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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 1413- 23 November Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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Case History: The patient is a 79 year old white man with a shave biopsy of a dark lesion that may have changed, taken from the left dorsal hand. There is a life-long history of the lesion.

Case posted by Dr Mark Hurt


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Dr. Mona Abdel-Halim

Posted

Acquired elastotic hemangioma associated with bullous solar elastosis. I think life long actually refers to a long duration which can be accepted in the context of a white skinned individual on the dorsum of the hand being subjected to solar damage.
I do not know why CD68 was done?

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Arti Bakshi

Posted

Difficult.. I think the ERG is staining normal vessels and is negative in the cystic spaces as is D240, which argues against a vascular or lymphatic malformation/lesion.
Bullous solar elastosis is a good idea (histology somewhat similar to the case Richard put in some time back), but life long history is odd. An EVG would be helpful.
What about some sort of traumatic aetiology in view of abundant haemosiderin?

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Mark A. Hurt MD

Posted

My interpretation was that of synovial metaplasia of the skin. I assume that there was trauma here, although whether it was lifelong is still a question in my mind. I obtained the vascular makers to exclude an endothelial cell proliferation. I thought that CD68 supported synovium -- it's similar to my experience in the past with such lesions.

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Mark A. Hurt MD

Posted

It's not a Masson's tumor because the ERG is negative in the papillary fronds.

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Dr. Richard Carr

Posted

I think it is an "old" ganglion cyst. Perhaps a large religious text "basher"! (apologies no offence intended)

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