Double Hatchet Flap for the Reconstruction of Scalp Defects.

tion, and the lipidized DF, with a homogeneous yellowish area.3,6 Although initially considered rare, sebaceous structures are identified in more than 15% of DFs,4,5,7 even in multiple forms.8 This finding is typical in lesions localized in the anatomical area of the shoulder (shoulder, proximal region of the arm, upper back and deltoid region), being observed in more than 40% of these cases, particularly in DF with seborrheic keratosis-type epidermal hyperplasia or with a sclerotic pattern.4 The dermoscopic image shows yellowish globular structures due to the sebaceous component.6 Although growth factors and cytokines have been implicated,9 the etiology of sebaceous induction and the reason for its predilection for DF of the shoulder remain unknown.4 In this case, the differential diagnosis should include sebaceous tumors and tumors with sebaceous differentiation, such as sebaceous hyperplasia, sebaceous nevus, sebaceous adenoma, sebaceous carcinoma, and reticulated acanthoma or poroma with sebaceous differentiation, which can include yellowish structures in the dermoscopy image.10 Yellowish globules have also been identified in melanocytic nevi and balloon cell melanomas. In conclusion, DF is a tumor with a marked variability of its clinical, histopathological, and dermoscopic presentation. A diagnosis of DF with sebaceous induction should be considered in lesions in the shoulder area with yellowish globules visible on dermoscopy.