Granulation Tissue-Like Spindle Cell Squamous Cell Carcinoma of the Skin Arising in a Burn Scar.
Tu Thanh Nguyen, Shinya Otsuki, Hiroaki Ito et al.
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Case in brief
A 66-year-old woman presented with a clinically ulcerated 3.5 × 2.7 cm mass arising in an upper-arm burn scar. Punch biopsy showed a deceptively bland but atypical spindle-cell proliferation with focal slit-like pseudovascular spaces, resembling granulation tissue. Immunohistochemistry supported cutaneous spindle cell squamous cell carcinoma (SCSCC), with diffuse CK5 and p40 positivity and p53 overexpression. The surgical specimen showed conventional SCC alongside spindle-cell areas, including granulation tissue-like regions, myxoid change, and overt cytologic atypia.
What made this case unusual
The SCSCC included bland, granulation tissue-like spindle-cell areas with slit-like pseudovascular spaces, an appearance that can mimic a benign reactive process, particularly in a limited biopsy.
Diagnostic / clinical pearl
A granulation tissue-like spindle-cell proliferation in a clinically ulcerated mass arising in a chronic scar may represent SCSCC; correlate the biopsy with the clinical setting and use immunohistochemistry when indicated.