Asymptomatic Cutaneous Plaques on the Scalp and Face in an Older Adult Woman

A 79-year-old female patient presented with a 2-year history of asymptomatic erythematous-infiltrated patches and plaques on the right side of her scalp and face. The lesions gradually enlarged and coalesced into large plaques and nodules. Mild erosions occurred occasionally on the surface of the lesions. She denied having fever, fatigue, chills, night sweats, or weight loss.

Physical examination demonstrated ill-defined, indurated erythematous-violaceous patches, nodules, and plaques involving the surface of her head and face with sporadic erosion and brownish crusts (Figure, A). The findings of systemic reviews were unremarkable, and there was no lymphadenopathy. The complete blood cell count revealed normal white blood cell count. The biopsy from an erythematous nodule displayed sheets of medium to large mononuclear cells infiltrated in the dermis, some of which filled and expanded apparent dermal blood vessels and had large, irregular, pleomorphic nuclei (Figure, B). In addition, some neoplastic cells formed a balloon appearance. No epidermotrophism was found. The initial immunohistochemical stain revealed the tumor cells were positive for CD3 and negative for CD20, AE1/AE3, CK20, chromogranin A, and melan-A. The Ki-67 labeling index was 70%.