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Letters to the Editor

3.
4.

isomorphic phenomenon? Indian J Dermatol 1996;41:70-1.


Lahiri K, Malakar S. Lichen planus developing along striae
gravidarum. Indian J Dermatol 2004;49:156-7.
Cerottini JP, Burren R, Panizzon RG. Pemphigus vulgaris
occurring simultaneously on a recent and an old surgical
scar due to a Koebners phenomenon. Eur J Dermatol
2000;10:546-7.

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DOI:
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Figure 4: Jet black tattoo pigment unassociated with the lichenoid


infiltrate seen deeper in the dermis. (H and E, 400)

explained by Koebners phenomenon. A hypertrophic


scar pathologically is composed of compactly
arranged and parallel bundles of thickened collagen
with fibroblasts. The pathology is primarily dermal,
but may be accompanied by some epidermal
hyperplasia at times. The currently recognised
pathomechanisms of Koebner phenomenon fail to
clarify if the phenomenon may occur in a 7-month-old
scar. We assume that there may be a phenomenon of
Koebner recall where development of isomorphic
pathologic lesions occurs at the sites of previous
trauma probably in predisposed individuals. There
may be immunological, vascular or other factors that
may be at work even in a dermis with fibroblastic
hyperplasia, which are yet to be defined as the causes
of this interesting clinical manifestation. Lahiri et al.
had described the occurrence of vitiligo[2] and lichen
planus[3] along stretch marks. Koebners phenomenon
seen in recent and old scars in pemphigus, which
manifest primarily as epidermal disease, has also
been described previously.[4]

Kinjal D. Rambhia, Siddhi B. Chikhalkar,


Uday S. Khopkar
Department of Dermatology, Seth GS Medical College
and KEM Hospital, Parel, Mumbai,
Maharashtra, India
Address for correspondence: Dr. Kinjal Deepak Rambhia,
Department of Dermatology, Seth GS Medical College and
KEM Hospital,Parel, Mumbai, Maharashtra, India.
E-mail: kinjal_rambhia@hotmail.com

REFERENCES
1.
2.
308

Thappa DM. The isomorphic phenomenon of Koebner. Indian J


Dermatol Venereol Leprol 2004;70:187-9.
Lahiri K, Sengupta SR. Vitiligo developing on striae: An

Clinical and dermoscopic


features of eccrine poroma
Sir,
A healthy 44-year-old male patient presented with
a 3-year history of a slow growing lesion on the
sole [Figure 1]. Occasional bleeding and mild local pain
under pressure were the only symptoms. Dermoscopy
showed a pink homogeneous area and an ivory halo
around the entire lesion. Multiple round-to-oval
reddish structures surrounded by a white halo
and dotted vessels were also seen. An incisional
biopsy confirmed the clinical diagnosis of eccrine
poroma (EP). The lesion was completely excised.
Sweat gland tumors represent approximately 1% of
primary skin lesions. Eccrine poroma is a benign
sweat gland neoplasm that accounts for roughly
10% of sweat gland tumors.[1] Clinically, the tumour
appears as a single slow-growing, asymptomatic,
soft, well-circumscribed papule, plaque, or nodule,
pink-to-red in color, with a surface ranging from
smooth to verrucous, with occasional ulceration and/
or scaling.[1,2] Eccrine poroma commonly develops
at the distal extremities, such as the soles, palms,
and fingers. However, multiple lesions, pigmented
variants, and other anatomical sites of localization,
including the head and neck, may also occur.[2]
Dermoscopy of eccrine poroma is characterized by
a vascular pattern, which may be polymorphous.
Glomerular, hairpin vessels and linear irregular
vessels, surrounded by a white to pink halo, may
be observed. Reddish-white globule-like structures

Indian Journal of Dermatology, Venereology, and Leprology | May-June 2015 | Vol 81 | Issue 3

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Letters to the Editor


Address for correspondence: Dr. Bruno Simo dos Santos,
Dermatologic clinic, Rua Miguel de Frias,
40, Niteri - Rio de Janeiro, Brazil.
E-mail: b.simao@ymail.com

REFERENCES
1.
2.

3.
4.
5.
6.

Moore TO, Orman HL, Orman SK, Helm KF. Poromas of the
head and neck. J Am Acad Dermatol 2001;44:48-52.
Ferrari A, Buccini P, Silipo V, De Simone P, Mariani G,
Marenda S, et al. Eccrine poroma: A clinical-dermoscopic
study of seven cases. Acta Derm Venereol 2009;89:160-4.
Kuo HW, Ohara K. Pigmented eccrine poroma: A report of
two cases and study with dermatoscopy. Dermatol Surg
2003;29:1076-9.
Minagawa A, Koga H. Dermoscopy of pigmented poromas.
Dermatology 2010;221:78-83.
Lallas A, Moscarella E, Argenziano G, Longo C, Apalla Z,
Ferrara G, et al. Dermoscopy of uncommon skin tumours.
Australas J Dermatol 2014;55:53-62.
Altamura D, Piccolo D, Lozzi GP, Peris K. Eccrine poroma in
an unusual site: A clinical and dermoscopic simulator of
amelanotic melanoma. J Am Acad Dermatol 2005;53:539-41.
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c
Figure 1: (a and b) Reddish papule with a scaly surface and a
clear-cut keratotic border, located on the sole. (c) Polarized light
dermoscopy with immersion fluid showing a pink homogeneous
area and an ivory halo around the entire lesion. Multiple roundto-oval reddish structures surrounded by a white halo and dotted
vessels may also be seen (original magnification, 10)

are occasionally seen, mimicking the red lacunae


typical of vascular lesions, such as hemangioma or
pyogenic granuloma. Milky-red areas, commonly
found in melanoma, may also be present.[2] Pigmented
globule-like structures, comedo-like openings, as well
as blue-gray ovoid nests, arborizing vessels, and maple
leaf-like structures similar to those of pigmented basal
cell carcinomas are also described in pigmented
variants of eccrine poroma.[3,4] The dermoscopic
findings described in previous reports of eccrine
poroma have been summarized by Lallas et al.[5]
Eccrine poroma may exhibit polymorphic features
that can make diagnosis difficult. The clinical and
dermoscopic differential diagnoses include, among
others, pyogenic granuloma, hemangioma, seborrheic
keratosis, melanocytic nevus, amelanotic melanoma,
and basal cell carcinoma.[6]

Bruno Simo dos Santos


Dermatologic clinic, Rua Miguel de Frias, 40,
Niteri - Rio de Janeiro, Brazil

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Recurrent cutaneous
leiomyosarcoma of the inner
thigh
Sir,
A 55-year-old African male from Senegal presented
with a large nodular lesion on the inner surface of
the left thigh [Figure 1]. The lesion had first appeared
8 years ago, had been interpreted as a keloid and
excised twice once 6 years ago and again 3 years ago
in Senegal without any histological examination.
Clinically, the lesion measured 45 55 mm, was
hard in consistency, moved easily over the deep
subcutaneous planes, and seemed to comprise of
separate, coalescing nodules. The overlying epidermis
was adherent. Bilateral inguinal lymph nodes were
palpable but normal. Patient reported feeling a stabbing
pain in the nodule. Complete blood examination,
human immunodeficiency virus antibodies, hepatitis
markers, and human herpesvirus 8 polymerase chain
reaction (PCR) from blood showed no abnormalities.

Indian Journal of Dermatology, Venereology, and Leprology | May-June 2015 | Vol 81 | Issue 3

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