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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 1561 - 20 June 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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The patient is a 75-year-old man with a shave biopsy of a pearly, telangiectatic papule on the right ventral medial proximal forearm.

Dr Mark Hurt


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Dr. Mona Abdel-Halim

Posted

Sebaceoma/ Muir Torre syndrome

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Mark A. Hurt MD

Posted

I'll give everyone a chance to catch up.  There was a glitch for a few days.

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Nitin Khirwadkar

Posted

Sebaceoma. The prominent cystic change and lymphocytic infiltrate prompt ruling out MTS.

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vincenzo polizzi

Posted

Initially Invasive Sebaceous Carcinoma ( odd extra ocular site ). It needs ruling out MTS!

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Guest Charlie Keen

Posted

Agree sebaceoma. No convincing infiltrative growth pattern. There is some pleomorphism/mitotic activity but not enough to suggest sebaceous carcinoma to me. But there is necrosis, so i'm not 100% sure on this distinction in this case.

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Cystic sebaceous adenoma/neoplasm of Muir-Torre syndrome.

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Mark A. Hurt MD

Posted

My diagnosis was sebaceous carcinoma, and I am well aware of the dissent on these kinds of lesions.  Here is my diagnosis and comment:

 

-- SEBACEOUS CARCINOMA

COMMENT:  In my opinion, the distinction between sebaceous carcinomas and sebaceomas can be fraught with difficulty.  In this particular case I believe that the diagnosis is sebaceous carcinoma based on the fact that these sebocytes tend to overlap each other, they contain considerable amounts of nuclear variation with some exception, and the Ki-67 index is quite high throughout.  The loss of MSH-2 and MSH-6 would also help me point toward carcinoma in this case.  I suggest at this point investigating for the Muir-Torre syndrome if appropriate clinically.

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