Presenter: Tony Nakhla, D.O.
Dermatology Program: Western University/Pacific Hospital of Long Beach
Program Director: David C. Horowitz, D.O.
Submitted on: Sep 17, 2008
CHIEF COMPLAINT: “I have a skin cancer behind my ear”
Signs and symptoms: A 55 year old white male who presented to our clinic with a 2 week history of a painful sore on the right post auricular region.
Previous Treatment: None
Other information: The patient has a past medical history of multiple non-melanoma skin cancers including five squamous cell carcinoma and six basal cell carcinomas, three of which required Mohs. He reports no other significant past medical history and is on no medications. He smokes approximately one pack per day. The patient has no medical insurance and was concerned with procedural costs. He was willing to pay for a complete excision but did not want to pay for a biopsy, since due to his history, he was convinced it was another skin cancer which needed to be removed
Cachectic 55 year old white male with poor hygiene. Large (approx 4.3x 3.5 cm), tender, ulcerated, erythematous plaque with impetiginized crusts and purulent drainage was present around and within the right retro-auricular sulcus.
Microscopic examination revealed a dome shaped, granulomatous infiltrate of foreign body giant cells, lymphocytes, and macrophages.
Numerous encapsulated, round to ovoid spores were present within macrophages and giant cells as well as in free spaces.
A PAS stain was performed which highlighted the spores.
A mucicarmine stain was positive confirming the diagnosis of cutaneous cryptococcosis
1. Squamous Cell Carcinoma
2. Basal Cell Carcinoma