The diagnosis should be differentiated with benign lymphoepithelioma, metastasis or infiltrated poorly differentiated squamous cell carcinoma and malignant lymphoma.
Conclusion PEA, a rarely seen disease,is hard to differentiate from synovioma, fibrosarcoma or giant cell tumors, whose diagnosis depends on pathological examination.
It is an unusual clinical presentation of speckled lentiginous nevus which must be differentiated from benign pigmented lesions due to a potential for malignant changes.