PMC3881086_01
Clinical and macroscopic image of a raised pigmented lesion on the right cheek.
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A new raised pigmented skin lesion 6 mm in diameter was discovered on his right cheek (Figure 1). Close macroscopic examination of the lesion on his right cheek (Figure 1) revealed that there was prominent surface scale overlying the posterior portion.
Dermatoscopic view of the lesion shown in Figure 1. Arrows point to white circles.
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A photograph was taken (Figure 2) with a non-polarizing Dermlite Fluid dermatoscope (3-Gen, San Juan Capistrano, CA) coupled to a Canon 50D single lens reflex camera(Canon, Tokyo, Japan). Dermatoscopically (Figure 2) the peri-lesional skin was white in between the red vascular plexus. The anterior (Figure 2, right side) part of the lesion was blue superiorly with blue and white inferiorly and in these parts linear, serpentine, and coiled vessels were seen. Posteriorly (Figure 2, left side), denser blue pigment partially obscured the vessels. As an additional clue two white circles were present dermatoscopically (arrows, Figure 2).
Histologic view (low power) of the lesion shown in Figures 1 and 2 shows invasive squamous cell carcinoma with aggregations of neoplastic keratinocytes, signs of abnormal cornification (eosinophilic cytoplasm and numerous dyskeratotic cells) and prominent acantholysis.
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It was signed out by the reporting pathologist as a "focally pigmented, moderately well differentiated acantholytic squamous cell carcinoma extending to mid-dermis." (Figures 3-5).
Additional low power histologic view.
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It was signed out by the reporting pathologist as a "focally pigmented, moderately well differentiated acantholytic squamous cell carcinoma extending to mid-dermis." (Figures 3-5).
High power view of boxed area in Figure 3 showing abnormal keratinocytes with large nuclei and prominent nucleoli, dyskeratotic cells, melanin (arrows) and acantholysis.
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It was signed out by the reporting pathologist as a "focally pigmented, moderately well differentiated acantholytic squamous cell carcinoma extending to mid-dermis." (Figures 3-5).