Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2022;12(1):e2022039 1

Not Every Isolated Plantar Lesion Is a Wart: 
A Case of Pagetoid Reticulosis Presenting 

as an Acral Lesion
Leonel Hidalgo1, Miguel Villaseca-Hernández1,2, Cristián Navarrete-Dechent1,3, 

Álvaro Abarzúa-Araya1,3

1 Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

2 Department of Pathology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

3 Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

Citation: Hidalgo L, Villaseca-Hernández M, Navarrete-Dechent C, Abarzúa-Araya A. Not every isolated plantar lesion is a wart:  
a case of pagetoid reticulosis presenting as an acral lesion. Dermatol Pract Concept. 2022;12(1):e2022039.  
DOI: https://doi.org/10.5826/dpc.1201a39

Accepted: July 8, 2021; Published: January 2022

Copyright: ©2022 Hidalgo 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: Álvaro Abarzúa-Araya, MD, Department of Dermatology, Escuela de Medicina Pontificia Universidad Católica de 
Chile, Santiago, Chile. E-mail: alvaroabarzuaaraya@gmail.com

Case Presentation

A 52-year-old woman was referred for a plantar wart. She 

reported a 2-month asymptomatic lesion on the right foot 

(Figure 1, A and B). Based on examination, surgery was per-

formed to rule-out a malignant neoplasm. The histopatho-

logical features and immunostaining were consistent with 

pagetoid reticulosis (PR) (Figure 1, C and D).

Teaching Point

PR is a rare variant of mycosis fungoides, manifesting 

as solitary indolent scaly or verrucous plaque frequently 

misdiagnosed as dermatitis or psoriasis [1]. Dermoscopy 

provides diagnostic clues: plantar warts show disruption of 

dermatoglyphics and irregular capillaries due to weight bear-

ing and trauma; calluses demonstrate homogenous opacities; 

corns exhibit a translucent core; Bowen disease has scale and 

glomerular vessels in clusters [2]. In this case dermoscopy 

showed a white hyperkeratotic center, aligned red dots, and 

slight-pinkish background. Prior reports of PR described reg-

ular dotted and glomerular vessels in a pinkish background, 

vessels halos, and scales [1].

Informed consent: Informed consent for publication of clini-

cal details and clinical images was obtained from the patient.



2 Image Letter | Dermatol Pract Concept. 2022;12(1):e2022039

References

1. Manoli SM, Lallas A, Ioannides D, et al. Dermoscopy of page-

toid reticulosis, with dermoscopic-pathologic correlation. Photo-

dermatol Photoimmunol Photomed. 2019;35(5):372-374. DOI: 

10.1111/phpp.12472. PMID: 31006145.

2. Zalaudek I. Dermoscopy in general dermatology. In: Marghoob 

AA, Malvehy J, Braun RP (eds). An Atlas of Dermoscopy. 2nd ed: 

Informa Healthcare; 2012: 325-336

Figure 1. (A) Reticuloid pagetosis. A 1-cm skin colored hyperkeratotic papule in the lateral surface of the right foot. (B) Reticuloid pagetosis. 

Dermoscopy revealed a white hyperkeratotic center surrounded by aligned red dots amidst a slight-pinkish background (polarized dermos-

copy, x10). (C) Reticuloid pagetosis.  Photomicrograph showing hyperkeratosis and atypical lymphocytes with intense epidermotropism 

(H&E x 40). (D) Reticuloid pagetosis. Immunostain were positive for CD3, CD4, and CD8.