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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 1511 - 08 April 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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M40. Forehead. 9 years, lesion discharges cheesy material when squeezed ?Epidermoid cyst.

Dr Richard Carr.


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Raul Perret

Posted

Lovely clinical history. I was thinking this could be a case of follicular SCC. Patient is young but the lesion is present since a longtime and there are cases of SCC in the younger group. The architecture is quite particular with a dilated pore like appearance

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Follicular SCC !? but 9 years long duration  but  when i saw figures via my laptop this consistent with warty dyskeratoma so i agree with mona

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Dr. Mona Abdel-Halim

Posted

A suggestion out of the box: why not Warty Dyskeratoma?

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vincenzo polizzi

Posted

Agree with Follicular SCC.

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Dr. Mona Abdel-Halim

Posted

The lesion has been there for 9 years? Isn't that a long duration for a SCC?

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I agree with Warty Dyskeratoma. It was my first impression. I can see acantholysis and structures like grains and corps rounds, despite the odd architecture.

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Whilst Mona's suggestion of warty dyskeratoma has made me doubt SCC, there is no clearly visible acantholysis and no protruding villi, as would be expected were this a warty dyskeratoma, and dyskeratosis is not a specific feature.  I'm sticking with my first thought.  Looking forward to the answer.

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vincenzo polizzi

Posted

My opinion about dyskeratosis in this case is they are neoplastic and associated with keratin pearls and nuclear atypia. But like Mona's suggestion. I wasn't thinking at all

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Guest Arash Daryakarr

Posted

my impression is also follicular SCC.but is there enough atypia to call this ?

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Dr. Mona Abdel-Halim

Posted

Check Fig 7.14 page 568 in the Cutaneous Adnexal Tumors by Kazakov.

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Raul Perret

Posted

Warty diskeratoma did not cross my mind and its indeed a nice suggestion Mona. The thing that bothered me when I saw the lesion is the cellular atypia, I considered there was acantholysis but this can be seen in many lesions as we know. Agree that 9 years is a lot of time, I thought that the lesion could have developed in a dilated pore of Winer

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amiratawdy

Posted

My first impression was also warty dyskeratoma

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Mark A. Hurt MD

Posted

It does look awfully like a warty dyskeratoma, but it seems to be missing corps ronds.

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Dr. Richard Carr

Posted

I called this warty dyskeratoma - agree it is certainly follicular.  The acantholysis is present throughout but just rather back to back!  Also I would have said there is at least one, if not more, very passable corps ronds in the lower left image. Dyskeratosis expected and the atypia is mild and consistent with a reactive change (although follicular SCC can have rather subtle atypia).  History is very wrong for follicular SCC which appear usually to grow quite quickly and are almost always on severely sun-damaged skin in the elderly.

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Raul Perret

Posted

Nice case and well done to Mona and the rest for getting it right. I will try to fix this image hoping not to commit the same mistake in the future

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Dr. Richard Carr

Posted

When 50% of the colleagues agree with you we don't use the term mistake - rather a discrepancy!

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