Abstract

Livedoid vasculopathy (LV) is a chronic disorder usually presenting as painful ulcers on the lower extremities in young to middle-aged women. We present a case of an 82-year-old female with a history of lupus erythematosus who presented with a persistent erythematous lesion on the forehead concerning for basal cell carcinoma. Microscopic examination showed vasculopathic changes including thickened blood vessel walls with hyalinization and fibrin thrombi within upper and mid-dermal vessels. Additionally, there was a superficial and deep perivascular lymphoid infiltrate with perieccrine accentuation and dermal mucin deposition consistent with a manifestation of lupus erythematosus. To our knowledge livedoid vasculopathy previously has neither been described on facial skin, nor as an erythematous lesion mimicking basal cell carcinoma. The unusual presentation of LV on the forehead challenges conventional understanding of the disease's localization and expands the clinical spectrum of LV. It is important for dermatopathologists to be aware of this unusual presentation, so that even in the absence of characteristic diagnostic features, lupus can be considered in the differential diagnosis. Similarly, clinicians should also keep LV in their differential for atypical facial lesions, particularly in individuals potentially predisposed to this process.