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Int J Surg Pathol 2019 Feb 14:1066896919830208. Epub 2019 Feb 14.

1 University of Montreal, Montreal, Quebec, Canada.

We report the case of a 94-year-old man with a rapidly growing nodule on the preauricular area, which on histology showed a poorly differentiated spindle cell tumor with negative p63 and p40 antibody immunostains, negative high- and low-molecular-weight cytokeratins albeit for a focal expression of cytokeratin AE1/AE3. Spindle cell melanoma, angiosarcoma, and leiomyosarcoma were excluded. We explore the diagnostic approach to this challenging conundrum. Read More

Oncol Lett 2019 Feb 27;17(2):1768-1776. Epub 2018 Nov 27.

Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, D-66421 Homburg, Germany.

Atypical fibroxanthoma (AFX) is a rare mesenchymal tumor with predominance in older male patients located mainly in chronically UV-exposed skin. Differentiation from clinically more aggressive pleomorphic dermal sarcoma (PDS) is still under debate and immunohistochemical markers are not available yet. An immunohistochemical study, including 41 cases of AFX was conducted to investigate the expression of 3q encoded oncogene in AFX and determine the associations with histomorphologic, clinical and viral parameters. Read More

J Dtsch Dermatol Ges 2018 Dec;16(12):1434-1442

Department of Dermatology, Eberhardt Karls University, Tübingen Germany.

Background: Cutaneous sarcomas are rare and characterized by pathogenetic heterogeneity. Knowledge about local infiltration patterns and recurrence rates may be useful in improving patient care and outcomes. The objective of the present study was to compare these two characteristics in sarcomas that had been treated using the identical surgical procedure. Read More

Dermatol Surg 2018 Dec;44(12):1644-1646

Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Actas Dermosifiliogr 2019 Jan - Feb;110(1):4-11. Epub 2018 Nov 5.

Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.

There are 3 types of leiomyosarcoma of the skin: dermal, subcutaneous, and metastatic cutaneous. Dermal leiomyosarcoma arises from smooth muscle fibers in arrector pili muscles, genital dartos muscles, and the nipple-areola complex. It is an intermediate-grade tumor associated with a tendency for local recurrence (24%) and low metastatic potential (4%). Read More

Exp Dermatol 2019 Jan 13;28(1):66-71. Epub 2018 Dec 13.

Department of Dermatology, University Medical Center Regensburg, Regensburg, Germany.

Background: In humans, there are four known proton-sensing G-Protein-coupled receptors (pH-GPCRs): GPR4 (GPR19), TDAG8 (GPR65, T-cell death-associated gene 8), OGR1 (GPR68, ovarian cancer GPCR1) and G2A (GPR132, G2 accumulation protein). They are known to be involved in sensing changes of extracellular proton concentrations in the acidic microenvironment of tumors, which leads to altered cell proliferation, migration, metastasis, immune cell function and inflammation. However, little is known about the expression of pH-GPCRs in the skin and especially skin cancers. Read More

Cureus 2018 Jul 13;10(7):e2979. Epub 2018 Jul 13.

Dermatology, Massachusetts General Hospital, Boston, USA.

Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal tissue tumor. Distinguishing PDS from similar conditions, such as atypical fibroxanthoma (AFX), its less aggressive tumor counterpart, is difficult, as they are clinically and histologically similar. We present a case of a 77-year-old man presenting with a large nodular scalp lesion of three weeks duration. Read More

Int J Dermatol 2019 Feb 6;58(2):190-193. Epub 2018 Sep 6.

Department of Dermatology, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.

Background: Nodular fasciitis is a benign pseudosarcomatous, self-limited, and reactive process. Based on its clinical and histological features - a fast-growing, solitary tumor with high cellularity and mitotic count - nodular fasciitis is considered to be a benign mimic of sarcoma.

Methods: We present four cases of nodular fasciitis and a review of the literature. Read More

J Cutan Pathol 2018 Dec 27;45(12):880-885. Epub 2018 Sep 27.

Institute of Pathology, University Hospital Cologne, Cologne, Germany.

Background: Atypical fibroxanthomas (AFXs) and pleomorphic dermal sarcomas (PDSs) are UV-induced pleomorphic skin tumors with a non-specific immunoprofile. For that reason, exclusion of other dedifferentiated tumor entities by immunohistochemistry is still mandatory to avoid misdiagnosis.

Methods: We determined the expression frequency of several melanocytic and myofibroblastic markers investigating 50 AFXs and PDSs. Read More

Dermatol Surg 2018 Sep;44(9):1229-1231

Department of Dermatology, Columbia University Medical Center, New York, New York.

Clin Exp Dermatol 2019 01 21;44(1):86-88. Epub 2018 Aug 21.

Institute of Dermatology, Department of Clinical-Surgical, Diagnostic and Pediatric Science, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.

Am J Dermatopathol 2018 Aug 6. Epub 2018 Aug 6.

Department of Pathology and Dermatopathology, Albany Medical College, Albany, NY.

Malignant melanoma (MM) may display highly variable phenotypic diversity, sometimes associated with loss of immunohistochemical melanocytic markers and acquisition of nonmelanocytic lineage of differentiation. Primary cutaneous MM with rhabdomyosarcomatous differentiation is extremely rare with only 5 reported cases in the literature. To date, a chronological progression of a MM to rhabdomyosarcoma has not been conclusively documented. Read More

J Cutan Pathol 2018 Nov 22;45(11):869-870. Epub 2018 Aug 22.

Department of Pathology, Hospital Clinico Universitario, University of Valencia, Valencia, Spain.

J Am Acad Dermatol 2018 Nov 5;79(5):929-934.e6. Epub 2018 Jul 5.

Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota.

Background: Atypical fibroxanthoma (AFX) is a fibrohistiocytic tumor with relatively high local recurrence rates but low metastatic potential. Wide local excision (WLE) and Mohs micrographic surgery (MMS) are common treatments, although no consensus exists regarding optimal therapy.

Objective: To systematically review evidence of AFX recurrence and metastatic rates after different surgical modalities. Read More

J Drugs Dermatol 2018 Jun;17(6):683-685

Background: Alternative therapies are favored by some patients. In skin cancer, this may be to try to avoid surgery out of fear for the procedure and its functional or cosmetic consequences. Frequently, use of these therapies is not curative and can cause harm. Read More

J Am Acad Dermatol 2018 Nov 19;79(5):853-859. Epub 2018 May 19.

Department of Dermatology, University of California San Francisco, San Francisco, California. Electronic address:

Background: Undifferentiated pleomorphic sarcoma (UPS) encompasses rare neoplasms that can arise either in the dermis or in the subfascial soft tissue. The behavior of UPS ranges from indolent to aggressive, but data predicting outcomes are limited.

Objective: Identify predictors of poor outcomes by analyzing a large collection of UPS cases. Read More

Pathol Res Pract 2018 Jun 11;214(6):821-825. Epub 2018 May 11.

Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address:

Microphthalmia-associated transcription factor (MiTF) is used as a marker of melanocytic differentiation. However, MiTF immunoexpression has also been observed in histiocytes, macrophages, smooth muscle cells and fibroblasts, which raise the concern of fibrohistiocytic (FH) lesions being misdiagnosed as melanoma based on MiTF immunoreactivity. MiTF has been known to be positive in FH tumors, but this is the first study evaluating ninety-three fibrohistiocytic neoplasms to understand and delineate the staining pattern of MiTF in these tumors. Read More

Ocul Oncol Pathol 2018 Apr 20;4(3):152-156. Epub 2017 Oct 20.

The Ohio State University Department of Ophthalmology, Columbus, OH, USA.

Background/aims: Atypical fibroxanthoma is an uncommon tumor that usually occurs in the skin of the head and neck of the elderly with significant sun exposure. We describe a unique case featuring a rare ocular surface conjunctival tumor (atypical fibroxanthoma) and provide insight on its characteristic clinical features, surgical management, and histology.

Methods: A 71-year-old male fisherman with no pertinent ocular history presented to an academic center with a rapidly enlarging bulbar conjunctival mass in the right perilimbal region for the past several months. Read More

Oncotarget 2018 Apr 20;9(30):21182-21189. Epub 2018 Apr 20.

Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany.

Atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) are rare malignancies typically occurring in elderly patients and predominantly located in skin regions exposed to UV-light. Thus, a role of UV-radiation-induced damage for AFX and PDS tumorigenesis has been postulated. gene amplification has been demonstrated as a distinctive feature of radiation-induced angiosarcoma. Read More

J Cutan Pathol 2018 Aug 12;45(8):619-622. Epub 2018 Jun 12.

David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.

Cellular neurothekeomas (CNTs) are rare, benign cutaneous tumors that arise primarily on the head and neck, with a slight female predominance. CNTs with atypical features have been described, including those with an infiltrative growth pattern. Although CNTs with atypical features are benign, recognition of this entity can pose diagnostic challenges. Read More

JAAD Case Rep 2018 May 31;4(4):292-294. Epub 2018 Mar 31.

Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

J Cutan Pathol 2018 Aug 22;45(8):581-587. Epub 2018 May 22.

Division of Dermatology, Washington University School of Medicine, Saint Louis, Missouri.

Background: We sought to compare the sensitivity and specificity of 2 different caldesmon antibodies in differentiating leiomyosarcoma from other cutaneous spindle cell neoplasms.

Methods: Representative cutaneous spindle cell neoplasms were identified, including leiomyosarcoma, atypical fibroxanthoma, dermatomyofibroma and spindle cell squamous cell carcinoma. Immunohistochemistry was performed with antibodies directed toward caldesmon, smooth-muscle actin (SMA) and desmin. Read More

J Cutan Pathol 2018 Jul 18;45(7):545-549. Epub 2018 May 18.

Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.

Epithelioid cells with foamy cytoplasm (histiocytoid features) are typical histopathologic findings among benign and malignant histiocytic neoplasms such as xanthoma and atypical fibroxanthoma. However, these changes are unusual in melanoma, which is typically composed of nested and variably pigmented atypical epithelioid cells. Here, we report a patient with metastatic melanoma in lymph nodes presenting with prominent balloon cell/histiocytoid features expressing melanocytic markers, after treatment with nivolumab. Read More

Case Rep Otolaryngol 2018 23;2018:6092169. Epub 2018 Jan 23.

Department of Histopathology, Calderdale Royal Hospital, Halifax, UK.

Objective: To report a unique case of pinna squamous cell carcinoma (SCC) arising shortly after resection of atypical fibroxanthoma (AFX) at the same site.

Case Report: An 81-year-old gentleman presented with a nodular right pinna lesion. This was excised, and histology confirmed AFX. Read More

Australas J Dermatol 2018 Nov 23;59(4):309-314. Epub 2018 Mar 23.

Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy.

Background/objectives: Little is known about the dermoscopic features of atypical fibroxanthoma.

Methods: This was a case-control study. Atypical fibroxanthoma lesions were compared with a control group with non-melanoma skin cancer. Read More

J Dtsch Dermatol Ges 2018 Mar 29;16(3):330-332. Epub 2018 Jan 29.

Department of Dermatology, Kawasaki Municipal Hospital, Kawasaki, Japan.

Pathology 2018 Apr 1;50(3):358-361. Epub 2018 Mar 1.

Biomedical Research Institute INCLIVA, Valencia, Spain; Department of Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; University of Valencia, Valencia, Spain. Electronic address:

Skin Res Technol 2018 May 24;24(2):285-293. Epub 2018 Jan 24.

Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.

Background: Seborrheic keratoses (SebK) with atypical dermoscopy presentation are increasingly reported. These lesions do not exhibit typical dermoscopy features of SebK and sometimes mimic melanoma, thus complicating the differential diagnosis. Reflectance confocal microscopy (RCM) is a non-invasive tool, which allows an in vivo imaging of the skin. Read More

Oncotarget 2017 Dec 25;8(65):109457-109467. Epub 2017 Nov 25.

Institute of Pathology, University Hospital Cologne, Cologne, Germany.

Atypical fibroxanthomas (AFX) and pleomorphic dermal sarcomas (PDS) are frequent cutaneous sarcomas typically arising on sun-exposed skin in elderly patients. In contrast to AFX, which generally do not recur after complete excision, PDS locally recur in up to 50% and metastasize in up to 20%. We recently detected characteristic UV-induced mutations as potential driver mutation in almost all PDS investigated as well as activating and gene mutations in around one third of our tumors representing targets for personalized treatments in patients with unresectable or metastasized PDS. Read More

PLoS One 2017 15;12(11):e0188272. Epub 2017 Nov 15.

Department of Dermatology, University of California, San Francisco, California, United States of America.

Atypical fibroxanthoma (AFX), is a rare type of skin cancer affecting older individuals with sun damaged skin. Since there is limited genomic information about AFX, our study seeks to improve the understanding of AFX through whole-exome and RNA sequencing of 8 matched tumor-normal samples. AFX is a highly mutated malignancy with recurrent mutations in a number of genes, including COL11A1, ERBB4, CSMD3, and FAT1. Read More

Cutis 2017 Sep;100(3):E14-E16

Department of Dermatology, Upstate Medical University, Syracuse, New York, USA.

We describe a painful atypical fibroxanthoma (AFX) arising in a setting of erosive pustular dermatosis of the scalp. Complete excision was curative and also was associated with resolution of pain and clearance of the erosive pustular dermatosis of the scalp. We review the diagnosis and management of AFX and discuss the role of actinic damage in this process. Read More

Mod Pathol 2018 03 3;31(3):418-428. Epub 2017 Nov 3.

Dermatopathology Friedrichshafen, Friedrichshafen, Germany.

Atypical fibroxanthomas and pleomorphic dermal sarcomas are tumors arising in sun-damaged skin of elderly patients. They have differing prognoses and are currently distinguished using histological criteria, such as invasion of deeper tissue structures, necrosis and lymphovascular or perineural invasion. To investigate the as-yet poorly understood genetics of these tumors, 41 atypical fibroxanthomas and 40 pleomorphic dermal sarcomas were subjected to targeted next-generation sequencing approaches as well as DNA copy number analysis by comparative genomic hybridization. Read More

Ann Plast Surg 2018 Jan;80(1):32-39

Background: Ear reconstruction with osseointegrated prosthetic implants is a well-established method of reconstruction after resection of skin malignancies on the external ear. There is limited literature reporting technique, outcomes, and patient satisfaction.

Methods: We evaluated our outcomes over a 5-year period looking at osseointegrated prosthetic reconstruction after auriculectomy for external ear skin malignancies. Read More

J Cutan Pathol 2018 Jan 8;45(1):59-62. Epub 2017 Nov 8.

Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan.

Pleomorphic fibroma is a rare benign cutaneous neoplasm characterized by spindle-shaped cells and multinucleated giant cells scattered throughout collagenous stroma. These morphologic features can lead to diagnostic confusion, including atypical lipomatous tumor as one consideration. In contrast to atypical lipomatous tumor, previous studies have found pleomorphic fibroma to be negative for MDM2 immunohistochemical staining and MDM2 gene amplification. Read More

Pan Afr Med J 2017 18;27:205. Epub 2017 Jul 18.

Service de Dermatologie, Centre Hospitalier Universitaire Ibn Sina, Rabat, Maroc.

We report the case of a 32-year old female patient, with no notable medical history, requiring dermatology consultation for evaluation of a nodule on her right cheek which had evolved over the past 10 years. Clinical examination showed a reddish dermal-based nodule with a smooth surface. The lesion measured 1cm in diameter and was located at the level of the right cheek (A). Read More

Arch Soc Esp Oftalmol 2018 Feb 23;93(2):97-100. Epub 2017 Aug 23.

Departamento de Oftalmología, Hospital Universitario y Politécnico la Fe, Valencia, España.

Case Report: A 7 year-old boy with Xeroderma Pigmentosum (XP) and who presents a recurrent conjunctival atypical fibroxanthoma after two surgeries. This is the third procedure and the patient is treated with a surgical excision of the tumour and cryotherapy at the surgical bed. Due to the risk of recurrence, topical Mitomycin C 0,02% was added at post-operative care achieving a good clinical outcome. Read More

Australas J Dermatol 2018 Feb 17;59(1):10-25. Epub 2017 Aug 17.

Skin and Cancer Foundation, Sydney, New South Wales, Australia.

Atypical fibroxanthoma (AFX) is a rare spindle cell neoplasm predominantly found on the head and neck of elderly individuals with sun-damaged skin, with no evidence-based guidelines for their management. A systematic retrospective review of the literature focusing on treatment modality found a recurrence and metastasis rate of 8.0% (5. Read More

Clin Lab Med 2017 09 15;37(3):603-631. Epub 2017 Jun 15.

Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Hilton 11, 200 First Street Southwest, Rochester, MN 55905, USA. Electronic address:

Fibrohistiocytic tumors are a diverse group of reactive and neoplastic lesions including xanthoma, fibrous histiocytoma and its variants, solitary xanthogranuloma, dermatofibrosarcoma protuberans, and atypical fibroxanthoma. This article reviews some of the more commonly encountered fibrohistiocytic tumors with an emphasis on clinical presentation, macroscopic and histologic characteristics, molecular/cytogenetic findings where applicable, and differential diagnoses. Read More

Curr Treat Options Oncol 2017 08;18(8):50

Department of Dermatology, Stanford University School of Medicine, 450 Broadway Street Pavilion C, 2nd Floor, Redwood City, CA, 94063, USA.

Opinion Statement: Atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) tumors share many clinical, etiologic, and histologic features and likely represent components of a tumor spectrum. In dermatologic oncology, differentiating between AFX and PDS is pivotal as tumors with histological features consistent with PDS are more likely to behave in a clinically aggressive manner. Importantly, the term "pleomorphic dermal sarcoma" (PDS) is a more appropriate designation than "undifferentiated pleomorphic sarcoma" (UPS) for describing deeper, more aggressive, histologically high-grade cutaneous tumors that otherwise resemble AFX. Read More

J Cutan Pathol 2017 Nov 22;44(11):951-953. Epub 2017 Aug 22.

Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California.

Atypical fibroxanthoma represents a low-grade sarcoma that usually presents in the elderly population on sun-damaged areas of the head and neck regions. This neoplasm is characterized on histology by atypical pleomorphic, epithelioid to spindled cells, arranged in a haphazard pattern, set within a background of solar elastosis. In this case report, we present a unique case of the rare variant of clear-cell atypical fibroxanthoma arising in an unusual place, specifically the lower extremities. Read More

Am J Dermatopathol 2017 Jul;39(7):504-507

*Department of Pathology, Baylor University Medical Center, Dallas, TX; †Department of Pathology, Pathologist Biomedical Laboratories, Dallas, TX; ‡Department of Pathology, UF Health, Jacksonville, Jacksonville, FL; §Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and ¶Department of Pathology, MD Anderson Cancer Center, Houston, TX.

Dermatofibromas (DF) are common, benign, skin tumors, usually easily differentiated from dermatofibrosarcoma protuberans (DFSP) by the presence of a relative low cellularity, lesser degree of infiltration of subcutaneous tissue, and immunohistochemical pattern (eg, FXIIIa in DF and CD34 in DFSP). Atypical fibrohistiocytic lesions (AFL) have features intermediate to DF and DFSP (trunk location, storiform pattern, infiltration of the subcutaneous tissue, and focal expression of both CD34 and Factor XIIIa). It is unclear if mitotic counts/degree of proliferation is helpful to distinguish DF from DFSP. Read More

J Dtsch Dermatol Ges 2017 Jun;15(6):630-648

Department of Dermatology and Allergology, Munich Technical University, Munich, Germany.

Cutaneous sarcomas comprise a heterogeneous group of mesenchymal spindle cell tumors of the dermis and subcutis, one of the best-known entities being dermatofibrosarcoma protuberans. Other sarcomas addressed in this review include atypical fibroxanthoma, cutaneous undifferentiated pleomorphic sarcoma, leiomyosarcoma, liposarcoma, and angiosarcoma. With the exception of dermatofibrosarcoma protuberans, which has its peak incidence in middle-aged adults, cutaneous sarcomas usually occur in elderly individuals starting in the sixth or seventh decade of life. Read More

J Contemp Brachytherapy 2017 Apr 25;9(2):158-160. Epub 2017 Jan 25.

DermaHealth Dermatology & Dermasurgery, Richland, WA, USA.

Purpose: To evaluate the suitability of treating atypical fibroxanthoma (AFX), an uncommon skin malignancy, with electronic brachytherapy.

Material And Methods: From Feb 2013 to Sep 2014, we were referred a total of 8 cases of AFX in 7 patients, all involving the scalp. All of them were treated with electronic brachytherapy 50 Kev radiations (Xoft Axxent, Fremont, California). Read More

Surg Pathol Clin 2017 Jun 14;10(2):319-335. Epub 2017 Mar 14.

Department of Pathology, University of Edinburgh, United Kingdom.

Atypical fibroxanthoma (AFX) represents a rare mesenchymal neoplasm arising predominantly in the head and neck area of elderly patients. Clinically, the neoplasm is characterized by a rapid and exophytic growth with frequent ulceration of the epidermis. Histopathologically, AFX represents a well-circumscribed, dermal-based neoplasm composed of a variable admixture of large histiocytoid cells, enlarged spindled and epithelioid tumor cells, and multinucleated tumor giant cells with bizarre and pleomorphic nuclei. Read More

Australas J Dermatol 2017 05;58(2):150-151

Princess Alexandra Hospital, Brisbane, Queensland,, Australia.

Int J Trichology 2016 Oct-Dec;8(4):191-194

Department of Pathology, S Nijalingappa Medical College, Bagalkot, Karnataka, India.

Squamous cell carcinoma (SCC) is the second most cutaneous malignancy after basal cell carcinoma (BCC) with increasing incidence. In the view its nodular manifestation; it can appear similar to nodular BCC, atypical fibroxanthoma, sclerosing liposarcoma and desmoplastic melanoma. Prognostic and therapeutic implications are different in all these conditions and thus their distinction becomes important. Read More

Pediatr Dermatol 2017 May 20;34(3):347-351. Epub 2017 Mar 20.

Department of Dermatology, Mayo Clinic, Rochester, Minnesota.

Dermatomyofibroma is a rare, benign mesenchymal proliferation not commonly reported in children. Two patients with biopsy-proven dermatomyofibroma were identified (one female, one male) at our institution, both with rather atypical clinical presentations. The clinical and histopathologic findings and a review of the literature are presented here. Read More

J Dermatol 2017 Mar;44(3):251-258

Boston University School of Medicine, Boston, Massachusetts, USA.

Since the initial description of the granular cell tumor in 1926, numerous other neoplasms, both benign and malignant, have been described to exhibit granular cell change. In most cases, diagnosis remains straightforward via recognition of retained histopathological morphology of the archetypal tumor, despite the presence of focal granular appearance. However, tumors with granular cell differentiation can present a diagnostic challenge either by mimicking alternative diagnoses, or by failing to exhibit architectural clues of the primary entity, thus requiring an immunohistochemical work-up. Read More

Am J Dermatopathol 2018 01;40(1):75-76

Service of Dermatology, Centro Médico-Cirúrgico Lisboa, Lisboa, Portugal.