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Langerhans Cell Histiocytosis Mimicking Malignant Melanoma: A Diagnostic Pitfall

Billings, Tomomi L MD*; Barr, Ronald MD; Dyson, Senait MD*†

The American Journal of Dermatopathology: October 2008 - Volume 30 - Issue 5 - p 497-499
doi: 10.1097/DAD.0b013e3181812b88
Brief Report

Langerhans cell histiocytosis (LCH), especially with an involvement limited to the skin, is a rare entity in adults. In formulating a differential diagnosis of a solitary skin lesion, LCH is rarely considered. Morphologically, cells seen in LCH can mimic those seen in a melanocytic tumor; moreover, they both show S-100 protein reactivity with immunoperoxidase staining. A 63-year-old male presented to a dermatology clinic with a solitary hyperpigmented macule on his right calf. A biopsy specimen showed epithelioid cells within the dermis, singly and in small groups, surrounded and infiltrated by collections of histiocytes and lymphocytes. These cells were diffusely positive for S-100 and negative for Melan-A. A diagnosis of malignant melanoma, spitzoid variant, was rendered, and the patient was sent to our melanoma center for surgical treatment. On histologic examination, some of the lesional cells had reniform, vesicular nuclei with central grooves. Additional immunoperoxidase staining showed strong, diffuse positivity for CD1a, supporting the diagnosis of LCH. LCH is morphologically similar to and can be misdiagnosed as malignant melanoma. It is important to be aware of this pitfall and utilize immunohistochemical and ultrastructural analysis to achieve correct diagnosis.

From the Departments of Pathology* and Dermatology†, University of California-Irvine, Orange, CA; and Laguna Pathology Medical Group‡, Laguna Beach, CA.

Reprints: Tomomi L. Billings, MD, University of California-Irvine, Department of Pathology and Laboratory Medicine, 101 The City Drive South, Orange, CA 92868-4805 (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.