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Warty dyskeratoma
See also in: Hair and Scalp
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Warty dyskeratoma

See also in: Hair and Scalp
Contributors: Sujitha Yadlapati MD, Mari M. Batta DO, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Warty dyskeratoma, or follicular dyskeratoma, is a relatively uncommon, benign, follicular adnexal neoplasm that usually appears between the fifth and seventh decades of life and is most prevalent in White men. The pathogenesis remains uncertain, but ultraviolet (UV) light, abnormal adhesion of keratinocytes, autoimmunity, and smoking may play a role. Architectural features resembling a wart-like growth have led to the suggestion of a viral infection to be the cause. However, human papillomavirus (HPV) infection has not been detected in these lesions.

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.

Codes

ICD10CM:
L85.8 – Other specified epidermal thickening

SNOMEDCT:
254676008 – Warty dyskeratoma

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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.
Multiple warty dyskeratomas:
  • 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.
Oral warty dyskeratoma:
Differential diagnosis of a single band of longitudinal erythronychia:

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    Last Reviewed:02/02/2022
    Last Updated:02/15/2022
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    Warty dyskeratoma
    See also in: Hair and Scalp
    Warty dyskeratoma (Skin) : Face, Neck, Scalp, Umbilicated papule, Sun-exposed distribution
    Clinical image of Warty dyskeratoma
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