

the suspicion for eccrine poroma [7,11]. These vascular struc-

tures may correlate with localization of proliferative vessels 

within the curved “canals” of tumor stroma.

Variation among dermoscopic characteristics reported in 

the literature can depend on whether contact and/or polarized 

dermoscopy was used, the location of the lesion, or variation 

in the angles of the tumor and the dermatoscope [10]. Larger 

studies are needed to determine the sensitivity and specificity 

of the dermoscopic criteria for eccrine poroma. 

Answer
Eccrine poroma

Discussion
Eccrine poromas are benign cutaneous adnexal neoplasms 

with terminal eccrine duct differentiation. In 2016, Ito et al 

reviewed 376 lesions and found that eccrine poromas occur 

most frequently on the lower extremities (44.4%), followed by 

the scalp (16.2%), trunk (11.7%), upper extremities (11.4%), 

face (9.8%), and neck (3.7%) [1]. Typically eccrine poromas 

appear as solitary plaques, papules, or nodules, but multiple 

tumors can be seen. Poromas commonly contain highly vas-

cularized stroma but can uncommonly have pigmentation [2].

The differential diagnosis of a non-pigmented papule 

arising in the field of prior radiotherapy should include 

amelanotic melanoma, squamous cell carcinoma, adnexal 

neoplasm, and basal cell carcinoma. Interestingly, eccrine 

poromas have been associated with radiotherapy and hema-

tologic malignancy [3,4].

Figure 3. A) Non-pigmented eccrine poroma: photomicrograph showing an exophytic, well-circumscribed nodular epithelial tumor with 

uniform cuboidal cells, round basophilic monomorphic nuclei, and sclerotic vascularized “poroma stroma” (hematoxylin-eosin stain, original 

magnification X20). B) Non-pigmented eccrine poroma: photomicrograph showing a pedunculated epithelial proliferation characterized by 

sharply demarcated broad epithelial downgrowths of cuboidal cells and characteristic sclerotic and vascular stroma (hematoxylin-eosin stain, 

original magnification X20). [Copyright: ©2017 Wolner et al.

A B



Quiz  |  Dermatol Pract Concept 2017;7(1):3 21

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22 Quiz  |  Dermatol Pract Concept 2017;7(1):3

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