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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
Case are uploaded each week day by 10 am UK time with the correct diagnosis will generally be posted at 8 pm UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 1537 - 16 May 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 76-year-old woman with a shave biopsy taken from the right nasal sidewall.

Dr Mark Hurt.


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vincenzo polizzi

Posted

Yes Sebaceous Carcinoma, i don't know if that is at least initially invasive. 

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Raul Perret

Posted

Sebaceous lesions are always hard I agree with sebaceous carcinoma, rather low grade for my eyes. Still I would perform some extra immunos (p53, bcl-2) to unveil a bit more the biological nature of the neoplasm. Do you have experience using these markers on difficult sebaceous lesions Dr. Hurt? and a last question, is it necrosis the eosinophilic amorphous material seen in the third image? 

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Nitin Khirwadkar

Posted

Going by the site and morphology, would think about a sebaceous carcinoma, provided other lesions with sebaceous differentiation are excluded with an IHC panel.

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Raul Perret

Posted

https://www.ncbi.nlm.nih.gov/pubmed/17122489  Personally I did not start using them in these lesions (yet). But I would like to try them eventually. Nevertheless, p53 and bcl-2 are sometimes hard to interpret and in the best of chances they are only useful for supporting the diagnosis. I think it is also true that in the case of p53 the assesment is somewhat confusing in general practice, strangely in the article they dont seem to consider a null cell pattern seen in some of the benign cases as indicative of mutation of P53... 

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