Re: 'Acanthosis nigricans and an alternative for its surgical therapy'.

摘要

I read with interest the article by lsket et al. describing an alternative surgical therapy for acanthosis nigricans. The authors nicely summarize the multiple variants of acanthosis nigricans, but do not specify which variant their patient had. Their patient's results after surgery appear very good. However, in my judgment, the patient's lesion appeared more consistent with an epidermal nevus rather than acanthosis nigricans. Although the authors note that their patient had received prior therapies (cryotherapy and electrosurgery) and these therapies may have altered the appearance of her condition, her lesions are not typical of acanthosis nigricans which tends to have confluent velvety hyperpigmented plaques. Instead, the figure in their article demonstrates patchy involvement with skip areas and linear lesions. The histopathological findings of 'hyperkeratosis, mild acanthosis, and papillomatosis in the epidermis' would be equally consistent with an epidermal nevus or extensive seborrheic keratoses. The additional histopathological finding of 'a cystic space lined by a double layer of cuboidal cells' in their case seems of uncertain etiology and not explained by the authors. Regardless, the surgical approach described by Isket et al, seems to represent a good option for managing either acanthosis nigricans or epidermal nevi, although the more patchy and linear nature of epidermal nevi and their smaller chance for recurrence (due to the lack of an underlying endocrine or genetic defect) would make them more appropriate for this therapy.