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Invasive Squamous Cell Carcinoma With Clear Cell Change of the Eyelid Arising in a Seborrheic Keratosis

Anna M. Stagner, MD1,2; Frederick A. Jakobiec, MD, DSc1,2; Mami A. Iwamoto, MD3
[+] Author Affiliations
1David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston
2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
3Ophthalmic Consultants of Boston, Boston, Massachusetts
JAMA Ophthalmol. 2015;133(12):1476-1477. doi:10.1001/jamaophthalmol.2015.3439.
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This case report describes an invasive squamous cell carcinoma arising in the eyelid skin in a seborrheic keratosis.

Seborrheic keratoses (SKs) are common, often numerous lesions of older patients, having a characteristic greasy, stuck-on appearance.1 They are often thought of as universally benign. Development of a malignant tumor within an SK is indeed a rare event.2 To our knowledge, this is the first report of an invasive squamous cell carcinoma (SCC) arising in an SK in the eyelid skin, a reminder that typical-appearing SKs can harbor a malignant neoplasm.

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Clinicopathologic Features of an Invasive Squamous Cell Carcinoma Arising in a Seborrheic Keratosis

A, Ulcerated seborrheic keratosis (SK; arrowhead). B, The SK transitions into tumor (arrowhead), and parakeratotic crust (asterisk) is present (hematoxylin-eosin, original magnification ×10). Inset, Magnified view of SK (hematoxylin-eosin, original magnification ×50). C, Tumor (arrowheads) involves hairs (hematoxylin-eosin, original magnification ×100). Inset, Along with hairs (arrowhead), prominent nucleoli are seen (hematoxylin-eosin, original magnification ×200). D, Low Ki-67 staining in SK (immunoperoxidase reaction, diaminobenzidine chromogen, hematoxylin counterstain, original magnification ×100). E, Prominent Ki-67 staining in malignant tumor cells (immunoperoxidase reaction, diaminobenzidine chromogen, hematoxylin counterstain, original magnification ×200). F, Positive periodic acid–Schiff staining of clear cells (arrowhead) (original magnification ×200). G, Negative periodic acid–Schiff staining after diastase pretreatment (arrowhead) (original magnification ×200).

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