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Excerpt
A 53-year-old woman presented with a 2-month history of a nodular growth on the left jaw line that resembled a mosquito bite. She recalled a focal area of crust; there was no associated pruritus or tenderness. Her history was significant for previous GCTs removed from the neck, breast, and groin. The lesion was brought to the attention of a local dermatologist, and a shave biopsy was performed. The pathology showed a crateriform proliferation of atypical keratinocytes suspicious for a keratoacanthoma (KA) versus an SCC.
The patient presented to our office for further management. The outside pathology slides were reviewed at our institution. The features were judged to be insufficient for carcinoma, but they suggested the “probable top of a keratoacanthoma.” On physical examination, there was a 4- by 3-mm ill-defined pink indurated biopsy site on the left lower chin (Figure 1). We proceeded with Mohs micrographic surgery for definitive treatment. Two Mohs stages were performed, and the surgical defect was repaired using a complex linear closure.
During intraoperative frozen section analysis of stage one of Mohs surgery, a dense infiltrate consisting of foamy granulomatous cells was noted, suspicious for a GCT (Figure 2). Given these unusual findings, after negative surgical margins were achieved, the stage one remnants were submitted for formalin-fixed paraffin sections for pathologic evaluation and confirmation. Review of the paraffin sections revealed GCT, Schwannian-type, positive for S100 protein and CD68 (Figure 3).
