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Case Reports

Abstract

A 74-year-old female with a history of psoriasis presented with a 2-cm verrucous pink plaque on the right cheek, suspicious for verrucous carcinoma, a rare variant of squamous cell carcinoma. A tangential biopsy was obtained, revealing regular psoriasiform epidermal hyperplasia with acanthosis, hyperkeratosis, spongiform neutrophilic deposition, and Munro microabscesses. Papillomatosis with buttressing of the peripheral rete ridges toward the center of the lesion was also demonstrated. At high power, epidermal neutrophils were visualized surmounting the tips of the suprapapillary plates with accompanying serum. The underlying dermis showed mild superficial perivascular inflammation and marked interstitial inflammation, both composed predominantly of neutrophils. Based on these findings, the differential diagnosis included verrucous psoriasis versus verrucous carcinoma; however, the neutrophil deposition and buttressing of rete ridges favored a diagnosis of verrucous psoriasis. A rare variant of psoriasis, verrucous psoriasis can mimic verrucous carcinoma both on clinical examination and histopathology. We conducted a review of literature revealing that 12.5% of reported verrucous psoriasis cases were initially diagnosed as verrucous carcinoma after histopathologic review. Awareness of this benign entity when evaluating possible malignant lesions in patients with psoriasis allows the dermatologist and dermatopathologist to avoid overdiagnosis.