Presentation
Slowly progressive fungating facial skin lesion, right-sided vision loss and ear pain.
Patient Data
There is an enhancing right scalp soft tissue mass that extends from the superior temporalis muscle superiorly, the mandibular angle inferiorly, the right nasal fold anteriorly, and to the preauricular region posteriorly. The mass reaches the lateral margin of the right orbital ridge without orbital involvement or evidence of intraconal invasion. Non-enhancing hypoattenuating thickening of the inferior orbital soft tissue is favored to represent edema. Gas locules within the mass within the preauricular region are in keeping with necrosis. There is loss of the fat plane with the superior aspect of the right temporalis muscle in keeping with invasion. No bony involvement. No lymphadenopathy.
Case Discussion
The patient proceeded to have a punch biopsy.
Histology:
MACROSCOPIC DESCRIPTION: "Skin - right zygomatic region": A 3 mm punch 2 mm in length. There is also a piece of cream tissue measuring 3 x 3 x 1 mm.
MICROSCOPIC DESCRIPTION: The skin punch biopsy shows a well differentiated squamous cell carcinoma. The tumor infiltrates to a depth of at least 2.3 mm, where it is transected at the deep edge of the biopsy. No lymphovascular or perineural invasion is seen.
DIAGNOSIS: Well differentiated squamous cell carcinoma; depth of invasion at least 2.3 mm.
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