Acantholytic acanthoma was originally described as a solitary lesion displaying histologic features of acantholysis without dyskeratosis. Solitary, non-genital lesions displaying confluent acantholysis and dyskeratosis have not been well described in the literature, clinically or histologically. We screened cases at our institution over a 6-month period and found 28 such lesions. Lesions were most often found on the trunk as a solitary papule, for which the clinical diagnosis was often basal cell carcinoma. There was a slight female predominance. Confluent acantholysis and dyskeratosis is a histologic pattern that may present as a solitary keratosis.