Pigmented Squamous Cell Carcinoma of the Nose - A Case Report from South-East Asia

Abstract

The pigmented subtype of squamous cell carcinoma (pSCC) is characterized by an extremely low incidence rate, ranging from 0.01 to 7%.[1] Very few cases have been reported in sun-exposed skin, as most of the reported pSCC instances have originated in the oral and ocular mucosa. This disease variant typically presents as a pigmented, dome-like papulo-nodular lesion. Differentiating it from a melanoma is crucial, given the markedly poorer prognosis of the latter. This report discusses the case of an 84-year-old Pakistani male diagnosed with pigmented squamous cell carcinoma on the nose. The pigmented nodular lesion on the bridge of his nose rapidly increased in size over the preceding three months. A punch biopsy was conducted by his dermatologist, considering basal cell cancer and melanoma as the primary differential diagnoses. Microscopic examination revealed characteristic morphological features of squamous cell carcinoma, including keratin pearls. Notably, melanin pigment was observed within the cytoplasm of these malignant cells. An immunohistochemical panel confirmed the diagnosis of the pigmented subtype of squamous cell carcinoma. Following standard procedure, the entire lesion was surgically excised. The prognosis for this subtype is similar to that of the typical form of squamous cell carcinoma. Early detection and treatment are paramount for optimal outcomes in all cancer cases. This is the first documented case of pigmented squamous cell carcinoma of the skin in a patient from Pakistan.