Epidermal cyst (EC) of the skin is a very common condition. Squamous cell carcinoma (SCC) very infrequently arises from EC. A 76-year-old Japanese woman was admitted to our hospital because of multiple papules in the nose and nasal cavity. The clinical diagnosis was sebaceous hyperplasia. An excisional biopsy was obtained from one papule. Histologically, the papule showed an EC. The EC communicated with the epidermis. Islands of atypical cells with hyperchromatic nuclei and infrequent pearl formation were recognized around and adjacent to EC. No connections were seen between the atypical cell islands and epidermis. The atypical cells had hyperchromatic nuclei and nucleoli. Mitotic figures and keratinous pearls were scattered. The HE diagnosis was probable SCC probably arising from EC. Immunohistochemically, the atypical cells were positive for pancytokeratin AE1/3, cytokeratin (CK) 5/6, CK14, CK18, CK 34BE14, EMA, p53, Ki-67 (labeling 90%), and p63. They were negative for pancytokeratin CAM5.2, CK7, CK8, CK19, CK20, vimentin, S100 protein, HMB45, synaptophysin, and CD56. CD68 was positive in histiocytes and giant cells in the foreign body reaction. The EC showed the same immunoprofile as the SCC, except for negative p53 and low Ki-67 labeling in the EC. The histological and immunohistochemical diagnosis was definite SCC arising from EC.
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