History
Warty dyskeratoma (WD) commonly presents as an asymptomatic keratotic nodule. Scalp, face, and neck are common sites of involvement. Mucosal lesions have been reported. [2, 3, 5, 13] Multiple lesions in the same patient have been reported. [6, 7, 14] Patients may report an insidious onset or a slight recent enlargement of the lesion.
Physical Examination
Warty dyskeratoma (WD) presents as a whitish or grayish hyperkeratotic papule with an umbilicated center, often involving the face, scalp, or back. Lesions are usually smaller than 1-2 cm.
Rarely, lesions with a similar appearance can be found involving the mucosal surfaces. [2, 3, 5, 13] Infrequently, subungual warty dyskeratoma occurs and when it does it produces longitudinal erythronychia. [15, 16] Multiple lesions may occur in exceptional cases. [6, 7, 14]
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Absence of sarco/endoplasmic reticulum Ca2+ ATPase 2 (SERCA2) staining by immunohistochemistry within a warty dyskeratoma (right side of image), in contrast to the unaffected epidermis (left side of image). Photomicrograph courtesy of James E. Fitzpatrick, MD.
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Warty dyskeratoma. An endo-exophytic squamous proliferation of cytologically benign, acantholytic, and dyskeratotic keratinocytes.
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Villi lined by acantholytic keratinocytes, some of which are dyskeratotic (corps ronds and corps grains).