Presentation
Fungating scalp lesion.
Patient Data
Large, lobulated soft tissue mass arising from the scalp vertex. It infiltrates the outer table, the diploic space and erodes the inner table. No periosteal reaction. No abnormal leptomeningeal enhancement. No intracranial extension. There is normal contrast filling of the major dural venous sinuses.
Case Discussion
The patient proceeded to have a shave biopsy of this lesion.
Histology:
MACROSCOPIC DESCRIPTION: A 15 x 12 x 3 mm shaved skin specimen. There is a partially ulcerated lesion 12 x 6 mm. Specimen is friable.
MICROSCOPIC DESCRIPTION: The sections show a malignant epithelioid neoplasm that extends to all of the peripheral and deep margins of the specimen. Immunoperoxidase studies were performed with the results as follows:
- Keratin AE1/3 - positive
- S100 - Negative
- SOX10 - Negative
- HMB45 - Negative
- pan-mel - Negative
- p40 - Positive
- p63 - Positive
The findings represent those of a poorly differentiated squamous cell carcinoma. The lesion extends to all of the peripheral and deep margins in this specimen.
DIAGNOSIS: Poorly differentiated squamous cell carcinoma, involving peripheral and deep margins.
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