Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2022;12(1):e2022020 1

Scalp Pink Tumors Showing Multiple Rosettes
Karla Patricia Estrada-Ramírez1, Denisse Herrera-Bringas2, Maribet González-González3, 

Daniel Alcalá-Pérez2

1 Department of Dermatology, Centro Dermatológico Dr. “Ladislao de la Pascua”, Mexico City, México

2 Department of Dermato-Oncology, Centro Dermatológico Dr. “Ladislao de la Pascua”, Mexico City, Mexico

3 Department of Dermatopathology, Centro Dermatológico Dr. “Ladislao de la Pascua”, Mexico City, México

Citation: Estrada-Ramírez KP, Herrera-Bringas D, González-González M, Alcalá-Pérez D. Scalp pink tumors showing multiple rosettes. 
Dermatol Pract Concept. 2022;12(1):e2022020. DOI: https://doi.org/10.5826/dpc.1201a20

Accepted: May 26, 2021; Published: January 2022

Copyright: ©2022 Estrada-Ramírez 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: Daniel Alcalá Pérez, MD, Department of Dermato-Oncology, Centro Dermatológico Dr. “Ladislao de la Pascua”, 
Mexico City, Mexico. E-mail: alcalad32@yahoo.com.mx

Case Presentation

A 46-year-old male with history of complete surgical excision 

of a well-differentiated cutaneous squamous cell carcinoma 

in the right preauricular area in 2018 visited the dermatol-

ogy unit complaining of 3 growing pink nodular lesions on 

the scalp (Figure 1A). Dermoscopy revealed  multiple rosettes 

with homogeneous white-pink areas (Figure 1B). Two tumors 

were excised with a preliminary diagnosis of basal cell carci-

noma, and histopathology reported molluscum contagiosum 

(MC) (Figure 1C). As the presence of giant MC on the face 

is a clue for HIV infection, laboratory tests were performed 

and confirmed the suspected cause of immunosuppression.

Teaching Point

The diagnosis of MC is straightforward when typical 

 findings are seen; however, some cases may be indistinguish-

able from other tumors, such as basal cell carcinoma [1]. 

Dermoscopy can improve the accuracy of pink tumor di-

agnosis, as rosettes can be observed in many tumoral skin 

lesions [2].  Multiple pink nodular lesions on the face or 

scalp with rosettes on dermoscopy should raise the suspi-

cion for MC.

Informed consent: Informed consent for publication of 

clinical details and clinical  images was obtained from the 

patient.



2 Image Letter | Dermatol Pract Concept. 2022;12(1):e2022020

References

1. Meza-Romero R, Navarrete-Dechent C, Downey C. Molluscum 

contagiosum: An update and review of new perspectives in eti-

ology, diagnosis, and treatment. Clin Cosmet Investig Derma-

tol. 2019;12:373-381. DOI:10.2147/CCID.S187224. PMID: 

31239742. PMCID: PMC6553952.

2. Haspeslagh M, Noë M, De Wispelaere I, et al. Rosettes and 

other white shiny structures in polarized dermoscopy: Histolog-

ical correlate and optical explanation. J Eur Acad Dermatology 

Venereol. 2016;30(2):311-313. DOI:10.1111/jdv.13080. PMID: 

25786770.

Figure 1. (A) Pink tumor on the left fronto-parietal scalp. (B) Dermoscopy demonstrated multiple rosettes. (C) Histopathology revealed 

epidermal lobes in the dermis containing the molluscum bodies. (H&E, magnification ×10).