title: Perplexing pigmented papules simulating malignant melanoma.
abstract: The clinical presentation of irregularly pigmented papules raises a spectrum of diagnostic possibilities. An eighty-five-year-old black man was referred for evaluation of lesions of fifty years' duration. The lesions were 1 to 2 cm hyperkeratotic, irregularly darkly-pigmented papules limited to sun-exposed areas. The histopathologic findings of large keratinocytes, acanthosis, hypergranulosis, and orthokeratosis were compatible with a diagnosis of large cell acanthoma. We believe large cell acanthoma should be included in the differential diagnosis of keratotic or irregularly pigmented lesions on sun-exposed skin, even in black patients.
authors.affiliation: Department of Dermatology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27103.
authors.forename: E F
authors.initials: EF
authors.lastname: Sherertz
authors.forename: S P
authors.initials: SP
authors.lastname: Hess
authors.forename: W L
authors.initials: WL
authors.lastname: White
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D010212:Papilloma / Q000175:diagnosis* / Q000473:pathology; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology