Track: Case Reports

Abstract:

Porokeratosis is a group of keratinization disorders with well-defined clinical and histologic features, including a hyperkeratotic ridge and cornoid lamella. It has several known associations, including genetic, UV radiation, and immunosuppression. While the pathogenesis is not entirely understood, there is evidence to support the role of defects in the mevalonate metabolic pathway and proliferation of mutated epidermal keratinocytes leading to development of these lesions. Here we describe an interesting case of postsurgical porokeratosis developing in the scar of an 87-year-old male veteran who had been treated with Mohs micrographic surgery two years prior for squamous cell carcinoma in-situ. This finding suggests localized skin trauma induced by surgical incisions could be a trigger for the development of porokeratosis. Published studies are limited regarding porokeratosis in postsurgical patients. It has previously been reported in its disseminated form in a trauma surgery patient and localized forms at a patient’s hemodialysis access site and within a patient’s longstanding burn scar. Mechanistically, we propose that surgical trauma-related changes in epidermal and dermal architecture could increase an individual’s likelihood of developing porokeratosis. This patient’s clinical course represents an important addition to the differential diagnosis for hyperkeratotic, scaly lesions developing at a prior Mohs surgery site.

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Edward Heilman