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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 978 - 24th March 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 37 year old woman with an excision with margin exam of an enlarging lesion present for 10 years taken from the left side of the chin. Clinical Diagnosis: skin neoplasm of unspecified nature.

Case posted by Dr. Mark Hurt.


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Eman El-Nabarawy

Posted

Agree. Micronodular Trichoblastoma.

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Eman El-Nabarawy

Posted

We r still waiting for the answer of the interesting previous case number 977 ( Dr Carr)!!

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Dr. Richard Carr

Posted

Funny because I posted it first thing this morning! Sorry for delay - still on my hols.

This is a small nodular trichoblastoma. Lesions at this site, particularly upper lip, can present as ill-defined plaque-like lesions and appear quite extensive and "invade" down in to skeletal muscle. Moh's surgery may be required to remove them. Some authors (wrongly in my opinion) have regarded them as low grade malignant based on deeply infiltrative and asymmetrical growth.

Rofagha R, Usmani AS, Vadmal M, Hessel AB, Pellegrini AE. Trichoblastic carcinoma: a report of two cases of a deeply infiltrative trichoblastic neoplasm. Dermatol Surg. 2001 Jul;27(7):663-6.

Altman DA, Mikhail GR, Johnson TM, Lowe L. Trichoblastic fibroma. A series of 10 cases with report of a new plaque variant. Arch Dermatol. 1995 Feb;131(2):198-201.

Cowen EW, Helm KF, Billingsley EM. An unusually aggressive trichoblastoma.J Am Acad Dermatol. 2000 Feb;42(2 Pt 2):374-7.

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Dr. Mona Abdel-Halim

Posted

Yes micro nodular trichoblastoma

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Robledo F. Rocha

Posted

Small nodular trichoblastoma.

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Mark A. Hurt MD

Posted

Yes, this is a small lobular trichoblastoma. Kudos to everyone for getting it right. I agree with Richard's position that this is a benign neoplasm despite its sometimes deep location around muscle on the face.

In the 1970's, lesions with this pattern were termed "trichogenic trichoblastoma."(1) Since Ackerman et al in 2001, trichoblastoma as become the dominant name.(2)

By the way, I use the term "lobular" because a nodule is a clinical term. It is true that many lobular trichoblastomas make nodules, but they are not synonymous terms.

1. [url="http://www.ncbi.nlm.nih.gov/pubmed/793411"]http://www.ncbi.nlm.nih.gov/pubmed/793411[/url]
2. [url="http://www.derm101.com/products/neoplasms-with-follicular-differentiation-second-edition/"]http://www.derm101.com/products/neoplasms-with-follicular-differentiation-second-edition/[/url]

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