PMC4809440_01
PMC4809440_02
PMC4809440_03
A, Recurrent nodular melanoma (dashed box) adjacent to advanced BCC (bracket) before ipilimumab therapy. B, Histolopathologic analysis of the nodule shows amelanotic nodular melanoma adjacent to BCC. Melanoma cells (double arrows) consisting of atypical epithelioid and spindled cells abut the BCC cells (single arrow) indicated by palisading basaloid cells with artifactual clefting. C, S100 positivity on immunohistochemical analysis highlights spindled cells, supporting melanoma histology (double arrows). BCC does not display S100 positivity (single arrow) (100x magnification, hematoxylin and eosin stain). D, After 8 weeks of ipilimumab exposure, the melanoma showed increased ulceration and growth (dashed box); however, the BCC had regressed with granulation tissue (bracket) filling the prior BCC ulcer bed and re-epithelialization (white arrow). Black arrow indicates site of biopsy that showed granulation tissue and no residual BCC. (B and C, Hematoxylin-eosin stain; original magnifications: B, x40; C, x100.)
gr1.jpg
PMC4809440_05_gr1.jpg
fig1
We were surprised to observe that the adjacent BCC had decreased in size from 9 x 8 cm before ipilimumab to 5 x 7 cm after ipilimumab, with significant granulation tissue replacing the previous BCC ulcer (Fig 1, D). Although it was not feasible to sample the entire granulation tissue area for residual BCC, we did perform a 4-mm biopsy by punch technique to confirm granulation tissue and lack of BCC (Fig 1, D, arrow).
PMC4809440_04
A, Recurrent nodular melanoma (dashed box) adjacent to advanced BCC (bracket) before ipilimumab therapy. B, Histolopathologic analysis of the nodule shows amelanotic nodular melanoma adjacent to BCC. Melanoma cells (double arrows) consisting of atypical epithelioid and spindled cells abut the BCC cells (single arrow) indicated by palisading basaloid cells with artifactual clefting. C, S100 positivity on immunohistochemical analysis highlights spindled cells, supporting melanoma histology (double arrows). BCC does not display S100 positivity (single arrow) (100x magnification, hematoxylin and eosin stain). D, After 8 weeks of ipilimumab exposure, the melanoma showed increased ulceration and growth (dashed box); however, the BCC had regressed with granulation tissue (bracket) filling the prior BCC ulcer bed and re-epithelialization (white arrow). Black arrow indicates site of biopsy that showed granulation tissue and no residual BCC. (B and C, Hematoxylin-eosin stain; original magnifications: B, x40; C, x100.)
gr1.jpg
PMC4809440_05_gr1.jpg
fig1
We were surprised to observe that the adjacent BCC had decreased in size from 9 x 8 cm before ipilimumab to 5 x 7 cm after ipilimumab, with significant granulation tissue replacing the previous BCC ulcer (Fig 1, D). Although it was not feasible to sample the entire granulation tissue area for residual BCC, we did perform a 4-mm biopsy by punch technique to confirm granulation tissue and lack of BCC (Fig 1, D, arrow).
PMC4809440_05
A, Recurrent nodular melanoma (dashed box) adjacent to advanced BCC (bracket) before ipilimumab therapy. B, Histolopathologic analysis of the nodule shows amelanotic nodular melanoma adjacent to BCC. Melanoma cells (double arrows) consisting of atypical epithelioid and spindled cells abut the BCC cells (single arrow) indicated by palisading basaloid cells with artifactual clefting. C, S100 positivity on immunohistochemical analysis highlights spindled cells, supporting melanoma histology (double arrows). BCC does not display S100 positivity (single arrow) (100x magnification, hematoxylin and eosin stain). D, After 8 weeks of ipilimumab exposure, the melanoma showed increased ulceration and growth (dashed box); however, the BCC had regressed with granulation tissue (bracket) filling the prior BCC ulcer bed and re-epithelialization (white arrow). Black arrow indicates site of biopsy that showed granulation tissue and no residual BCC. (B and C, Hematoxylin-eosin stain; original magnifications: B, x40; C, x100.)
gr1.jpg
PMC4809440_05_gr1.jpg
fig1
We were surprised to observe that the adjacent BCC had decreased in size from 9 x 8 cm before ipilimumab to 5 x 7 cm after ipilimumab, with significant granulation tissue replacing the previous BCC ulcer (Fig 1, D). Although it was not feasible to sample the entire granulation tissue area for residual BCC, we did perform a 4-mm biopsy by punch technique to confirm granulation tissue and lack of BCC (Fig 1, D, arrow).