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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 831 - 23rd August Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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75 years old female Upper Lip. x4 BCC on face.

Case posted by Dr. Richard Carr


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Guest Yüksel OKUMUŞ, MD

Posted

Basaloid follicular hamartoma + Basal cell carcinoma

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Guest Romualdo

Posted

Agree. The absence of mitotic figures, apoptosis and nuclear atypia is shown in the small hamartomatous lesions, as contrasted with BCC. Immunostains with Ki-67, CD34 and bcl-2 will certainly emphasize the differences between the two conditions.

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Guest Graham Reilly

Posted

Agree with above comments - BFH and BCC

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Guest Jim Davie MD

Posted

I agree with the opinion of BFH and BCC (given aberrant mitoses and apoptotic figures [bottom right photo]). The lesion has been traumatized.
The differential would include a trichoepithelioma in conjunction with a basaloid follicular hamartoma.

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Mark A. Hurt MD

Posted

To be a contrarian, my opinion is that all of this is basal cell carcinoma. My concept of a hamartoma is that it consists of mature structures; these are immature, so it's either a trichoblastoma (trichoepithelioma) or it's carcinoma, i.e., BCC. I don't think that the epithelial-stromal relationship is all that great for a benign neoplasm. Oddly enough, my associates and I battle this kind of issue all the time, so I have learned to expect some disagreement in cases like this.

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Dr. Richard Carr

Posted

I reported this as BFH (this is really a very typical example) and BCC. BFH lesions were present in multiple areas of the patients excision biopsy. Importantly BFH lesions are superficial (limited to upper dermis) and clearly limited to pre-existing (abnormal/hamartomatous) follicular units and mitoses are inconspicuous. This case was from afar and I do not know if it was part of a larger congenital unilateral case as I would suspect. In contrast to TE/TB, BFH lack stromal condensations of papillary mesenchymal cells but in my experience do have reactive Merkel cells (as were present in this case). Note the stromal clefts in the BFH that are common in benign follicular lesions. I have an exactly similar case in a patient with multiple BCC in the field of a large unilateral congenital BFH on the face. The latter patient was fair skinned and had significant solar damage.

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