Mohs Micrographic Surgery for the Treatment of Cutaneous Lymphadenoma

November 2011 | Volume 10 | Issue 11 | Case Report | 1324 | Copyright © 2011

Matteo C. LoPiccolo MD,a Marsha L. Chaffins MD,a David J. Kouba MD PhDa,b

aDepartment of Dermatology, Henry Ford Health System, Detroit, MI bToledo Clinic Dermasurgery and Laser Center, Toledo, OH

Abstract

Cutaneous lymphadenoma (CL) is a benign neoplasm commonly presenting on the head and neck of young and middle-aged adults. Complete surgical excision of CL is the treatment of choice and appears to be curative. As compared to local excision without margin control, Mohs micrographic surgery (MMS) may allow for more definitive tumor extirpation for large cases of CL and allow for greater tissue preservation at functionally and aesthetically sensitive sites. We present a case of cutaneous lymphadenoma presenting on the right cheek of a middle-aged male who was successfully treated with MMS.

J Drugs Dermatol. 2011;10(11):1324-1326.

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INTRODUCTION

Cutaneous lymphadenoma (CL) is a benign neoplasm commonly presenting on the head and neck of young and middle-aged adults as a small, solitary nodule.1-3 The histogenesis of these tumors is uncertain, and the incidence of CL appears to be equal in men and women.4 Complete surgical excision of CL has been the treatment of choice and appears to be curative. CL is easily identified on frozen sections without the need for special stains, making it amenable to treatment with Mohs micrographic surgery (MMS). As these tumors tend to present in functionally or cosmetically sensitive areas, MMS can be used as a tissue sparing procedure with strict margin control to improve the outcome of CL excision. We present a case of cutaneous lymphadenoma presenting on the right cheek of a middle-aged male that was successfully treated with MMS.

CASE REPORT

A 58-year-old Caucasian man presented to our clinic with a 30- year history of a slowly growing, asymptomatic plaque on the cheek. He was otherwise healthy and had no personal or family history of melanoma or non-melanoma skin cancer. Physical exam showed an erythematous, pearly, dome-shaped plaque with a slightly infiltrated base measuring 2 cm in diameter on the right mid cheek. A saucerization biopsy was performed to establish the diagnosis.

Histopathology with hematoxylin and eosin (H&E) staining showed a non-encapsulated dermal tumor comprised of multiple lobules of basophilic epithelial cells, which displayed peripheral palisading. Multiple lymphocytes were noted within tumor islands, and the tumor was invested with a fibrovascular stroma. No tumor-stromal retraction was observed (Figure 1). Leukocyte common antigen (LCA) staining decorated lymphocytes within the tumor islands (Figure 2). The histology was consistent with the diagnosis of cutaneous lymphadenoma. Complete removal was recommended.

Because of the large size of the tumor and location on the cosmetically sensitive mid cheek, the patient was referred for definitive treatment by MMS. The tumor cells were readily observed on the first Mohs section with H&E staining (Figure 3). A tumor free margin was achieved after three stages and six tissue sections. The final defect size was 3.2 cm and the wound was repaired. The patient tolerated the procedure, and there were no intraoperative or postoperative complications. After seven months, no recurrence has been observed.

DISCUSSION

Cutaneous lymphadenoma was first introduced by Santa Cruz in 1987 as an adnexal neoplasm with basaloid features and

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