PMC5828143_01
Clinical photograph showing a one-centimetre nodular lesion on the right upper pinna.
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There was a one-centimetre nodular lesion on the right upper pinna (Figure 1).
Clinical photograph showing appearance of the right upper pinna following wedge excision of the initial one-centimetre nodular lesion with 4-millimetre resection margins.
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Two weeks after initial presentation, a wedge excision of the lesion was performed under local anaesthesia with 4-millimetre resection margins (Figures 2 and 3).
Clinical photograph showing right pinna after wedge excision of the initial nodular lesion and primary wound closure.
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fig3
Two weeks after initial presentation, a wedge excision of the lesion was performed under local anaesthesia with 4-millimetre resection margins (Figures 2 and 3).
Photomicrograph of excised nodular lesion (H&E stain) showing a dermal spindle cell lesion exhibiting marked pleomorphism and brisk mitoses. Immunohistochemically, focal staining with CD68 was seen. Morphologically and immunohistochemically, the features are consistent with AFX. (a) x40 magnification. (b) x20 magnification.
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Histological analysis revealed a dermal spindle cell lesion exhibiting marked pleomorphism and brisk mitoses (Figure 4).
Clinical photograph showing the right pinna with a one-centimetre raised, ulcerative, crusted lesion at the upper margin of the previous incision site.
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At this time, a one-centimetre raised, ulcerative, crusted lesion was seen at the upper margin of the incision site (Figure 5).
Photomicrograph of punch biopsy from the second ulcerative lesion (H&E stain). This demonstrates full-thickness infiltration by a well-differentiated keratinising SCC. (a) x20 magnification. (b) x2.5 magnification.
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The histological analysis showed full-thickness infiltration by a well-differentiated keratinising squamous cell carcinoma (Figure 6).
Clinical photographs showing wide excision (with 5-millimetre resection margins) of the right pinna ulcerative, crusted lesion and full-thickness skin grafting (FTSG). The underlying cartilage has also been excised, and a local full-thickness skin graft was raised from the right level II region to cover the skin defect. Primary closure of the donor site is also illustrated in the lower image.
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fig7
The underlying cartilage was also excised, and a local full-thickness skin graft was raised from the right neck level II region to cover the skin defect (Figure 7).
Photomicrograph of excised ulcerative, crusted lesion (H&E stain). This demonstrates moderately differentiated SCC. (a) x10 magnification. (b) x2.5 magnification.
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There was no perineural or lymphovascular invasion, and the lesion was 4.5 millimetres thick (Figures 8 and 9(a)-9(c)).
(a) Photomicrograph of wide locally excised ulcerative, crusted lesion (H&E stain) at x2 magnification. Nests of squamous cell carcinoma are seen infiltrating the dermal tissue without involvement of the underlying cartilage (cartilage is seen in the right-hand field). (b) x4 magnification of the same area; this demonstrates infiltrating nests of keratinising squamous cell carcinoma associated with a host inflammatory response. (c) p63 immunohistochemistry confirms the squamous phenotype of the tumour (nuclear positivity).
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fig9
There was no perineural or lymphovascular invasion, and the lesion was 4.5 millimetres thick (Figures 8 and 9(a)-9(c)).
Clinical photographs showing the right pinna appearance at the most recent 4-month follow-up. The wound has healed well with successful grafting. The patient is comfortably able to wear his hearing aids and spectacles.
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fig10
To date, no local or regional recurrence has been noted at his most recent 4-month follow-up, and the wound has healed well with successful grafting (Figure 10).