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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 1289 - 02 June 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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40 year old woman with cluster of papules on the right wrist.

Case posted by Dr Uma Sundram

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Mark A. Hurt MD


I also favor GA, but interstitial granulomatous dermatitis might be a distant second. A distant third and fourth are metastatic breast cancer and epithelioid sarcoma, both of which seem unlikely.

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Uma Sundram


Yes, deep GA. Apologies if people thought this was too easy. Interstitial infiltrates are difficult to diagnose and entities such as epithelioid sarcoma and metastatic breast cancer come up in the differential. I thought this biopsy was particularly interesting--the classic palisading histiocytes are not seen until much deeper into the biopsy and can be missed on a superficial biopsy.

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