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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 1238 - 23 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 52-year-old white woman with a punch biopsy of a lesion on the right fourth digit. Clinical Diagnosis: R/O foreign object.

Case posted by Dr Mark Hurt


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Guest Jim Davie MD

Posted

[color=#111111][font=Arial, Helvetica, sans-serif][size=3]Porokeratotic eccrine ostial and dermal duct nevus (PEODDN).[/size][/font][/color]

[color=#111111][font=Arial, Helvetica, sans-serif][size=3]Cornoid lamella involving an eccrine duct (acrosyringium) is a key finding for PEODDN, and helps differentiate from DDx of punctate palmoplantar keratoderma. This would be an unusual presentation if showing up as a solitary lesion de novo in an adult..was it solitary? [/size][/font][/color]

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Mark A. Hurt MD

Posted

To my current knowledge, it was a solitary lesion.

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Dr. Mona Abdel-Halim

Posted

Looks like it is on the palmar surface of the digit, Could it be keratosis punctata of the palmar crease? It can be centered on an acrosyringium. Although delayed onset of PEODDN has been reported, it is usually not a solitary lesion. Could it be an unusual punctate porokeratosis?

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Arif Usmani

Posted

Porokeratoma ([color=#000000][font=arial, helvetica, clean, sans-serif][size=2][url="http://www.ncbi.nlm.nih.gov/pubmed/18043046#"]Am J Surg Pathol.[/url][/size][/font][/color][color=#000000][font=arial, helvetica, clean, sans-serif][size=2] 2007 Dec;31(12):1897-901[/size][/font][/color])

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Dr. Mona Abdel-Halim

Posted

I thought of porokeratoma but in textbooks it says that it shows multiple confluent cornoid lamellae??

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Arif Usmani

Posted

There is also a case report of a solitary PEODDN.
[color=#000000][font=arial, helvetica, clean, sans-serif][size=2][url="http://www.ncbi.nlm.nih.gov/pubmed/?term=solitary+peoddn#"]Am J Dermatopathol.[/url][/size][/font][/color][color=#000000][font=arial, helvetica, clean, sans-serif][size=2] 2009 Aug;31(6):582-6. doi: 10.1097/DAD.0b013e3181a09b62.[/size][/font][/color]

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Mark A. Hurt MD

Posted

My diagnosis was PEODDN, and I have to admit that I have never seen a solitary case before. Kudos to Jim for his initial diagnosis -- and to Arif for the reference on solitary PEODDN. I don't think this is a porokeratoma, as those lesions tend to be much broader, at least in my experience and in the cases we reported in 2007. As for keratosis punctata, I considered it but rejected the diagnosis when I was able to find the duct in close proximity to the abnormal columnar cornification.

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