Skin - Nonmelanocytic tumors
Benign (nonmelanotic) epidermal tumors or tumor-like lesions
Pseudoepitheliomatous hyperplasia

Reviewer: Hillary Elwood, M.D. (see Authors page)

Revised: 13 October 2016, last major update September 2015

Copyright: (c) 2003-2015,, Inc.

PubMed Search: Pseudoepitheliomatous hyperplasia [title]
Cite this page: Pseudoepitheliomatous hyperplasia. website. Accessed October 24th, 2016.
Definition / General
  • Pseuodepitheliomatous (pseudocarcinomatous) hyperplasia (PEH) is a histologic pattern, not a specific diagnosis
  • Histologic mimic of squamous cell carcinoma
  • PEH occurs in a wide range of settings such as:
    • Chronic irritation, including borders of ulcers and healing wounds, urostomy/colostomy sites, prior biopsy site, stasis ulcer, pyoderma gangrenosum, prurigo nodularis, lichen simplex chronicus, halogenoderma
    • Inflammatory dermatoses such as hypertrophic lichen planus, pemphigus vegetans, chronic arthropod bite
    • Infectious dermatoses such as tuberculosis verrucosa cutis, pyoderma vegetans, atypical mycobacterial infection, deep fungal infection
    • Overlying tumors such as granular cell tumor, cutaneous T cell lymphoma, CD30+ lymphoproliferative disorders, Spitz nevi, melanoma
  • Differential for PEH with intraepidermal neutrophilic microabscesses includes:
Case Reports
Micro Description
  • Prominent acanthosis of epidermis and adnexal epithelium with deep, somewhat bulbous, downgrowths of epithelial cells that may appear invasive
  • Dermal fibrosis and reactive vascular proliferation may be present
  • In cases associated with an inflammatory or infectious process, there may be intraepidermal microabscesses
  • Often associated with trapping of elastic fibers within epidermis
  • Absent or minimal atypia, rare mitoses
Micro Images
Missing Image

Inflammatory infiltrate in dermis

Missing Image

Pseudo-epitheliomatous hyperplasia

Missing Image

Surface epithelium

Missing Image

Acanthotic squamous epithelium

Missing Image

Mild chronic inflammation

Differential Diagnosis
  • Pseudoepitheliomatous hyperplasia can be seen in a number of settings, as outlined above, and its presence should prompt a search for an underlying infectious process, inflammatory process or tumor as appropriate
  • Well differentiated squamous cell carcinoma:
    • Can be extremely difficult to impossible to distinguish PEH from squamous cell carcinoma (SCC), especially on superficial shave biopsies
    • PEH is mainly differentiated by clinical findings and / or the discovery of an underlying reason for its presence
    • Findings that favor SCC include increased mitoses particularly atypical mitoses, more pronounced cytologic atypia, perineural / lymphovascular invasion