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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 1541 - 20 May 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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?Actinic keratosis

Dr Richard Carr


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Nitin Khirwadkar

Posted

Large cell acanthoma

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Dr. Mona Abdel-Halim

Posted

Yes, large cell acanthoma

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Guest Arash Daryakarr

Posted

large cell acanthoma

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Mark A. Hurt MD

Posted

Yes, LCA. I see these daily en masse. If you do Melan-A on them, you will see periodically placed melanocytes. Ki67 shows basal and suprabasal staining of keratocytes.

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Dr. Richard Carr

Posted

My report:

Slightly pigmented large cell acanthoma. No frank dysplasia.

 

I agree from personal experience that they often appear to be closely related to solar lentigo (all be it the "keratosis" outweighing the pigmentation).  The point is they are rather subtle and nice to have in your diagnostic armamentarium. I have always discussed with dermatology colleagues that solar lentigo is on a spectrum with thin seborrhoeic keratosis (and not a lentiginous melanocytic proliferation at all). In that sense LCA and thin seborrheoic keratosis are not really alike as the former is composed of larger and paler keratinocytes without significant cellular hyperplasia compared with the latter. Perhaps LCA is worth keeping as a separate entity.

 

Slightly radical thought, perhaps solar lentigo should be renamed pigmented LCA! and reported as follows:

 

Pigmented large cell acanthoma (formerly known as solar lentigo).

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