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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 943 - 3rd February 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 74 year old man with a shave biopsy taken from the right jaw.

Case posted by Dr. Mark Hurt


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Guest Maria George

Posted

Viial cytopathic changes can be a differenal but I favor SCC.

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Guest Havva Gökçe

Posted

Acantolytic SCC vs Malign Melanoma

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Dr. Mona Abdel-Halim

Posted

Melanoma vs epithelioid cell variant of AFX vs SCC, waiting for the immunos...

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Robledo F. Rocha

Posted

Malignant epithelial tumor showing keratinization and intercellular bridges. Evidence of local origin is lacking. I favor metastatic squamous cell carcinoma from primary site in the oral cavity.

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Agree, SCC x Melanoma. Less probably Sebaceous carcinoma, I would include adipophilin in my IHQ pannel.

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Guest Romualdo

Posted

Primary acantholytic squamous cell carcinoma.

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Sasi Attili

Posted

looks like an SCC to me. Sebaceous Carcinoma would certainly be a consideration given the focal suggestion of sebaceous differentiation particularly in 2nd image from the bottom (right)

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Mark A. Hurt MD

Posted

Here are some immunostains I had done on the case. I'll post my diagnosis ~20:00 GMT.

MAH

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE943_Image%2009.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE943_Image%2010.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE943_Image%2011.jpg[/img]

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Dr. Richard Carr

Posted

SCC probably follicular variant (acantholytic). Individual tricholemmal cell keratinisation. The lack of bowenoid change it typical of this common variant but need to see the nice infundibular connections so only a provisional diagnosis at this stage. You could see if there is follicular mucin with alcian blue. Many of our cases are p53 null or diffuse, p16 neg.

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Dr. Mona Abdel-Halim

Posted

SCC for sure now ... Lovely stains !!

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Mark A. Hurt MD

Posted

My diagnosis was acantholytic SCC.

By H&E I was reasonably sure this was epithelial; however, over the years I seen a few melanoma and epithelioid angiosarcoma mimics. AFX was not high on my list, but it is effectively excluded with the epithelial marker. I did not consider sebaceous carcinoma, as there was considerable "glassy" intracytoplasmic cornification, which biased me against that diagnosis. I thank Richard for his proposal of "follicular" SCC. I had not considered it, probably because of educational bias. I think this should be a topic for a more in-depth discussion at some point.

Thanks, everyone, for your diagnoses and ideas!

MAH

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