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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 853 - 24th September Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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The patient is a 92-year-old man with a shave curettage of a 6 mm, tender, erythematous papule taken from the right malar area.

Case posted by Dr. Mark Hurt.


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Guest Maria George

Posted

Ulcerated Basal Cell Carcinoma (BCC).Possibly. clear cell BCC or BCC with myxomatous degeneration.

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Dr. Richard Carr

Posted

Agree BCC. True (intra-cellular) clear cell change can be related to sebaceous differentiation and outer root sheath (tricholemmal) differentiation or a non-specific intra-cytoplasmic degenerative process. In this instance the phenomenon is mainly related to the myxoid stroma and is probably not intra-cellular at all i.e. it looks like extra-cellular "myxoid-spongiotic" pseudo-clear cell change. I have noticed this many times but I am not sure anyone has drawn attention to this particular sub-type of pseudo-clear cell BCC.

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Guest Jim Davie MD

Posted

Nodular BCC with clear cell changes.

Differential Dx of more aggressive entities for exclusion would be: Merkel Cell CA, SCCa / metatypical (basosquamous) Ca, melanoma, metastatic Ca, and Sebaceous Ca.
The absence of high NC ratios/high mitotic rate/neuroendocrine features, focal/minor squamous metaplasia, focally prominent peripheral palisading, and mucinous nature lacking sebaceous vacuolation and showing retraction artefact...taken as a whole...help exclude these DDx considerations.

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Robledo F. Rocha

Posted

Basal cell carcinoma with striking intratumoral mucin.

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Mark A. Hurt MD

Posted

My diagnosis was: Basal Cell Carcinoma.

I thought this was an interesting case because of the "clear" cells in the neoplasm. I have seen examples of BCC in which there was "water-clear" cytoplasm, but this example is different from those. All of you got it!

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