Lesions usually present as a slow-growing, solitary, well-demarcated, skin-colored-to-red-brown umbilicated papule or nodule with a crusted, keratotic center. Most are asymptomatic; rarely, patients complain of pruritus or burning, and bleeding, crusting, or drainage may occur.
Warty dyskeratomas are most commonly located on sun-exposed areas of the body (scalp, face, and neck). They have been documented to coexist with other skin lesions, including actinic keratosis, squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and verruciform xanthoma. Multiple lesions, lesions involving the oral and vulvar mucosa, and subungual involvement have occasionally been reported. Eruptive warty dyskeratomas have been reported to occur in 2 patients with end-stage renal disease.
Warty dyskeratomas are benign. Malignant transformation has not been reported.
L85.8 – Other specified epidermal thickening
254676008 – Warty dyskeratoma
Differential Diagnosis & Pitfalls
- Verruca vulgaris
- Epidermal inclusion cyst
- Seborrheic keratosis
- Hypertrophic actinic keratosis
- Acantholytic squamous cell carcinoma – Distinct architectural configuration of cup-shaped papule or nodule, presence of follicular infundibula at the base is noted in a warty dyskeratoma. Lack of atypia and mitotic figures is noted in comparison to SCC.
- Keratoacanthoma – Shows a similar cup-shaped appearance to warty dyskeratoma. Keratoacanthoma lacks areas of acantholytic dyskeratosis and reveals atypical keratinocytes with increased mitotic activity.
- Acantholytic acanthoma – Histopathologic findings of acantholysis, with or without dyskeratosis. The architecture is flat in comparison.
- Flat warts
- Seborrheic keratoses
- Darier disease – Autosomal dominant inherited dermatosis with multiple keratotic papules on the face, trunk, and extremities that worsens in the summertime and after UV exposure.
- Transient acantholytic dermatosis (Grover disease) – Transient papulovesicular eruption that flares with sun exposure; crops commonly occur on the trunk of elderly men.
- Hailey-Hailey disease – Serpiginous grouping of eroded and crusted bullae / vesicles in the intertriginous areas.
- Proliferative verrucous leukoplakia
- Oral SCC
- Traumatic ulcerative granuloma
- Malignant salivary gland tumor
- Chronic herpes simplex virus (HSV)
- Glomus tumor
- Solitary lesion of lichen planus
- Bowen disease
- Invasive SCC
- Melanoma in situ