PMC4325690_01
Clinical image of a non-pigmented skin lesion on the left mid cheek of a 67-year-old man. [Copyright:  2014 Inskip, Magee.)
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It was non-pigmented and was composed of a clearly demarcated flat white plaque (Figure 1).
Dermatoscopy showing a dense white structureless area with fine linear branched blood vessels centrally. Note the white clods of variable diameter superiorly. (Copyright:  2014 Inskip, Magee.)
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A notable feature was the white clods of variable diameter superiorly (Figure 2).
Low power view demonstrates a poorly circumscribed, deeply invasive, infiltrative neoplasm, with superficial cyst formation and calcification, and a more morphoeiform desmoplastic deep component (Copyright:  2014 Inskip, Magee.)
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Hence, in conjunction with the positive CEA, the findings favoured a microcystic adnexal carcinoma (Figures 3 to 11).
Intermediate power image shows superficial follicular differentiation with cysts and calcification, and more infiltrative deep component. (Copyright:  2014 Inskip, Magee.)
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Hence, in conjunction with the positive CEA, the findings favoured a microcystic adnexal carcinoma (Figures 3 to 11).
Intermediate power of superficial follicular keratin-filled cysts. (Copyright:  2014 Inskip, Magee.)
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Hence, in conjunction with the positive CEA, the findings favoured a microcystic adnexal carcinoma (Figures 3 to 11).
Intermediate power of superficial follicular keratin-filled cysts. (Copyright:  2014 Inskip, Magee.)
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Hence, in conjunction with the positive CEA, the findings favoured a microcystic adnexal carcinoma (Figures 3 to 11).
High power of basaloid infiltrative aggregates in deeper portion of tumor. (Copyright:  2014 Inskip, Magee.)
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Hence, in conjunction with the positive CEA, the findings favoured a microcystic adnexal carcinoma (Figures 3 to 11).
Focus of perineural invasion in deeper portion of tumor. (Copyright:  2014 Inskip, Magee.)
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Hence, in conjunction with the positive CEA, the findings favoured a microcystic adnexal carcinoma (Figures 3 to 11).
Ber-Ep4 stain is strongly positive. This finding is not specific as Ber-Ep4 is positive in basal cell carcinoma. One study showed Ber-Ep4 positivity in 38% of microcystic adnexal carcinomas, 57% of desmoplastic trichoepitheliomas, 100% of basal cell carcinomas, and 38% of squamous carcinomas. (Copyright:  2014 Inskip, Magee.)
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Hence, in conjunction with the positive CEA, the findings favoured a microcystic adnexal carcinoma (Figures 3 to 11).
Cytokeratin 15 stain is also strongly positive. CK15 is a marker of the stem cells in the hair follicle bulge area. This finding favours microcystic adnexal carcinoma. Hoang et al found 92% of MAC and 100 % of desmoplastic trichoepitheliomata expressed CK15 whilst morphoeic BCC and squamous cell carcinomata were all negative. Thus this is a helpful marker to distinguish MAC from morphoeic BCC with adnexal differentiation. (Copyright:  2014 Inskip, Magee.)
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Hence, in conjunction with the positive CEA, the findings favoured a microcystic adnexal carcinoma (Figures 3 to 11).
CEA stain marks some of the ductular lumina within the aggregates. This is a marker of eccrine and apocrine ducts, which would favor microcystic adnexal carcinoma. (Copyright:  2014 Inskip, Magee.)
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Hence, in conjunction with the positive CEA, the findings favoured a microcystic adnexal carcinoma (Figures 3 to 11).