Scanning magnification of a pilar sheath acanthoma shows a dilated follicular structure lined by a thickened squamous epithelium with endophytic, lobulated areas
.

Higher magnification of the lobular areas shows acanthotic squamous epithelium with peripheral palisading
and scattered clear-staining cells
.
High magnification of the epithelium shows a prominent granular layer
(consistent with infundibular keratinization). The cells are mildly enlarged and squamoid appearing, with scattered pale/clear cells
.
Foci of keratinization with squamous pearls
may be seen surrounded by bland squamoid to clear
cells.CLINICAL ISSUES
Epidemiology
Natural History
• Slow-growing, stable lesion

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