An Asymptomatic Verrucous Plaque on the Right Temple of an Adolescent Girl

Abstract

An adolescent girl presented with an asymptomatic slightly reddish verrucous plaque on the right temple. The skin lesion was nail sized when first noticed 1½ years earlier, then gradually developed over the 8 months prior to presentation. The patient denied any associated fevers, weight loss, or night sweats. Physical examination revealed a slightly reddish verrucous mass with translucent papules and plaques on the right temple, about 5 cm in diameter, with surface hemorrhagic crust in the side adjacent to right eyebrow arch (Figure , A). The lesion was nontender with no purulent discharge and no severe necrotic changes. There was no hepatosplenomegaly or superficial lymphadenopathy. Laboratory tests, including blood cell counts, urinalysis, and kidney and hepatic panels, revealed no abnormalities. A skin biopsy was performed and submitted for histopathologic analysis (Figure , B-D). Diagnosis D. Primary cutaneous embryonal rhabdomyosarcomaClinical image A Original magnification ×40 B Original magnification ×400 C Immunohistochemical staining D Figure.A, A slightly reddish verrucous mass with translucent papules and plaques on the right temple. B, The histological examination showed papillomatous epidermal hyperplasia, edema of dermal papillae, and neoplastic infiltration consisting of small round blue cells with alternating areas of dense and loose cellularity (hematoxylin-eosin). C, Small, round blue cells were observed in the dermis with round, fusiform, or oval hyperchromatic nuclei, conspicuous nucleoli, and scant cytoplasm (hematoxylin-eosin). D, Tumor cells were positive for MyoD1 (original magnification ×400).