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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 997 - 18th April 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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M85. Lesions 13 x 10mm ?following local trauma years ago. Previous liquid nitrogen. ?Bowen’s ?SEBK

Case posted by Dr. Richard Carr.


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Dr. Mona Abdel-Halim

Posted

Follicular SCC, atypical proliferation related to follicular structures with characteristic orange red pilar keratinization.

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Eman El-Nabarawy

Posted

First impression SCC(probably follicular).

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Guest Romualdo

Posted

I completely agree with Mona: the presence of squamous nests with central tricholemmal type keratinisation, the absence of an in situ epidermal component, the absence of epidermal conections, except via dilated infundibula and the cytologic atypia are all consistent with follicular squamous cell carcinoma.

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Mark A. Hurt MD

Posted

I also favor a superficial squamous carcinoma. I would add a word of caution, however. Some years ago, I saw a similar case -- in a curettage specimen from the shin -- and made the diagnosis of SCC. In follow-up, no residual was seen in the excision, and the patient developed more clinical nodules adjacent to the site of the original lesion, all of which looked like LSC when any were biopsied. The patient was presented at a clinicopathologic conference where the proposal was made of "prurigo en plaque." No one there believed my diagnosis of SCC.

This underscores the issue of the differential diagnosis in these kinds of lesions. I tend to be fairly aggressive, especially with lesions like the one above (unless I have a reason not to think it's cancer - such as finding an organism in one of them). Yet, there [u][i]are[/i][/u] mimics of cancer, and this is just the kind of lesion that raises that question.

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Dr. Richard Carr

Posted

Well done. I am glad you are recognising this rather rare, predominantly infundibular-cystic variant of follicular SCC that was drawn attention to by Kossard in 2008 and Misago 2011. There is perineural invasion in the last image.

Kossard S, Tan KB, Choy C. Keratoacanthoma and [size=4]infundibulocystic squamous cell carcinoma. Am J Dermatopathol. [/size][size=4]2008 Apr;30(2):127-34. [/size]

Misago N, Inoue T, Toda S, Narisawa Y. Infundibular [size=4](follicular) and infundibulocystic squamous cell carcinoma: a [/size]clinicopathological and immunohistochemical study. Am J [size=4]Dermatopathol. 2011;33:687-94. [/size]

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Guest Jim Davie MD

Posted

The first low power image also seems to show a subcutis focus of perineural invasion with inflammatory cuffing (bottom, left of image). Thanks for sharing this interesting case!

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Dr. Richard Carr

Posted

Yes well spotted Jim, quite correct and I forgot to point that out as the image was carefully chosen for that feature!

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