Porocarcinoma is a rare malignant neoplasm of the acrosyringium with metastatic potential that most commonly presents on the acral skin in older adults (mean age = 72 years). We present the case of a 43-year-old woman who developed a rapidly growing de novo porocarcinoma on the scalp with an unusual oncocytic appearance. The tumor consisted of benign eccrine poroma that arose from the epidermis and broad pushing borders with minimal cytological atypia but ample eosinophilic cytoplasm with numerous mitotic figures. Although some tumors may appear deceptively bland, the histologic recognition of pushing/infiltrative borders and mitotic figures are helpful to make the appropriate diagnosis of carcinoma. This lesion was treated with Mohs micrographic surgery and the patient remained free of recurrence after more than 2 years. It is important to recognize the eosinophilic variants of eccrine porocarcinoma because it can histologically mimic a squamous cell carcinoma.
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