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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 895 - 22nd November 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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F89. Keratin horn on eyebrow.

Case posted by Dr. Richard Carr.


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Guest Dr.Yüksel Okumuş

Posted

Cutaneous horn overlies an irritated seborrheic keratosis

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Guest Marwa Fawzy

Posted

[color=#1C2837][font=arial, verdana, tahoma, sans-serif][size=4]Cutaneous horn on top of an irritated seborrheic keratosis[/size][/font][/color]

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Robledo F. Rocha

Posted

Irritated seborrheic keratosis topped by filiform keratotic horn. It also can be an irritated filiform wart.

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Guest Juan Carlos Garcés, Ecuador

Posted

Agree with irritated seborrheic keratosis

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Sasi Attili

Posted

Benign Cutaneous horn arising from an irritated Seborrhoeic keratosis

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Guest Romualdo

Posted

I prefer verruca vulgaris with squamous eddies over irritated seborrheic keratosis (inverted follicular keratosis). I think there are two clues to this diagnosis: rete ridges converging to the center and fusing in the base of the lesion and hemorrhages within the horn.

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Dr. Mona Abdel-Halim

Posted

Cutaneous horn overlying an old wart with squamous eddies. Controversy exists about inverted follicular keratosis and its relation to warts...

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Guest Jim Davie MD

Posted

Agree with the above (ISK vs. filiform irritated SK).

For sake of an expanded differential, I would also consider a markedly irritated trichilemmoma. There is focal clear cell changes (low power images) and a thickened eosinophilic basal layer. CD34 may be useful to evaluate.

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Mark A. Hurt MD

Posted

ISK vs Wart. I usually call these ISK's. Many with this internal pattern are inverted structurally, in contrast with the case presented here. My experience with these kinds of lesions, when I stain them with CD34 and HPV markers, is that they are negative.

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Guest Dr. Taskin Erknuresin

Posted

cutaneous horn overlying an old verruca vulgaris

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Guest Engin Sezer

Posted

IFK based on conspicious squamous eddies (which is already a seb ker).

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Guest Mazen charaf iddin

Posted

I've looked in lever dermatopathology book, Isee it come in the contexts of hyperkeratotic type of SK, I couldn't see the clear signs of Warts

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Dr. Richard Carr

Posted

This is an inverted follicular keratosis with nice follicular mucin. CD34 was negative which is also my experience with these lesions although they clearly are very close to tricholemmoma. It is quite a case as most keratin horns of this degree are usually related to underlying actinic keratosis. Clearly the name (inverted) needs to be taken with a pinch of salt.

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