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]}

Differential Diagnoses

Szymanski FJ. Warty dyskeratoma; a benign cutaneous tumor resembling Darier's disease microscopically. Arch Derm. 1957 Apr. 75(4):567-72. [QxMD MEDLINE Link].
Allon I, Buchner A. Warty dyskeratoma/focal acantholytic dyskeratosis--an update on a rare oral lesion. J Oral Pathol Med. Mar 2012. 41(3):261-7. [QxMD MEDLINE Link].
Azuma Y, Matsukawa A. Warty dyskeratoma with multiple lesions. J Dermatol. 1993 Jun. 20(6):374-7. [QxMD MEDLINE Link].
Phelps PO, Hinshaw MA, Potter HD. Warty Dyskeratoma of the Eyelid. Ophthalmology. 2015 Jul. 122 (7):1282. [QxMD MEDLINE Link].
Duray PH, Merino MJ, Axiotis C. Warty dyskeratoma of the vulva. Int J Gynecol Pathol. 1983. 2(3):286-93. [QxMD MEDLINE Link].
Koç M, Kavala M, Kocatürk E, Mete O, Can B, Zindanci I, et al. Multiple warty dyskeratomas on the scalp. Dermatol Online J. 2009 Feb. 15(2):8. [QxMD MEDLINE Link].
Heymann WR. Warty dyskeratoma appearing in a patient with Darier's disease. Int J Dermatol. 1988 Sep. 27(7):521-2. [QxMD MEDLINE Link].
Allon I, Buchner A. Warty dyskeratoma/focal acantholytic dyskeratosis - an update on a rare oral lesion. J Oral Pathol Med. 2011 Sep 21. [QxMD MEDLINE Link].
Jang EJ, Lee JY, Kim MK, Yoon TY. Warty dyskeratoma involving two adjoining follicles. Ann Dermatol. 2011 Feb. 23(1):98-100. [QxMD MEDLINE Link]. [Full Text].
Savignac M, Edir A, Simon M, Hovnanian A. Darier disease : a disease model of impaired calcium homeostasis in the skin. Biochim Biophys Acta. 2011 May. 1813(5):1111-7. [QxMD MEDLINE Link].
Kaddu S, Dong H, Mayer G, Kerl H, Cerroni L. Warty dyskeratoma--"follicular dyskeratoma": analysis of clinicopathologic features of a distinctive follicular adnexal neoplasm. J Am Acad Dermatol. 2002 Sep. 47(3):423-8. [QxMD MEDLINE Link].
Szymanski FJ. Warty dyskeratoma; a benign cutaneous tumor resembling Darier's disease microscopically. AMA Arch Derm. 1957 Apr. 75(4):567-72. [QxMD MEDLINE Link].
Ghasemi Basir HR, Alirezaei P, Ebrahimi B, Khanali S. Oral warty dyskeratoma: An unusual presentation. Dermatol Reports. 2020 Jun 25. 12 (1):8236. [QxMD MEDLINE Link].
Zhao Q, Zhou H, Geng S. Multiple warty dyskeratoma on the scalp. An Bras Dermatol. 2019 Sep - Oct. 94 (5):630-631. [QxMD MEDLINE Link].
Baran R, Perrin C. Focal subungual warty dyskeratoma. Dermatology. 1997. 195(3):278-80. [QxMD MEDLINE Link].
Cohen PR. Longitudinal erythronychia: individual or multiple linear red bands of the nail plate: a review of clinical features and associated conditions. Am J Clin Dermatol. 2011 Aug 1. 12 (4):217-31. [QxMD MEDLINE Link].

Media Gallery

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.
Warty dyskeratoma. An endo-exophytic squamous proliferation of cytologically benign, acantholytic, and dyskeratotic keratinocytes.
Villi lined by acantholytic keratinocytes, some of which are dyskeratotic (corps ronds and corps grains).

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Author

Molly Ann Allen Hinshaw, MD Associate Professor, Department of Dermatology, University of Wisconsin School of Medicine and Public Health

Molly Ann Allen Hinshaw, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Dermatology Foundation, Wisconsin Dermatological Society, Women's Dermatologic Society

Disclosure: Have a 5% or greater equity interest in: Accure Medical, I founded this company with two partners so have 33% interest in the company. We have spent our personal funds to start the company, have no products, and no income yet.

Specialty Editor Board

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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD Herman Beerman 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, American Medical Association, American Society of Dermatopathology, Pennsylvania Academy of Dermatology

Disclosure: Received royalty from Lippincott Williams Wilkins for textbook editor.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Timothy McCalmont, MD Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco; Editor-in-Chief, Journal of Cutaneous Pathology

Timothy McCalmont, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Dermatopathology, California Medical Association, College of American Pathologists, United States and Canadian Academy of Pathology

Disclosure: Received consulting fee from Apsara for independent contractor.

Warty Dyskeratoma Clinical Presentation

History

Physical Examination

References

Tables

Contributor Information and Disclosures

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