Premalignant Fibroepithelial Tumor (Pinkus Tumor) Workup
- Author: Darius Mehregan, MD; Chief Editor: Dirk M Elston, MD more...
The diagnosis can be easily confirmed by performing a skin biopsy.
The classic fibroepithelioma of Pinkus typically shows long, thin, branching and anastomosing strands of basal cell carcinoma embedded in a loose fibrovascular stroma. Many strands show a connection with the epidermis. The basaloid strands show 2 distinct-appearing cells. A lighter staining cell comprises the bulk of the strand. Scattered, small groups of darker cells are seen tapering off the main trunk in a palisading arrangement like buds on a branch.
Nuclear pleomorphism may be present, and staining with proliferation markers such as Ki-67 shows an increased proliferative index. Coexpression of androgen receptor and cytokeratin 20, a marker for the presence of Merkel cells within islands of basaloid cells, may aid in the diagnosis of fibroepithelioma of Pinkus. The tumor is superficial and well demarcated at its lower border. It bears strong histologic resemblance to reticulated seborrheic keratosis but lacks a typical horn and pseudohorn pearls. Hyperkeratosis is rarely present.
Pinkus H. Premalignant fibroepithelial tumors of skin. AMA Arch Derm Syphilol. 1953 Jun. 67(6):598-615. [Medline].
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. 1996 Mar 15. 65(6):778-80. [Medline].
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. 1998 Jun. 110(6):885-8. [Medline].
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. 2012 Jan. 166(1):88-97. [Medline].
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. 2011 Jun-Jul. 32(6-7):326-8. [Medline].
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. 2011 Mar. 17(1):155-7. [Medline].
Stern JB, Haupt HM, Smith RR. Fibroepithelioma of Pinkus. Eccrine duct spread of basal cell carcinoma. Am J Dermatopathol. 1994 Dec. 16(6):585-7. [Medline].
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].
Hartschuh W, Schulz T. Merkel cell hyperplasia in chronic radiation-damaged skin: its possible relationship to fibroepithelioma of Pinkus. J Cutan Pathol. 1997 Sep. 24(8):477-83. [Medline].
Bryant J. Fibroepithelioma of Pinkus overlying breast cancer. Arch Dermatol. 1985 Mar. 121(3):310. [Medline].
Warner TF, Burgess H, Mohs FE. Extramammary Paget's disease in fibroepithelioma of Pinkus. J Cutan Pathol. 1982 Oct. 9(5):340-4. [Medline].
Heymann WR, Soifer I, Burk PG. Penile premalignant fibroepithelioma of Pinkus. Cutis. 1983 May. 31(5):519-21. [Medline].
Zalaudek I, Leinweber B, Ferrara G, Soyer HP, Ruocco E, Argenziano G. Dermoscopy of fibroepithelioma of pinkus. J Am Acad Dermatol. 2005 Jan. 52(1):168-9. [Medline].
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. 2001 Nov. 28(10):538-41. [Medline].
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. 2007 Feb. 29(1):7-12. [Medline].
Fecher LA, Sharfman WH. Advanced basal cell carcinoma, the hedgehog pathway, and treatment options - role of smoothened inhibitors. Biologics. 2015. 9:129-40. [Medline].
Mehregan AH. Proliferation of sweat ducts in certain diseases of the skin. Am J Dermatopathol. 1981. 3(1):27-31. [Medline].