This is a skin graft site on the thigh. A rash has arisen
within the graft site. That rash is itchy and has a violaceous colour. The
condition is lichen planus. The patient
had this graft taken to place on a lump on the leg that was excised. It had
previously been biopsied and reported as an
inflamed well differentiated squamous cell carcinoma. A new rash is also
now appearing in the centre of the grafted
excision site on the shin. Is this a recurrence of the excised SCC? No
it also is lichen planus. The problem is the initial lesion reported as a well
differentiated SCC was actually
hypertrophic lichen planus! The lump would have responded to intralesional
steroid injections and the surrounding rash to a strong topical steroid under
occlusion. Mistaking hypertrophic lichen planus for a well differentiated SCC
is a well recognised error in dermatopathology. Just to complicate things
rarely an SCC can arise in very long standing poorly treated lichen planus!
Whoever said “Life was not meant to be easy”, was probably thinking of
dermatopathologists.
