Malignant Transformation of Facial Nevus Sebaceous – Unrelated with Size

A 34-year-old male presented with swelling for 6 months and came for cosmetic reasons.He initially noted a skin-coloured swelling from childhood which increased in size over the past 6 months.Examination revealed a solitary 4-mm skin-coloured non-tender papule in the left nasolabial fold with telangiectasias surrounding the lesion, over the nose, chin and bilateral malar prominence [Figure 1].Dermoscopy showed yellowish globules with central brown globules and surrounding branched and reticular vessels [Figure 2].An excisional biopsy was done with the differentials of sebaceous hyperplasia and appendageal tumours such as sebaceoma, trichoepithelioma, trichofolliculoma.H&E stain of skin biopsy showed epidermis and dermis with the marked proliferation of sebaceous glands, with many of the sebaceous ducts being superficially located and not associated with hair follicles.Furthermore, a small area of basaloid cell islands with surrounding retraction artefacts was noted in the form of clear spaces in the superficial dermis.These basaloid tumour cell islands showed mild-to-moderate membranous positivity for BerEP4.Epithelial membrane antigen (EMA) immune stain was negative in basaloid tumour cell islands but highlighted sebaceous glands.Melan-A immunostain was negative in basaloid tumour cell islands https://ijpgderma.org