Histology: On biopsy, the hallmark of porokeratosis is recognition of the cornoid lamella. The cornoid lamella is the pathological representation of the hyperkeratotic peripheral rim of tissue seen on clinical examination. The cornoid lamella is positioned at an angle away from the center of the lesion. The granular cell layer underneath the cornoid lamella is often absent or severely thinned. The appearance of the center of the lesion is dependent on the clinical variant seen. The area can be atrophic or acanthotic. It is not uncommon to see an inflammatory infiltrate underneath the lesion, composed predominantly of lymphocytes.
Treatment: Treatment is difficult and often unsuccessful for widespread areas such as those involved in DSAP. Sun protection and sunscreen use are recommended. Solitary lesions can be removed surgically. Multiple disseminated lesions can be ablated with carbon dioxide laser ablation, 5-fluorouracil, or dermabrasion. These therapies are not always effective and may be associated with scarring. It is imperative to continue to monitor these patients with routine skin examinations, because porokeratoses have a potential for malignant degeneration.
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