| Introduction: Solitary keratotic lesions in elderly individuals often pose diagnostic challenges due to their clinical resemblance to both benign and malignant conditions. Common differentials include seborrheic keratosis, Bowen’s disease, and angiokeratoma. Dermoscopy can provide important clues, but histopathology remains the gold standard for confirmation. Case Report: A 63-year-old female presented with a solitary raised lesion over the right shin persisting for five months. Clinical differential diagnoses considered were seborrheic keratosis, Bowen’s disease, and angiokeratoma. On examination, a solitary keratotic papule measuring 0.8 × 0.8 mm was noted. Dermoscopic evaluation revealed well defined homogeneous pink-red lesion with whitish keratotic edge, lacking glomerular clustering. A 3 mm punch biopsy was performed for histopathological assessment. Histopathology Findings: Microscopy demonstrated mild reticulated epidermal hyperplasia with well-circumscribed nests of poroid cells within the acanthotic epidermis. Scattered melanocytes were observed, with no evidence of cytological atypia or vascular dilatation. Diagnosis: Based on histopathology, a final diagnosis of Hidraacanthoma simplex was made—a rare benign adnexal tumor of poroid differentiation. Conclusion: Hidraacanthoma simplex is an uncommon poroid neoplasm that may clinically mimic malignant conditions such as Bowen’s disease, leading to potential diagnostic confusion. This case underscores the importance of correlating dermoscopic findings with histopathological confirmation to ensure accurate diagnosis and avoid unnecessary aggressive treatment. Keywords: Hidraacanthoma simplex, poroid neoplasm, solitary keratotic lesion, Bowen’s disease mimic |
