摘要
报告分次手术切除巨大汗孔角化症1例.患者男,54岁,因右上腹部紫红色斑伴瘙痒29年就诊.皮肤科情况:右上腹可见一直径约15 cm大小类圆形紫红色斑片,境界清楚,表面角化粗糙,附有少许鳞屑,周围呈褐色,无明显隆起,无糜烂、渗出.皮损组织病理:板状层角化过度,见一角化不全柱,其下方表皮无颗粒层,见数个角化不良细胞,余表皮棘层不规则增厚,真皮浅层血管扩张,管周少量或中等量单一核细胞浸润,间有噬色素细胞.皮肤镜检查:暗红背景,界限清,边缘可见白色轨道征及线状血管,中央可见灶状色素减退,弥漫线状血管及逗号样血管,周围可见增厚性黄色鳞屑.诊断:Mibelli型汗孔角化症.采取分次切除的方法分4次将皮损切除,术后皮损愈合较好,随访1年,无复发.
Abstract
To report a case of staged surgical excision of giant porokeratosis.A 54-year-old man had been seeking medical attention for 29 years due to an itchy purplish-red spot on the right upper abdomen.Dermatological examination revealed a well-defined round purplish-red patch,ap-proximately 15 cm x 15 cm,with rough keratinization and few attached scales on the surface.Brown color was observed around the lesion without any noticeable elevation,erosion or exudation.Histopathological analysis showed hyperkeratosis and parakeratosis,loss of granular layers,irregu-lar thickening of the stratum spinosum,superficial dermal vasodilation and perivascular infiltration of mononucleated cells along with melanophages.Dermoscopy revealed dark red background with clear boundaries,whitish peripheral rim and linear vessels,focal hypopigmentation,comma-like vessels at center,as well as thickened yellow scales in the surrounding area.Diagnosis was poro-keratosis of Mibelli.The skin lesion was surgically removed using a staged excision method over four stages,resulting in successful healing without recurrence during one-year follow-up.
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