Skin Colored Papule on the Left Cheek

A 77-year-old man presented to the dermatology clinic for a routine skin cancer screening.

History. The patient had been followed by the dermatology clinic for the past 3 years after a history of non-melanoma skin cancers (NMSC). The patient reported a growing lesion over his left cheek in recent months. He denied any symptoms associated with this lesion. Upon examination, the patient had a 7 mm verrucous, flesh-colored papule on the left cheek. Further examination of the lesion with a dermoscopy revealed yellow, milia-like cysts and arborizing vessels (Figure 1A-B).

Figure 1. (A) A flesh-colored papule noted on the left cheek can be seen. (B) Dermoscopy evaluation with yellow granules and arborizing vessels is shown.

Diagnostic testing. A shave biopsy procedure was done for histologic examination, and a hematoxylin and eosin (H&E) stain was performed on the biopsied lesion (Figure 2A-B). The patient’s BerEP4 immunohistochemical stain was negative. PMS-2, MLH-1, MSH-2, and MSH-6 immunohistochemical stains showed retention of staining within nuclei.

Figure 2. (A) The patient’s H&E stain (four times the original magnification) is shown, demonstrating lobulated neoplasm with more than half the lesion composed of basaloid cells. (B) The patient’s H&E stain (20 times the original magnification) shows sebaceous ductal structure and few mitotic figures.

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