An 80-year-old woman presented with a chief complaint of an erythematous nodule on her right cheek. A partial biopsy suggested a diagnosis of keratoacanthoma, and it was subsequently resected. Pathological examination revealed clear surgical margins but showed evidence of perineural invasion, which led to diagnosis of squamous cell carcinoma arising from keratoacanthoma. Two months after the surgery, the tumor recurred locally, necessitating re-resection. The pathological analysis of the re-resected specimen again revealed perineural invasion, prompting the addition of postoperative radiation therapy. There has been no subseguent evidence of local recurrence or distant metastasis. Perineural invasion is typically associated with malignant tumors, but it is also reported in keratoacanthoma; several cases of local recurrence have been reported. This report discusses the clinical significance of perineural invasion in keratoacanthoma and related lesions, its management, and a review of the relevant literature.

Dermatologists play a crucial role in the diagnosis of VEXAS syndrome, given its high incidence of neutrophilic dermatosis and other cutaneous manifestations. We conducted a retrospective investigation to explore the potential diagnosis of VEXAS syndrome in patients previously diagnosed with Sweet syndrome. Our findings revealed that six of the 27 patients who underwent multiple biopsies for refractory skin lesions had histiocytoid Sweet syndrome (HSS), a feature consistent with VEXAS syndrome. No UBA1 mutations were identified in this cohort. Nevertheless, given that HSS can also be the initial manifestation of VEXAS syndrome, early diagnosis through more sensitive genetic testing and appropriate therapeutic intervention is crucial.