Lymphoepithelioma like Skin Cancer: an Exceedingly Rare Primary Skin Cancer

We would like to share our case of lymphoepithelioma like carcinoma of the skin (LELCS) and further expand on this extremely rare primary skin cancer. In August 2013 a 79-year old man presented with a short history of an asymptomatic 9 mm pearlescent nodule on the left medial cheek. There was no history of trauma or an insect bite and clinically it resembled a basal cell carcinoma so no photographs were taken. A diagnostic superficial shave biopsy revealed a dermal nodule composed of islands of epithelial cells which show quite marked atypia and scattered mitoses (Figure 1a). Immunohistochemistry staining showed positive staining of the epithelial cells for cytokeratins and EMA and the overall appearances were suggestive of LELSC and so a wide local excision of 10 mm was arranged. Further histological examination revealed a completely excised tumour composed of aggregates of malignant undifferentiated cells surrounded by a dense reactive lymphoplasma cellular infiltrate (Figure 1b).