主诉 病史

Here we share a case report of squamous cell carcinoma with dermatoscopy and histology images. An 80 year-old man with Fitzpatrick type 2 skin, presented for a routine skin check. A new raised pigmented skin lesion 6 mm in diameter was discovered on his right cheek (Figure 1).

查体 辅查

A photograph was taken (Figure 2) with a nonpolarizing Dermlite Fluid dermatoscope coupled to a Canon 50D single lens reflex camera. The lesion was excised in toto. 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).

诊断 处理

Diagnosis: Cutaneous pigmented invasive squamous cell carcinoma. Treatment: The lesion was excised in toto.

随访 讨论

In the case we present here malignancy was predicted on the basis of the “chaos and clues” algorithm: there was “chaos” (asymmetry) and the clues of “eccentric structureless zone (blue)” and “polymorphic vessels.” Of the three pigmented malignancies (pigmented melanoma, pigmented BCC, and pigmented SCC), pigmented SCC should be considered because of the presence of surface scale (seen macroscopically) and white circles (seen dermatoscopically). The blue color was not consistent with pigmented SCC in-situ; the color blue indicated the presence of melanin in the deep dermis. Therefore, invasive pigmented SCC was considered, and this was confirmed histopathologically.