Abstract
We present an interesting case of a pigmented squamous cell carcinoma. A 75-year-old male presented with a recurrent squamous cell carcinoma (SCC) on the right cheek. Histopathological examination showed a CK5/6 positive acantholytic SCC infiltrating the reticular dermis, in which benign melanocytes were seen to be colonising the tumour. Pigment was seen in CD68 positive melanophages. The benign, colonising melanocytes showed strong diffuse positivity for HMB45 and MART1, and strong focal staining for SOX10. The tumour was diagnosed as a pigmented SCC. Pigmented SCCs are relatively rare tumours and are estimated to comprise between 0.01 to 7% of all squamous cell carcinomas, according to English literature.1 They frequently present clinically as a rapidly evolving crusted papule on sun-damaged skin.2 Histologically, they consist of a proliferation of atypical keratinocytes and bland dendritic melanocytes and melanophages.1 The differential diagnosis of pigmented SCCs is broad and includes benign entities such as melanoacanthoma, malignancies such as melanoma with overlying pseudoepitheliomatous hyperplasia, and biphasic tumours such as squamomelanocytic tumour. It is important to distinguish pigmented SCCs from these differential diagnoses, as this will have significant bearing on the patient’s prognosis.
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