05/10/2016 1:30 PM Suffix - Tissue Types HI026782B/16

1 - Skin Biopsy 2 - Skin Biopsy

Report sequence 1 Authorised 04/11/2016 16:21

By Dr T Bracey CELLPATH (Tim's laptop)

NATURE OF SPECIMEN:

1. Excision lesion left wrist.

2. Excision lesion mid back.

CLINICAL DETAILS:

1. ?SCC

2. ?BCC

GROSS DESCRIPTION:

1. An ellipse of skin measuring 34 x 20 x 6 mm, bearing an ill-defined, crested, brown lesion which measures 7 x 6 x 2 mm.

S2 1B SK KW

2. An ellipse of skin measuring 27 x 16 x 7 mm, bearing an ill-defined, crusted debris pigmented lesion which measures 7 x 7 x 2 mm.

S2 1B SK KW

HISTOLOGY:

1. Excision of sun damaged skin showing an ulcerated carcinoma arising from the epidermis measuring 7 mm diameter and 3 mm in maximum thickness. The lesion has a biphasic appearance, partly resembling basal cell carcinoma with prominent follicular differentiation and horn cysts. The other part of the lesion has a more squamoid appearance with a greater degree of nuclear pleomorphism, prominent nucleoli and extremely prominent brown cytoplasmic pigment. Immunohistochemistry shows diffuse positivity for BerEP4 and patchy positivity for EMA and CK 5. S-100 is negative, and MelanA shows very prominent benign melanocytic colonisation, with dendritic processes surrounding the tumour cells.

Melanocytes colonisation is well described in skin tumours showing pilar/pilomatrix differentiation. Pilar/pilomatrix carcinoma is rare and while it is reported to have a higher rate of local recurrence, metastases are infrequent. This lesion has a cohesive growth pattern at the base, being at least 4 mm from the deep margin and 4.5 mm from the nearest peripheral margin. There is no vascular or nerve invasion.

Conclusion

1. Excision left wrist - carcinoma with hair follicle differentiation and melanocytic colonisation (see text)