HYPERTROPHIC DISCOID LUPUS ERYTHEMATOSUS
Hypertrophic discoid lupus erythematosus (HDLE) may present as a verrucoid lesion, a lesion resembling a keratoacanthoma, or as a plaque. The prominently thickened basement membrane (when present) is a very helpful in distinguishing HDLE from squamous cell carcinoma or from hypertrophic lichen planus. The density of lymphocytic infiltrates varies from lesion to lesion.

This is a biopsy of a large, erythematous plaque having a silvery scale on the arm of a 56 year old female. This patient had lesions typical for discoid lupus erythematosus elsewhere.
 
Scan power view. Note the pseudoepitheliomatous hyperplasia. Lymphocytic infiltrates are minimal in this example.
A low power view. The clusters of large keratinocytes can be mistaken from carcinoma. Universal keratinocyte enlargement is a feature of lupus erythematosus that is of diagnostic importance but can lead to an impression of 'atypia'.
A medium power view. The basement membrane is so tremendously thickened that it can be recognized in this H&E stained section. There is also involvement of vessel walls in this case. The basement membrane material was PAS positive and negative for amyloid.
A high power view. Apoptotic keratinocytes (APK) are seen in some examples of lupus erythematosus as well as in lichen  planus and in a few other conditions. The markedly thickened basement membrane is not a feature of lichen planus or of the other conditions. Basement membrane thickening is not noted by light microscopy in most early cases of LE and is usually not this prominent in systemic LE.

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