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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 1213 - 16 February Posted By: Guest

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The patient is a 75 year old white man with a shave biopsy of a friable, bleeding lesion taken from the left lower back. Clinical Diagnosis: SCC vs BCC vs other.

Case posted by Dr Mark Hurt


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Guest Romualdo

Posted

In the absence of at least moderate nuclear atypia, necrosis and frank invasion I would call this neoplasm a sebaceoma. Sebaceomas may exhibit frequent mitotic figures.

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Dr. Mona Abdel-Halim

Posted

In contrast to the case of Dr Carr, I find this architecture and cytology consistent with Sebaceoma.

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Guest Jim Davie MD

Posted

Agree, sebaceoma. Architecture and cytology appear low-grade.

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White more than blue.Mature sebocytes more than germinative cells.Therefore ,I like to call it Sebaceus adenoma.

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Mark A. Hurt MD

Posted

My diagnosis was sebaceous carcinoma. I realize that many if not most of you will disagree with this point of view. Consider, however, the growth pattern as well as the nuclear features, and I think it fits as a carcinoma.

Of course, one point of controversy is the relationship (the natural history) of sebaceous "adenoma" to sebaceous carcinoma. Ackerman, who influenced me heavily on this point, regarded most "adenomas" as carcinomas, a viewpoint I hold also. He regarded sebaceoma as the only authentic sebaceous adenoma, and it has an entirely different pattern of growth compared to the lesion is question here. I argue that authentic sebaceous adenomas are not "on their way" to becoming carcinomas; rather, they are what they are: adenomas. I argue also that the carcinomas generally arise [i]de novo [/i]and do not require an adenoma as the substrate for their origin.

If you have never read his point of view on this matter, I urge you to do so, then decide for yourself. As an aside, my own associates don't agree with me on the matter, so I'm used to the angst about it.

References:

Nussen S, Ackerman AB. Sebaceous "adenoma" is sebaceous carcinoma. Dermatopathol Pract Concept 1998; 4:5-14.

[color=#000000]Troy JL, Ackerman AB. Sebaceoma. A distinctive benign neoplasm of adnexal epithelium differentiating toward sebaceous cells. Am J Dermatopathol. 1984 Feb;6(1):7-13. PubMed PMID: 6703260.[/color]

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Mark A. Hurt MD

Posted

By the way, if you have trouble finding the Nussen & Ackerman article from 1998, let me know, and I will send you a PDF copy of it, as it is out of print. You can read it online at derm101.com, but you will have to be a subscriber to that site to read it.

go to my [url="http://markahurt.com"]website[/url], to get my email address if you wish to contact me about it.

MAH

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Dr. Richard Carr

Posted

Agree with sebaceoma on this case. I like the abrupt transition from germinative to mature sebocytes and circumscript borders (I realise I am more benign than most). Would definitely consider Muir Torre.

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