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November 1993

Asymptomatic Papule on the Lower Leg

Author Affiliations

Naval Hospital, San Diego, Calif

Arch Dermatol. 1993;129(11):1509-1510. doi:10.1001/archderm.1993.01680320143020

REPORT OF A CASE  A 38-year-old Filipino man presented for evaluation of a slowly growing papule on his left lower leg. The asymptomatic papule had been present for 1 year.Physical examination was remarkable for a 5×5-mm reddish-pink, firm papule over the medial aspect of the left lower leg (Figure 1). The papule had a flat, smooth surface centrally and a collarette of fine scale at the periphery. The skin adjacent to the papule had brown hyperpigmentation. The cutaneous examination was also remarkable for a Becker nevus over the right upper arm.A punch excision from the left lower leg is shown in Figures 2 through 4.What is your diagnosis?

DIAGNOSIS:  Clear-cell acanthoma.

HISTOPATHOLOGIC FINDINGS  Hematoxylin-eosin—stained sections revealed a sharply demarcated, acanthotic epidermis composed of large keratinocytes that stained lighter than the adjacent epidermis. Parakeratosis and an absent granular layer were

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