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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 985 - 2nd April 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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87 year-old male with a lesion on the scalp. Clinical impression: rule out BCC.

Case posted by Dr. Hafeez Diwan.


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Pleomorphic neoplasm. A low-power view is needed for architecture, subcutaneous, perineural and vascular invasion, et cetera, as is immunohistochemistry for epithelial, melanocytic and myoid differentiation.

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amiratawdy

Posted

One of my D.D is atypical fibroxanthoma, but certainly IHC is needed to exclude other neoplasms of epiermal,vascular or melanocytic origin.

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amiratawdy

Posted

sorry for the spelling mistake i mean epidermal

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Dr. Richard Carr

Posted

My panel 1st Panel: CD10, Pan-keratin, p63, S100 (I don't bother with any others for bog standard cases - when CD30+ lymphoma and angiosarc. are unlikely). I also don't bother with myoid markers on biopsies as dermal limited lesions are not treated different to AFX.

Most likely in order of rate we see AFX (or sarcoma NOS if beyond dermis or ill-defined margins), Melanoma and undiff. Ca.

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Robledo F. Rocha

Posted

Atypical fibroxanthoma. Lesion occurs in a sun-damaged skin, evidenced by marked solar elastosis, and seems to be superficial. Those pleomorphic neoplastic cells, including bizarre multinucleated giant cells, are also features of atypical fibroxanthoma.

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Eman El-Nabarawy

Posted

First impression is AFX(or sarcoma NOS). Immunos are needed to exclude melanoma or undifferentiated carcinoma

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Dr. Mona Abdel-Halim

Posted

My first impression also was AFX, agree with other DDx

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Agree with the above comments. First diagnosis of AFX. Immunostains needed.

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Mark A. Hurt MD

Posted

AFX differential as well.

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Dr. Hafeez Diwan

Posted

Atypical fibroxanthoma. The following immunos were negative: CK5/6, p63, S-100 and melan-A.

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