Case 001: 76-Year-Old White Male with Plaque on the Left Cheek

Contributed by Andre Thompson, M.D. and Jian-Ping Cai M.D. under the supervision of Andrzej Slominski, M.D., Ph.D.

Clinical History

A 76-year-old white male with slow-growing, indurated, flesh-colored, and slightly depressed plaque on the left cheek.

Histopathology

(Click a photo to view a larger image.)

Image (1) Sun-damaged skin (solar elastosis on the left side) with atrophic epidermis, fibrosis in the papillary and superficial reticular dermis, micronodular inflammatory infiltrate, and diffuse proliferation of spindle cells in deep reticular dermis.
Image (1) Sun-damaged skin (solar elastosis on the left side) with atrophic epidermis, fibrosis in the papillary and superficial reticular dermis, micronodular inflammatory infiltrate, and diffuse proliferation of spindle cells in deep reticular dermis.


Image (2) Admixed with inflammatory infiltrate and bundles of collagen are small fascicles of atypical spindle cells.
Image (2) Admixed with inflammatory infiltrate and bundles of collagen are small fascicles of atypical spindle cells.


Image (3) Some of the proliferating cells have epithelioid appearance with occasional prominent nucleoli.
Image (3) Some of the proliferating cells have epithelioid appearance with occasional prominent nucleoli.


Image (4) High power view showing proliferation of atypical epithelioid cells with mitosis.
Image (4) High power view showing proliferation of atypical epithelioid cells with mitosis.


Diagnosis

  • Desmoplastic melanoma

Comment: Immunohistochemical staining showed that neoplastic cells were positive for S-100 and negative for Keratin.