PMC3663386_01
Clinical (A), macro (B) and dermatoscopic (C) images of a rapidly growing, non-pigmented, raised lesion on the foot of a 94-year-old female.
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A 94-year-old lady presented with a rapidly growing, non-pigmented nodular lesion on the lateral side of the right foot (Figure 2).
Biopsy procedure of the lesion shown in Figure 2 using the double-bladed scalpel (images taken by Marcia Muraca, RN). Note that a second standard scalpel (with single blade) was used to transect each end and to undermine the base of the biopsy specimen.
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Biopsy was performed under sterile conditions in the General Practice Operating Room (Figure 3).
Processing for dermatopathologic assessment involved mounting the entire biopsy specimen, without sectioning, so that the 'full face' of the lesion was presented to the dermatotome.
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In accordance with the instruction "block whole:longitudinal section" the biopsy specimen was not sectioned prior to mounting in paraffin but was laid on its side intact so that the full face of the lesion from the stratum corneum (in this case surface keratin) to the deepest part of the dermis and through the full width of the lesion was presented to the dermatome (Figure 4).
Low power overview (A) and high power view of boxed area in A (B), of the lesion shown in Figure 2. Figure 2A illustrates the typical architecture of KA, while B shows the typical cytology of a KA with nests containing large pale central cells.
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Dermatopathologic assessment by author DW revealed a squamoproliferative lesion with a characteristic crateriform appearance with buttressing of both side margins (Figure 5A). The central cells of each squamous nest showed the characteristic pale pink cytoplasm characteristic of KA (Figure 5B).