- Author: Molly Ann Allen Hinshaw, MD; Chief Editor: Dirk M Elston, MD more...
Warty dyskeratoma (WD) is a benign epidermal proliferation first reported in 1957 because of its distinctive histologic findings. WD presents as an umbilicated papule with a keratotic plug, usually limited to the head, neck, or face. Lesions are generally solitary and sporadic and may be associated with a follicular unit. Oral involvement,[2, 3] particularly the hard palate, and genital involvement have been reported. Multiple lesions may occur in the same patient.[5, 6, 7, 8]
Although originally referred to as isolated keratosis follicularis, no data support that patients with a WD bear germline mutations in ATP2A2, the gene responsible for Darier disease. Patients with Darier disease have been reported with WDs occurring spontaneously or during treatment with systemic retinoids.
WD represents a sporadic localized error in epithelial maturation and cohesiveness. James Fitzpatrick, MD, of Dermatopathology Consultants of Colorado, has shown using immunohistochemistry that these tumors lack SERCA2 thus providing evidence that an acquired genetic mutation in ATP2A2 plays a role in tumor development. Malunion and premature keratinization of epithelial cells occur. Attempts to demonstrate that human papillomavirus plays a role have proven unsuccessful. Other adhesion molecules may also play a role.
Warty dyskeratoma is an uncommon lesion. Involvement of the mucosal surfaces is also uncommon.
No racial predilection is known.
By a modest margin, warty dyskeratoma affects men more commonly than women.
The average patient age at diagnosis for focal, oral warty dyskeratoma is 52.2 years; 10 of 13 reported patients were between the fifth and seventh decades of life.
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