Medical Images
Nonhealing Ulcer at a Surgical Site
A man in his 80s was evaluated for a 4.5 cm necrotic ulcer with a violaceous border at a previous surgical site (Figure 1). The nonhealing ulcer despite treatment was concerning for squamous cell carcinoma (Marjolin ulcer). Punch biopsy from the ulcer border revealed epidermal hyperplasia with intraepidermal acantholysis, dermal hemorrhage, and lymphoplasmacytic inflammation (Figure 2). Tissue cultures, Grocott methenamine silver, Gram, and acid-fast bacillus stains and immunohistochemistry for herpes simplex virus were unremarkable.A Rare Case of Pembrolizumab-Associated Granulomatous Panniculitis
A 59-year-old woman developed a cutaneous reaction after prolonged immunotherapy for treatment of metastatic high-grade serous and endometrioid endometrial cancer. Following her 17th cycle of pembrolizumab therapy, the patient developed 1-cm, tender, erythematous nodules on the right calf and ankle of 2 weeks' duration (Figure 1). The differential diagnosis included erythema nodosum, infection, vasculitis, and autoimmune or metastatic disease. Histopathological examination revealed a predominantly lobular panniculitis (Figure 2A) with acute and chronic focally granulomatous inflammation (Figure 2B and C), without evidence of vasculitis.
