Immunohistochemical stains for synaptophysin, chromogranin and CD56 are positive. Graham, P. LCH frequently presents as a multi-systemic disease, being the skin the second most common involved organ.
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The dermis showed lymphohistiocytic infiltrate, with palisading atypical lymphocytes and wiry collagen. T-cell receptor gamma gene rearrangement study performed on peripheral blood revealed a monoclonal spike. The lesion was excised and sent for histopathological evaluation.
The tumor was diagnosed as atypical fibroxanthoma AFX , keloidal variant and subsequently treated with Mohs micrographic surgery.