V. Mangkorntongsakul 1 , V. Howard2, S.D. Smith3,4,5
Peristomal plaques are a common skin condition which occur in up to 73% of patients with stomas1. We reported on two cases of perplexing peristomal plaques.
The ﬁrst case was an 88-year-old Asian-Caucasian female with Ulcerative Colitis and a 55-year-old ileostomy pre- senting with a 5-year history of worsening peristomal skin irritation. She had a 5cmx4 cm eroded, granulomatous papulonodular friable peristomal plaque which extended infero-medially from the mucosa-cutaneous junction into the abdomen. Two shave biopsies were performed and histopathology demonstrated mild papillomatosis, hyperk- eratosis and acute-on-chronic inﬂammation with focal erosion and epithelial islands resembling colonic epithelium, mixed with squamous epithelium. This was consistent with cutaneous peristomal intestinal metaplasia (PIM). She sub- sequently underwent high frequency desiccator of electro- cautery with no recurrence to date.
The second case was a 79-year-old male with a history of ileal conduit post radical prostatectomy presenting with a
6-month history of a peristomal lesion. The eruption ini-
tially started as a small red spot and had grown in size across the upper half of the stoma zone. On examination, he had a friable fan-like growth with rolled and non-vio- laceous edges which appeared in continuity with the upper portion of the stoma from 9 o’clock to 3 o’clock in the peristomal zone. A shave biopsy was performed, demon- strating massive granulation tissue plaque and was subse- quently debulked.
These two cases highlight the importance of biopsy of peri- stomal ulcers which do not respond to topical treatments with consideration for PIM since it can be effectively trea- ted with electrocautery.
1. Ono R, Oka M, Sakaguchi M, Kawakami F, Nagano T, Kunisada M, et al. Peristomal skin ulcer with intestinal metaplasia. Br J Dermatol. 2012 Jul;167(1):204–6. https://doi.org/10.1111/j.1365-