The spectrum of clinical and histopathologic features associated with chronic graft-versus-host disease (GVHD) is broad, with recognized variants simulating scleroderma, lichen sclerosus, eosinophilic fasciitis, and de novo diffuse melanoderma. We report a case of a patient with multiple myeloma who presented approximately 1 year after his allogeneic hematopoietic stem cell transplantation with lesions of chronic lichenoid GVHD that harbored features of hypertrophic lupus erythematosus (LE) and that was initially mistaken for a superficial well-differentiated squamous cell carcinoma (SCC). However, in 4 years of follow-up, the patient failed to develop any evidence of cutaneous or systemic LE, actinic damage, or SCC, and the lesions cleared with topical and systemic treatments appropriate for chronic GVHD. For proper interpretation of the histologic findings of GVHD, it is important for the dermatopathologist to be aware of unusual manifestations. Knowledge of the occurrence of hypertrophic LE and familiarity with its histologic features is also important to avoid an erroneous diagnosis of SCC in immunosuppressed patients.
*New York University Ronald O. Perelman Department of Dermatology, New York, NY
†Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, NY
‡Adult Allogeneic Bone Marrow Transplantation Inpatient Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
§Department of Dermatopathology, Memorial Sloan-Kettering Cancer Center, New York, NY.
The authors have no conflicts of interest to disclose.
The patient has provided written consent for use of his images.
Reprints: Stephanie W. Hu, MD, 545 1st Avenue, Apt. 10B, New York, NY 10016 (e-mail: firstname.lastname@example.org).