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Off-Center Fold
February 2013

Numerous Facial Lesions in a 47-Year-Old Woman—Diagnosis

JAMA Dermatol. 2013;149(2):224. doi:10.1001/archderm.149.2.223-g

On histological examination of the Mohs sections, 3 additional benign-appearing tumors were identified in addition to the malignant BCCs. The first type of tumor was characterized by circumscribed lobules of basaloid cells without pleomorphism or mitoses and several hyaline deposits (Figure 2). Evaluation of the second tumor revealed cellular lobules with hyaline droplets surrounded by thickened basement membranelike material in a jigsaw puzzle–type pattern (Figure 3). Histologic findings of the third tumor showed small basaloid nests and cords with peripheral palisading, fibrotic stroma, and papillary mesenchymal bodies (Figure 2and Figure 3). For the first, second, and third tumors, the pathological features were consistent with spiradenoma, cylindroma, and trichoepitheliomas, respectively. We continue to monitor the patient closely in our clinic and have a low threshold to biopsy any changing lesions.