case_images: PMC10715753_01
case_images: a Clinical presentation at the first visit. A polypoid erythematosus nodule measuring 25 x 20 mm with scales, crusts, and ulcers on her left cheek. b, c Histological examination of a biopsy specimen from the nodule showed a proliferation of atypical spindle cells and infiltrating lymphocytes on the dermis [hematoxylin-and-eosin staining; original magnification, x100 (b) and x200 (c)].
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case_images: PMC10715753_01_cro-2023-0016-0001-535194_F01.jpg
case_images: F1
case_images: Physical examination showed a polypoid erythematosus nodule measuring 25 x 20 mm with crusts on her left cheek (Fig. 1a). Histological examination of a biopsy specimen from the nodule showed a proliferation of atypical spindle cells and infiltrating lymphocytes on the dermis (Fig. 1b, c).
case_images: a Clinical presentation after the decapitation of a nodule. An ulcer measuring 12 x 8 mm developed on the base of the polypoid nodule. b Histological examination of the decapitated nodule showed proliferating atypical spindle cells covered by the epidermis and necrotic cells around the peduncle of this nodule (hematoxylin-and-eosin staining; original magnification, x40). c Immunohistochemical staining showed that proliferating cells were positive for tyrosinase (original magnification, x100). d Histological examination of the resected specimen of the ulcerative lesion showed no atypical cells with infiltration of lymphocytes around the ulcer (hematoxylin-and-eosin staining; original magnification, x40). e Immunohistochemical staining showed that infiltrating lymphocytes around the ulcer were positive for CD8 (original magnification, x40).
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case_images: PMC10715753_01_cro-2023-0016-0001-535194_F02.jpg
case_images: F2
case_images: However, 3 weeks after the biopsy, the nodule decapitated spontaneously without bleeding, and an ulcer developed on the base of the polypoid nodule (Fig. 2a). Histological and immunohistochemical examination of the decapitated nodule showed SOX10, melan-A, and tyrosinase-positive proliferating atypical spindle cells covered by the epidermis and necrotic cells around the peduncle of this nodule (Fig. 2b, c). The immunohistochemical examination revealed that these lymphocytes were dominantly positive for CD3 and CD8, and partially positive for CD4, around the ulcer (Fig. 2d, e).
case_images: A timeline summarizing the main events of this case.
case_images: cro-2023-0016-0001-535194_F03.jpg
case_images: PMC10715753_01_cro-2023-0016-0001-535194_F03.jpg
case_images: F3
case_images: After that, no recurrence or metastasis has been observed for 4 years without any therapies (Fig. 3).