Wickham's striae-like appearance in Kaposi's sarcoma: A derm
The present case has been published in the Indian Association of Dermatologists, Venereologists & Leprologists.

A 45-year-old human immunodeficiency virus-seropositive man presented with 6-month history of progressively enlarging solitary asymptomatic swelling over the left leg. Cutaneous examination revealed a solitary firm, nontender, violaceous nodule of size 5 mm × 5 mm over the medial aspect of left leg with mild surface scaling.

A differential diagnosis of lichen planus, Kaposi's sarcoma, basal cell carcinoma and malignant melanoma was considered. On nonpolarized contact dermoscopy, the nodule displayed a central prominent Wickham's stria-like appearance (red arrow), bluish-red areas (blue arrows), blue-white veil-like structure (yellow arrows) and multiple brown globules [black arrows. The central Wickham's striae-like area was “out of focus”.

His CD4 count was 432/mm and serological tests for hepatitis B antigen, anti-hepatitis C virus antibodies and venereal disease research laboratory tests were negative. The histopathology of the excised nodule revealed hyperkeratosis, hypergranulosis, irregular acanthosis and proliferation of spindle-shaped endothelial cells forming slit-like vascular spaces in the upper and middle dermis admixed with variable lymphoplasmacytic infiltrate, and hemorrhage.

Promontory sign characterized by protrusion of new vessels into existing large vessel was also demonstrated. Both hemosiderin-laden macrophages and free hemosiderin deposition was evident in the dermis. On immunohistochemistry, the spindle cells were positive for CD-31 [Figure 4d] and CD34. Based on clinical, histopathology and immunohistochemistry, a final diagnosis of Kaposi's sarcoma was made.

Key takeaway:-
- The presence of out of focus Wickham's striae-like appearance under nonpolarized contact dermoscopy in a case of nodular Kaposi's sarcoma can be a dermoscopic pitfall.

- The presence of multicolored pattern can help in differentiating it from other clinical mimics.

Read more here: https://pxmd.co/zTZ4R
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