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\begin{document}

\title{Pigmented and polypoid tumor of the pubis}



\author[1]{Mariem Rekik}%
\author[2]{Khadija Sellami}%
\author[1]{Fatma Hammami}%
\author[1]{Massara Baklouti}%
\author[1]{Hamida Turki}%
\affil[1]{Hedi Chaker Hospital}%
\affil[2]{Hopital Hedi Chaker}%


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  \date{May 28, 2024}


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\begin{abstract}
Seborrheic keratosis is a common benign epidermal tumor occurring in
patients aged over 50 years. It is located preferentially in the trunk,
head and neck. The genital location is rare. We report a case of 59
year-old-men presenting a seborrheic keratosis of the pubis.%
\end{abstract}%



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Introduction~:

Seborrheic keratosis (SK) is a common benign epidermal tumor with
predominance in adult patients aged over 50 years. It is preferentially
located in the trunk, head and neck. The genital location is rare. We
report an original case of 59 year-old-men presenting a SK of the pubis.

Case presentation~:

A 59 year-old-men, with no medical history, presented to our department
for a 15-year history of a gradually enlarged and pigmented tumor of the
pubis. Physical examination showed humped, well defined, verrucous
lesion measuring 6 cm in diameter with a rough and warty appearance
(\textbf{Fig.1} ). No ulceration, crusts, or bleeding were noted.
Dermoscopy revealed~cerebriform convolutions with densely packed
exophytic papillary structures which were separated by black irregular
crypts. Black comedo-like openings, fissures as well as hairpin and
dotted vessels were present (\textbf{Fig.2} ). The lesion was excised.
Histological examination revealed papillomatous hyperplasia of the
epidermis with hyperpigmentation of the basal membrane. It also showed
tunnels and multiple pseudohorn cysts with ortho-keratotic
hyperkeratosis. The dermis was richly inflammatory with no melanocytic
cells. There were no ko\selectlanguage{ngerman}ïlocytes. The diagnosis of SK was retained.

Discussion~:

SK is a common benign epidermal tumor with predominance in adult
patients aged over 50 years. They are preferentially located in the
trunk, head and neck. The genital location is rare and can mimic genital
warts (1). Different clinical and histologic subtypes have been
identified (hyperkeratotic type, acanthotic type, reticular/adenoid
type, clonal type, irritated type, regressing type, melanoacanthoma, and
verrucous SK with keratoacanthoma-like features) (2). For our patient,
the histologic features match more with the hyperkeratotic type in which
hyperkeratosis and papillomatosis of the epidermis are pronounced (3).

The clinical variability of SK raises some diagnostic
difficulties.~Dermoscopy~is the preferred non-invasive diagnostic
method. Most cases of SK exhibit the typical dermoscopic findings of
fissures and ridges, hairpin vessels with white halo, comedo-like
openings, and milia-like cysts. Histopathologically, these dermoscopic
characteristics correspond to papillomatous surface of the epidermis,
enlarged capillaries of the dermal papillae, pseudohorn cysts in the
epidermis opened to the surface of the lesion and intraepidermal cysts,
respectively (3).

Dermoscopy of genital warts reveals distinctive patterns and vascular
features (4). The pattern, mosaic in flat lesion, fingerlike and
knoblike in papillomatous lesions (5), reflects the life stages of
genital warts. The vascular features include hairpin, glomerular or
dotted vessels (4). Unna nevus is a variant of melanocytic nevus. It
corresponds to a papillomatous dermal or compound nevus. Clinically, it
presents as a soft polypoid or sessile lesion, usually papillomatous,
light- to dark-brown in colour (6). On dermoscopy, it shows a typical
globular pattern composed of numerous tan to dark-brown, round to oval
globules and can in some instances display exophytic papillary
structures (6). Moreover, dermoscopy usually shows, especially at the
periphery, the typical ``comma-like'' vessels (6). Sometimes, milia like
cysts and comedo-like openings are also detected by dermoscopy (3). The
wobble sign is useful to distinguish Unna nevus from SK, as
papillomatous dermal nevi, unlike SK, wobble when the dermoscope is
pushed from site to site (6).

Conclusion~:

Making a definitive diagnosis of SK can be challenging. The dermoscopy
facilitates the diagnosis but histology may be necessary in some cases
especially in pubic location. In the latter, dermoscopy may show
papillary structures which can be seen in SK but also in unna nevus and
genital warts.

Author contribution:

RM and SK: wrote the manuscript. AM: revised the manuscript. BM, HF, TH:
contributed to the management of the patient and revised the article.
TH: critically reviewed the manuscript and gave final approval. All
authors have read and approved the final manuscript and agree to take
full responsibility for the integrity and accuracy of the work.

References:

1. Naciri I, Ismaili N. Unusual location of giant seborrhoeic keratoses.
Pan Afr Med J. 2017 Sep 25;28:72.

2. Wollina U. Recent advances in managing and understanding seborrheic
keratosis. F1000Res. 2019 Aug 28;8.

3. Minagawa A. Dermoscopy--pathology relationship in seborrheic
keratosis. J Dermatol. 2017 May;44(5):518-524.

4. Dong H, Shu D, Campbell TM et al. Dermatoscopy of genital warts. J Am
Acad Dermatol. 2011 May;64(5):859-64.

5. Ozdemir F, Kilinc-Karaarslan I, Akalin T. A
pigmented,~hemorrhagic~genital~wart: clinical, dermoscopic, and
histopathologic features. Arch Dermatol. 2008 Aug;144(8):1072-3.

6. Soyer, H.P., Argenziano, G., Hofmann-Wellenhof, R., Johr, R.H.
(2007). Color Atlas of Melanocytic Lesions of the Skin. Berlin.
Springer, 333p\selectlanguage{english}
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