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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 1496- 18 March 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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F74. Back of hand. Sudden onset 5/52 ago, like a tiny nipple, enlarged. Not changed. ?KA or SCC.

Case posted by Dr Richard Carr


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vincenzo polizzi

Posted

Epidermal keratinization...follicular growth pattern...i go with Infundibulocystic SCC.

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Raul Perret

Posted

This one is hard. I think this is verrucous SCC because the lesion seems way too endophytic (surpasses the eccrine glands level seen on first page) and there seem to be some neutrophils with focal microabscess formation (Curiously Weedon states that is an important clue to verrucous SCC). Appart from that, to my eyes this lesion does not have the architecture for a KA. Lastly, the clinical history is of course consistent with KA.

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Raul Perret

Posted

By the way, how much time is 5/52 ago? (5-52 days ago?). Thanks in advance

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Dr. Mona Abdel-Halim

Posted

I think Raul it means 5 weeks (as the year is 52 weeks).. Correct me colleagues if I am wrong!!

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Dr. Richard Carr

Posted

I called this KA en plaque also known as "follicular KA".

Mentioned in Weedon text-book 2010, in an excellent review by Santa Cruz 2008 and by Kossard in 2007 (cited by Weedon).  I think it is one of the most frequently missed KA variants and once you come to recognise it I am sure you will diagnose it occasionally.  It is an uncommon variant that often lacks the central crater and involves distinct follicular units.  I don't think there are really any clinico-pathological features here to warrant consideration of SCC.  I appreciate that many regard KA as an SCC variant.

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