The papulokeratotic type of solitary benign lichenoid keratosis

A 67-year-old housewife was referred to us for a papulonodular keratotic lesion on the left side of the left eyebrow (Fig. 1). The lesion had started to develop 6 months earlier and had gradually reached a size of 2 cm in diameter. It was firm, nonitching, and painless on pressure. Figure 1. Papulokeratotic lesion on the left eyebrow Download figure to PowerPoint Histologic examination of a punch biopsy obtained from the reddish edge of the nodule showed a jagged epidermal profile with areas of hyperplasia alternating with areas in which the epidermis was thin. The epidermis showed multifocal acanthosis, diffuse hypergranulosis, and hyperorthokeratosis; only focal hyperparakeratosis was present. The basal layer showed spotty areas of liquefaction degeneration, with superimposed lymphocytic infiltrate, and exocytoses that indented the profile of the dermo-epidermal junction. Focally, some eosinophilic bodies were present. Keratinocytes with hyperchromatic nuclei were also present in the lower layer of the epidermis (Fig. 2). Figure 2. Histologic examination showing epidermis with acanthosis, hypergranulosis, and hyperorthokeratosis; keratinocytes with hyperchromatic nuclei can also be seen in the lower layer. The papillary dermis shows a band-like lymphocytic infiltrate (original magnification, × 10) Download figure to PowerPoint The papillary dermis showed a mostly band-like infiltrate consisting predominantly of lymphocytes, a few melanin-poor histiocytes, and very rare eosinophils; telangiectases and solar elastosis were also present.