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Extraocular sebaceous carcinoma in association with a clonal seborrheic keratosis: Dermoscopic featuresDear Editor, The clinical diagnosis of extraocular sebaceous carcinoma is challenging due to the lack of specific clinical manifestations of this neoplasm. However, previous reports of extraocular sebaceous carcinomas using dermoscopy have been limited. 1 Here, we present a case of an extraocular sebaceous carcinoma in association with a clonal seborrheic keratosis and we describe its dermoscopic features.A 75-year-old woman presented with a tumor in a black plaque on her abdomen. The patient had a history of burn injury on her abdomen 30 years prior. Her burn scar had gradually become black and then developed a tumor with bleeding 3 months earlier.Physical examination revealed a 20 mm 9 12 mm black keratotic plaque with an elevated tumor in the center of her abdomen infraumbilically (Fig. 1a). Dermoscopic examination revealed that this lesion had two components: polymorphous vessels with homogenous yellow backgrounds in the center and blue-gray globules at the periphery (Fig. 1b). The polymorphous vessels were composed of linear irregular vessels, glomerular vessels and hairpin-like vessels (Fig. 1c). At the periphery, similar findings with bluegray structures of various size and shape were observed. Figure 1. (a) A 20 mm 9 12 mm black keratotic plaque with an elevated tumor on the patient's abdomen. (b) Dermoscopic features showing two components: polymorphous vessels with homogenous yellow backgrounds in the center and blue-gray globules at the periphery. The dotted line indicates the section of the histopathological specimen. The two dashed boxes indicate magnified dermoscopic photos shown in (c) and (d). (c) Dermoscopic features of the component of polymorphous vessels with homogenous yellow backgrounds. The dotted line indicates the section of the histopathological specimen. (d) Dermoscopic features of blue-gray globules at the periphery of the lesion. These multiple blue-gray globules were variably sized bluish globular-like structures as described by Longo et al. 2 The dotted line indicates the section of the histopathological specimen. (e) Histopathological examination at low magnification showing tumor nests of the sebaceous carcinoma on the right side and the clonal seborrheic keratosis on the left side. The dashed boxes (right and left) indicate areas shown in (f) and (h), respectively (hematoxylin-eosin [HE], original magnification 940). (f) Tumor nests composed of lobular aggregations (HE, 9100). (g) Tumor nests consisting of atypical neoplastic cells, some of which had vacuolated cytoplasm and scalloped nuclei (HE, 9400). (h) Intraepidermal nests of basaloid or pale cells with extensive pigmentation at the periphery (HE, 9100). (i) Immunohistochemistry with adipophilin (9100).

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