Cleft-like appearance of accessory nipple in digital microscopy.

Dear Sir,

Accessory nipples are solitary or multiple rudimentary nipples developing along the two vertical 'milk-lines'. Most cases are sporadic and asymptomatic. Accessory nipple occurs in 1-6% of the population and affects both genders equally.[1] It is often mistaken as dermatofibroma in clinical or dermatoscopic examination. Blum et al. have reported a case of accessory nipple indistinguishable from dermatofibroma, with dermatoscopic features such as peripheral pigment network and central scar-like white-colored area.[2] Oztas and Gurer detected a cleft-like appearance in the dermatoscopic evaluation of four of their five patients.[3] Herein, we would like to point out the potential of portable digital microscopy for the diagnosis of accessory nipple in clinical practice. In our clinic, we use a Celestron handheld digital Microscope model #44301, at 30-fold magnification, provided with a focus ring and six LED ring illuminators. It has a resolution of 1280 x 1024 pixels and provides JPEG-format digital images, which are downloaded via USB connection to a personal computer.

A 30-year-old man presented with a congenital 4x5 mm brownish-pink nodule in his right subcostal region (Figure 1). We could not detect a cleft-like appearance in dermatoscopic evaluation. Dermatoscopic examination disclosed a dermatofibroma-like appearance with peripheral pigment network and a central scar-like area (Figure 2). However, the cleft-like appearance was observed in digital microscopy (Figure 3).

FIGURE 1

A 5x5 mm brownish-pinknodule along the right milkline

FIGURE 2

Dermatoscopy of accessory nipple with peripheral pigment network and a central scar-like patch

FIGURE 3

Digital microscopy of accessory nipple (Arrow shows cleft-like appearance responding to nipple tip)

A portable digital microscope with 30- to 100-fold magnification is a more affordable imaging device than a dermatoscope and it can be helpful in the diagnosis of accessory nipple in clinical practice.