Fibroepithelioma of Pinkus

Fibroepithelioma of Pinkus was first described by Hermann Pinkus in 1953 as a rare, premalignant fibroepithelial tumour. Pinkus observed that some of the lesions had a peculiar histologic appearance that resembled both a reticulated seborrhoeic keratosis and a basal cell carcinoma (BCC). Pinkus thus considered the tumour to be a variant of basal cell carcinoma, which illustrated the interaction and interdependence of stromal and epithelial components of basal cell carcinoma.

Lesions are often diagnosed retrospectively, mostly commonly being mistaken clinically for a skin tag.

This chapter is set out as follows:

• More common in patients with skin types 1 and 2
• Affects men and women equally
• Usually develops in people aged 40-60, but can arise at any age
• Grow slowly 

Distribution

• Usually solitary
• The lower trunk (especially the lower back) is the most common site although it is not limited to this region and may develop on other body sites, including the extremities, abdomen, head, and genitalia
• It also presents more frequently in areas of radiation-damaged skin

Morphology

• A pink to flesh-coloured (occasionally slightly brown-grey), well-demarcated plaque
• Infrequently may be pedunculated, polypoid, or ulcerated
• The tumour can present alone or with associated features of a seborrhoeic keratosis and / or basal cell carcinoma

Dermoscopic features

• One paper examining the dermoscopic features of 10 such lesions found fine arborising vessels, either alone or associated with dotted vessels, and short white lines (in 100%, 70%, and 90% of lesions, respectively). Other reports have also remarked on small irregularly shaped and distributed linear vessels. It is important to note that short white lines are not very specific and can be found in a number of benign and malignant lesions      

• Treatment is primarily surgical - lesions tend to be excised for diagnostic purposes 
• If a BCC is present the lesion must be completely excised with a 4 mm margin of normal surrounding skin