Acantholytic and Acantholytic Dyskeratotic Acanthoma
Christine J. Ko, MD
Key Facts
Clinical Issues
Generally a solitary papule
Often on trunk
Often submitted as “rule out basal cell carcinoma”
Microscopic Pathology
Flat, plaque-like architecture
Minimal to no cytologic atypia
Acantholytic acanthoma
Acantholysis without dyskeratosis
Acantholytic dyskeratotic acanthoma
Acantholysis with dyskeratosis (corp ronds and grains)
Top Differential Diagnoses
Warty dyskeratoma
Acantholytic actinic keratosis
Grover disease
Acantholytic dermatosis of genital area
Hailey-Hailey disease
 An acantholytic acanthoma is a solitary keratosis characterized by acantholysis (dyscohesion of keratinocytes)  , which is full thickness in this example. There is a lack of dyskeratosis (corp ronds and grains). |
 An acantholytic dyskeratotic acanthoma is a solitary keratosis with acantholysis  and dyskeratosis (corp ronds  and grains  ). The overall architecture is flat and plaque-like. |
TERMINOLOGY
Synonyms
Some consider these 2 entities synonymous
Criterion used to “split” these into 2 entities is presence or absence of dyskeratosis (corp ronds and grains)
Definitions
Benign lesions with flat, plaque-like architecture and acantholysis
Acantholytic acanthoma
Lacks dyskeratosis (corp ronds and grains)
Acantholytic dyskeratotic acanthoma
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