A case of surgical excision of giant porokeratosis

To report a case of staged surgical excision of giant porokeratosis. A 54-year-old man had been seeking medical attention for 29 years due to an itchy purplish-red spot on the right upper abdomen. Dermatological examination revealed a well-defined round purplish-red patch, approximately 15 cm×15 cm, with rough keratinization and few attached scales on the surface. Brown color was observed around the lesion without any noticeable elevation, erosion or exudation. Histopathological analysis showed hyperkeratosis and parakeratosis, loss of granular layers, irregular thickening of the stratum spinosum, superficial dermal vasodilation and perivascular infiltration of mononucleated cells along with melanophages. Dermoscopy revealed dark red background with clear boundaries, whitish peripheral rim and linear vessels, focal hypopigmentation, comma-like vessels at center, as well as thickened yellow scales in the surrounding area. Diagnosis was porokeratosis of Mibelli. The skin lesion was surgically removed using a staged excision method over four stages, resulting in successful healing without recurrence during one-year follow-up.