Premalignant Fibroepithelial Tumor (Pinkus Tumor) 

  • Author: Darius Mehregan, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 24, 2012
 

Background

The fibroepithelioma of Pinkus is an unusual neoplasm that was first described by Hermann Pinkus in 1953 as a premalignant fibroepithelial tumor.[1] Clinically, the lesion is a benign-appearing, pedunculated, pink tumor that may resemble an acrochordon. However, Pinkus noted 4 such lesions to have a peculiar histologic appearance that resembled both a reticulated seborrheic keratosis and a basal cell carcinoma. Pinkus considered the tumor to be a variant of basal cell carcinoma, which illustrated the interaction and interdependence of stromal and epithelial components of basal cell carcinoma.

Next

Pathophysiology

Current advances in molecular biology are allowing new insights into the pathogenesis of skin cancer. The TP53 gene codes for a protein product that is a strong negative regulator of normal human cell growth and is thought to act as a tumor suppressor.[2] Deletion or mutation of this gene results in decreased control of cellular proliferation and can contribute to the formation of an immortalized cell. It is now believed that this gene is intricately involved in the development of nonmelanoma skin cancer, including the fibroepithelioma of Pinkus. Further study of this pathway is currently underway.

Evidence implicates another genetic pathway that may be involved in the transformation of cells in skin cancer. Studies of both nevoid basal cell carcinoma syndrome and sporadic basal cell carcinomas have shown mutations in the PATCHED gene.[3] Mutation of this gene eliminates a crucial inhibitory signal for a cellular regulation pathway known as the Hedgehog pathway, which is named after a similar pathway found in Drosophila. Loss of this inhibition results in increased expression of the GLI family of transcription factors, promoting cell growth. Constitutive activation of this pathway in human keratinocytes has been shown to produce a neoplasm identical to basal cell carcinoma. Further study of this pathway is also underway and will likely have considerable relevance to the pathogenesis of basal cell carcinoma and the fibroepithelioma of Pinkus.

Although the fibroepithelioma of Pinkus has been accepted as a variant of basal cell carcinoma, the reason for its distinct histologic pattern remains a mystery.[4, 5, 6] Several authors have proposed that the initial change is the invasion of an eccrine duct by a basal cell carcinoma.[7] Eventual obliteration of the ductal lumen would then impart the characteristic histologic pattern.

Previous
Next

Epidemiology

Frequency

United States

The true frequency of the fibroepithelioma of Pinkus is unknown. Its epidemiology is thought to mirror that of basal cell skin cancer. Unlike other histologic types of basal cell carcinoma, lesions are more common on the trunk and extremities than the face.

Mortality/Morbidity

The fibroepithelioma of Pinkus generally runs an indolent course. It can, however, ulcerate and invade into underlying tissue. To date, none has resulted in death.

Race

The fibroepithelioma of Pinkus, like other basal cell carcinomas, is more common in lighter skin types and relatively rare in dark skin types.

Sex

Available reports indicate that this tumor has an equal sexual distribution.

Age

Available reports indicate that this tumor usually develops in persons aged 40-60 years, similar to other forms of basal cell carcinoma. However, a few cases have been reported in children.[8]

Previous
Proceed to Clinical Presentation
 
 
Contributor Information and Disclosures
Author

Darius Mehregan, MD  Associate Professor, Hermann Pinkus Chairman of Dermatology, Department of Dermatology, Wayne State University; Clinical Associate Professor of Pathology, University of Toledo; Dermatopathologist, Pinkus Laboratory; Consulting Staff, Department of Dermatology, J Dingell Veterans Affairs Medical Center

Darius Mehregan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society of Dermatopathology, International Society of Dermatology, International Society of Dermatopathology, Phi Beta Kappa, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Jennifer Michelle Heyl, MD  Resident Physician, Department of Dermatology, Wayne State University School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Maureen B Poh-Fitzpatrick, MD  Professor Emerita of Dermatology and Special Lecturer, Columbia University College of Physicians and Surgeons; Professor of Medicine (Dermatology), University of Tennessee Health Science Center College of Medicine

Maureen B Poh-Fitzpatrick, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and New York Academy of Medicine

Disclosure: Lundbeck, Inc. Honoraria Review panel membership; Clinuvel Pharmaceuticals, Ltd. Honoraria Consulting

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, David Pegouske MD, to the development and writing of this article.

References

  1. Pinkus H. Premalignant fibroepithelial tumors of skin. AMA Arch Derm Syphilol. Jun 1953;67(6):598-615. [Medline].

  2. Matsumura Y, Nishigori C, Yagi T, Imamura S, Takebe H. Characterization of p53 gene mutations in basal-cell carcinomas: comparison between sun-exposed and less-exposed skin areas. Int J Cancer. Mar 15 1996;65(6):778-80. [Medline].

  3. Aszterbaum M, Rothman A, Johnson RL, Fisher M, Xie J, Bonifas JM, et al. Identification of mutations in the human PATCHED gene in sporadic basal cell carcinomas and in patients with the basal cell nevus syndrome. J Invest Dermatol. Jun 1998;110(6):885-8. [Medline].

  4. Sellheyer K, Nelson P, Kutzner H. Fibroepithelioma of Pinkus is a true basal cell carcinoma developing in association with a newly identified tumour-specific type of epidermal hyperplasia. Br J Dermatol. Jan 2012;166(1):88-97. [Medline].

  5. Tarallo M, Cigna E, Fino P, Lo Torto F, Corrias F, Scuderi N. Fibroepithelioma of Pinkus: variant of basal cell carcinoma or trichoblastoma? Case report. G Chir. Jun-Jul 2011;32(6-7):326-8. [Medline].

  6. Ioannidis O, Papaemmanuil S, Kakoutis E, Papadopoulos G, Chatzopoulos S, Kotronis A, et al. Fibroepithelioma of pinkus in continuity with nodular basal cell carcinoma: supporting evidence of the malignant nature of the disease. Pathol Oncol Res. Mar 2011;17(1):155-7. [Medline].

  7. Stern JB, Haupt HM, Smith RR. Fibroepithelioma of Pinkus. Eccrine duct spread of basal cell carcinoma. Am J Dermatopathol. Dec 1994;16(6):585-7. [Medline].

  8. Pan Z, Huynh N, Sarma DP. Fibroepithelioma of pinkus in a 9-year-old boy: a case report. Cases J. 2008;1(1):21. [Medline].

  9. Hartschuh W, Schulz T. Merkel cell hyperplasia in chronic radiation-damaged skin: its possible relationship to fibroepithelioma of Pinkus. J Cutan Pathol. Sep 1997;24(8):477-83. [Medline].

  10. Bryant J. Fibroepithelioma of Pinkus overlying breast cancer. Arch Dermatol. Mar 1985;121(3):310. [Medline].

  11. Warner TF, Burgess H, Mohs FE. Extramammary Paget's disease in fibroepithelioma of Pinkus. J Cutan Pathol. Oct 1982;9(5):340-4. [Medline].

  12. Heymann WR, Soifer I, Burk PG. Penile premalignant fibroepithelioma of Pinkus. Cutis. May 1983;31(5):519-21. [Medline].

  13. Zalaudek I, Leinweber B, Ferrara G, Soyer HP, Ruocco E, Argenziano G. Dermoscopy of fibroepithelioma of pinkus. J Am Acad Dermatol. Jan 2005;52(1):168-9. [Medline].

  14. Naeyaert JM, Pauwels C, Geerts ML, Verplancke P. CD-34 and Ki-67 staining patterns of basaloid follicular hamartoma are different from those in fibroepithelioma of Pinkus and other variants of basal cell carcinoma. J Cutan Pathol. Nov 2001;28(10):538-41. [Medline].

  15. Katona TM, Ravis SM, Perkins SM, Moores WB, Billings SD. Expression of androgen receptor by fibroepithelioma of Pinkus: evidence supporting classification as a basal cell carcinoma variant?. Am J Dermatopathol. Feb 2007;29(1):7-12. [Medline].

  16. Barr RJ, Herten RJ, Stone OJ. Multiple premalignant fibroepitheliomas of Pinkus: a case report and review of the literature. Cutis. Mar 1978;21(3):335-7. [Medline].

  17. Jaffe ES. Premalignant fibroepithelioma of Pinkus. Arch Dermatol. 1964;89:768.

  18. Lever WF, Schaumberg-Lever G. Fibroepithelioma. In: Histopathology of the Skin. Philadelphia, Pa: Lippincott; 1983:570.

  19. Mehregan AH. Proliferation of sweat ducts in certain diseases of the skin. Am J Dermatopathol. 1981;3(1):27-31. [Medline].

  20. Val-Bernal JF, Gómez-Ortega JM, Fernández-Llaca H, Gómez-Román JJ. Fibroepithelioma of pinkus with tumor giant cells. Am J Dermatopathol. Aug 2002;24(4):336-9. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.