Coexistence of Acantholytic Dyskeratosis and Epidermolytic Hyperkeratosis in a Single Cutaneous Lesion: A Case Report and Brief Review.

Acantholytic dyskeratosis and epidermolytic hyperkeratosis are distinct histopathologic patterns reflecting abnormalities in keratinocyte differentiation. Although typically considered separate histopathologic reaction patterns, their coexistence within a single lesion is uncommon and remains poorly characterized. We report the case of a 51-year-old woman with a lumbar skin lesion excised for suspected intradermal nevus or basal cell carcinoma. Histopathologic examination revealed a combination of Acantholytic dyskeratosis and epidermolytic hyperkeratosis features without evidence of malignancy. This association, previously described in the literature, suggests that both patterns may represent overlapping responses within a shared spectrum of epidermal alterations, potentially triggered by external factors or occurring as incidental findings. Recognition of this coexistence is important for accurate histopathologic classification of keratotic lesions and to avoid overinterpretation of incidental epidermolytic change. In most cases, it likely represents a secondary phenomenon without direct clinical significance, although further studies are needed to clarify its pathogenic basis.