Case 1065 - An Elderly Male with a Long-standing Non-healing Ulcer

Pooja Srivastava, MD, Katherine Doeden, MD


A man in his 80's who was admitted to our hospital and was being treated for pneumonia, complained of a slow growing, non-healing lesion of unknown duration near his right shoulder. Patient's medical history was significant for atrial fibrillation, and COPD and surgical history was significant for a Basal cell carcinoma on nasal tip. Clinical examination revealed 2.0 cm ulcerated plaque with pink border on the right shoulder (Figure 1) and another pink plaque with crust on the left frontal scalp which measured 1.4 cm in maximum dimension. Considering the patient's past history and clinical presentation of the lesions; basal cell carcinoma was high on differential and both of these lesions were treated with excisional biopsy with electrodessication and curettage and the specimen was sent for histopathological examination.

On histopathological examination the lesion on the scalp showed features consistent with superficial and nodular types of basal cell carcinoma while the lesion on the right shoulder interestingly showed epidermal ulceration and proliferation of infiltrating glandular structures within the dermis (Figure 2). The glands were composed of markedly pleomorphic squamoid cells (Figure 3) and contained intraluminal secretions. There was significant atypia with presence of mitosis, tumor cell necrosis and foci of perineural invasion (Figures 4A, 4B). On immunohistochemistry the neoplastic cells were positive for p63 (Figure 5), and weak positive for GATA3. CEA showed intraluminal staining pattern (Figure 6). Mucicarmine stain was negative for presence of intracytoplasmic mucin.


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