Diagnostic Challenges of Hypertrophic Lupus Erythematosus

Abstract

Hypertrophic lupus erythematosus (HLE) often occurs in the absence of systemic symptoms and can be misdiagnosed as squamous cell carcinoma (SCC) as both appear clinically as erythematous scaling plaques in sun exposed areas and histologically show significant epithelial hyperplasia. No single criterion confidently differentiates HLE from SCC histologically, postulating the need for CD123 immunostaining in evaluating locally recurring, supposed SCCs. We present a woman who presented for evaluation of multiple supposed left lower leg well-differentiated SCCs (wdSCC), that did not resolve following Mohs Micrographic Surgery and other techniques aimed at cancer removal. The lesions improved following intralesional Kenalog injection and showed positive CD123 immonostains, which both led to the diagnosis of HLE.