Oncology Case Challenge: A Construction Worker Who Drinks Daily Has an Eyelid Lesion

Nail Alouch, MD; Doina Ivan, MD; Phyu P. Aung, MD, PhD; Victor G. Prieto, MD, PhD


November 02, 2022

Physical Examination and Workup

Upon physical examination, the lesion is erythematous and measures 6 mm in diameter, with a central scar from the prior biopsy site (performed at an outside facility). The physical examination, including ophthalmic examination, is otherwise unremarkable.

Laboratory studies, including complete blood cell count, glucose level, metabolic panel, electrolyte levels, lactate dehydrogenase level, and coagulation studies, are within normal ranges. Imaging studies are negative for metastatic disease and other significant findings.

A skin shave and subsequent resection are performed at an outside institution and reveal a predominantly intraepidermal proliferation of basophilic atypical cells (Figure 1). The cells are single or arranged in nests and are noted at all levels of the epidermis, with prominent pagetoid upward migration (Figure 2). The cells are round to oval, with scant cytoplasm, and the nuclei are hyperchromatic, with nuclear molding and inconspicuous nucleoli (Figure 3). No invasion of the atypical cells into the dermis is noted.

Figure 1.

Figure 2.

Figure 3.

Immunohistochemical studies reveal that the atypical cells are diffusely positive for cytokeratin 20 (Figure 4), high-molecular-weight cytokeratin, synaptophysin (Figure 5), and BerEp4. The atypical cells are negative for CK5/6 (Figure 6), S100 protein, melan-A, carcinoembryonic antigen, and CD45.

Figure 4.

Figure 5.

Figure 6..


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