I'll first start by introducing myself. 39 year old male that spends a lot of time outdoors (mostly running) and admittedly, was never diligent about using sunscreen. I do usually cover up and always wear a hat, and see a dermatologist annually, as I had a suspicious mole removed from my shoulder a few years back that turned out to be nothing (fortunately!).
About 2.5 months ago, I noticed a small 2mm bump on my scalp behind my ear. I initially thought I nicked myself shaving my head and dismissed it. It's also in the area of my scalp where the band of my hat rubs constantly, and it accumulates a lot of sweat and friction while I'm running. After about a month, it became extremely tender, red and inflamed. It also started to crust over and wouldn't heal. I tend to heal very quickly, so that was alarming.
I made an appointment with my dermatologist, who upon visual inspection said it looked like an irritated mole. By this time, it was about 5mm x 4mm. She did a shave biopsy and the biopsy was inconclusive. The biopsy was immunonegative for P40, SOX10, CD31, however, it was immunopositive for CD10, cytokeratins and mild atypia (slightly spindled cells). The pathologist wrote that this lesion was either atypical fibroxanthoma or a ruptured cyst/hair follicle. The shave scar healed extremely well and she noted condition was improving.
A week later they called me back for a punch biopsy, which based on the Dr's write up, still seems to me as inconclusive, however, they have diagnosed me with Spindle Cell (dedifferentiated) Squamous Cell Carcinoma. His exact words, "Since you have documented coexpression of cytokeratin and CD10 in pleomorphic cells that infiltrate the epidermis, I agree that that differential diagnosis includes atypical fibroxanthoma on one hand and spindle cell carcinoma on the other. I favor the latter diagnosis, both on the basis of the cytologic qualities of the atypical cells and on the basis of the immunophenotype that has been defined. The CD10 immunopositivity and p40 immunonegativity that you have identified are both common immunophenotypic anomalies that occur in the context of dedifferentiation." I am currently scheduled for Moh's surgery in two weeks.
My question for the more educated types on this forum, do you think they are erring on the side of caution here? I'm going Monday for a consultation and I have many questions to ask. A friend of mine who is a PA has mentioned to me that AE1/AE3 expression, CD10 expression and mild atypia/spindle cells can also be associated with wound healing, especially if the wound was irritated and infected (which I suspect it was due to the accumulation of sweat from the hat).
I have no previous history of skin cancer, and my mom has had a few BCC's in her 60's.
I appreciate your thoughts.
Hi UltraRunner13 and welcome to the online community
I'm sorry to read that you've recently been diagnosed with a Squamous Cell Carcinoma (SCC) but it's good to hear that you don't have long to wait for Mohs surgery.
If by 'the more educated types' you mean people who have had some form of skin cancer, then I think you'll find most of us qualify and will be happy to share our experiences with you. However, if you mean people who understand all the medical terminology that you've quoted then I think we'll all fall in to the 'uneducated' category. However, I would think that if there's any chance it could be a SCC they would want to remove it to be on the safe side.
Sadly you do not have to have had a previous skin cancer to get a SCC and they are not hereditary, so your mum having BCCs wouldn't make any difference to your susceptibility.
Do come back and let us know how tomorrow's appointment goes.
"Never regret a day in your life, good days give you happiness, bad days give you experience"
