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Dissociating Fibroepithelioma of Pinkus From Internal Malignancy: A Single-Center Retrospective Study

Cutis. 2023 January;111(1):E26-E30 | doi:10.12788/cutis.0698
January 25, 2023|Dermatology
Joseph B. Kim, MD;Austin Gable, MD;Andrea F. McGlynn;Aaron S. Cantor, MD;J.B. Walsh, DO;Nicholas F. Logemann, DO;David Hill, DO;Curtis Lamar Hardy, DO
Author and Disclosure Information

Drs. Kim, Gable, Logemann, and Hardy are from the Naval Medical Center San Diego, California. Ms. McGlynn is from the Naval Medical Center, Portsmouth, Virginia. Dr. Cantor is from the Walter Reed National Military Medical Center, Bethesda, Maryland. Dr. Walsh is from the Naval Hospital, Sigonella, Italy.

Coauthor David Hill, DO, died December 2, 2019.

The authors report no conflict of interest.

The views expressed in this article reflect the results of research conducted by the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government.

Correspondence: Curtis Lamar Hardy, DO, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 (Curtis.hardy@me.com).

Fibroepithelioma of Pinkus (FeP) is a rare skin tumor with a clinical presentation similar to benign neoplasms such as acrochordons and seborrheic keratoses. Our study analyzed if there is an association between FeP and internal tumors, specifically gastrointestinal tract tumors. We retrospectively reviewed the medical records of patients with FeP for other tumors throughout their lives until 2020. Although the quality of documentation for each patient may have differed, this study suggests that the presence of FeP does not indicate the presence of gastrointestinal tract tumors, and there is no need for altered cancer screening recommendations forthose with FeP.

PRACTICE POINTS

  • Dermatologic reactions may be the initial presentation of an internal malignancy.
  • Fibroepithelioma of Pinkus is considered on the spectrum between adnexal neoplasms and a nonaggressive variant of basal cell carcinoma (BCC).
  • Fibroepithelioma of Pinkus should be managed similar to nonaggressive variants of BCC such as nodular BCC.
  • Fibroepithelioma of Pinkus is not associated with internal malignancy.

Relationship With Colonoscopy Results—By analyzing those patients with FeP who specifically had documented colonoscopy results, we did not find a correlation between FeP and gastrointestinal tubular adenoma or carcinoma at any time during the patients’ available records. Although some patients may have had undocumented colonoscopies performed outside the DoD medical system, most had evidence that these procedures were being performed by transcription into primary care provider notes, uploaded gastroenterologist clinical notes, or colonoscopy reports. It is unlikely a true colorectal or other malignancy would remain undocumented over years within the electronic medical record.

Study Limitations—Because of the nature of electronic medical records at multiple institutions, the quality and/or the quantity of medical documentation is not standardized across all patients. Not all pathology reports may include FeP as the primary diagnosis or description, as FeP may simply be reported as BCC. Despite thorough data extraction by physicians, we were limited to the data available within our electronic medical records. Colonoscopies and other specialty care often were performed by civilian providers. Documentation regarding where patients were referred for such procedures outside the DoD was not available unless reports were transmitted to the DoD or transcribed by primary care providers. Incomplete records may make it more difficult to identify and document the number and characteristics of patients’ tubular adenomas. Therefore, a complete review of civilian records was not possible, causing some patients’ medical records to be documented for a longer period of their lives than for others.

Conclusion

Our data demonstrated no statistically significant temporal relationship between the development of FeP and other benign or malignant tumors. Additionally, the prevalence of tubular adenoma or gastrointestinal malignancy is not substantially higher in those with FeP than the age-adjusted population. Current guidelines recommend that patients with FeP should be treated and return for follow up at regular intervals, similar to patients with a history of BCC. This study does not establish FeP as a risk factor for development of any type of cancer that would require earlier or more frequent intervals beyond the established age-appropriate screening guidelines.

Given the discrepancies in our findings with the previous study,3 future investigations on FeP and associated tumors should focus on integrated health care systems with longitudinal data sets for all age-appropriate cancer screenings in a larger sample size. Another related study is needed to evaluate the pathophysiologic mechanisms of FeP development relative to known cancer lines.

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