Pseudoepitheliomatous Hyperplasia: Harbinger of Underlying Squamous Cell Carcinoma - Lessons Learnt

Pseudoepitheliomatous hyperplasia (PEH) is a benign condition marked by reactive epithelial proliferation seen in response to various insults like trauma, infection, persistent inflammation and neoplasia. In this report, we discuss a case of a 35-year-old man who presented with a perineal swelling, later turned into a non-healing ulcer, first diagnosed as PEH. Still, after clinical suspicion, a deeper biopsy was conducted, confirming the diagnosis of squamous cell carcinoma and directing treatment appropriately.
Non-healing perineal lesions are not uncommon. Most of the lesions turn out to be Squamous Cell Carcinoma. But, if the histopathological picture suggests Pseudoepitheliomatous Hyperplasia, it is vital to consider the limitations of the biopsy, and a solid clinicopathological correlation is required to look aggressively for underlying Squamous Cell Carcinoma. Due to the benign nature of PEH, most cases are treated via excision biopsy, while grafts or flaps are occasionally required to restore severe tissue defects.
It is therefore crucial to rule out and distinguish this condition from other benign and malignant conditions, as the treatment and prognosis differ widely. It is of utmost importance to sample the base of the lesion, analyze multiple sections, and consider clinical data to ensure an accurate diagnosis.