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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 1847 - 27 June - Dr Uma Sundram 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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Clinical History: 56 year old male with left lower leg lesion.

Case Posted by Dr Uma Sundram


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Admin_Dermpath

Posted

Dr Uma Sundram wraps up her June cases with a lovely set of images.

Geoff Cross - DermpathPRO Projects

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dermpath1

Posted

Follicular induction overlying Dermatofibroma.

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Raul Perret

Posted

I thought of superficial trichoblastoma and wonder about an association with nevus sebaceous, if clinically consistent.

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Dr. Mona Abdel-Halim

Posted

Why not a BCC overlying a DF? There is peritumoral mucinous retraction artefacts. 

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Anil Patki

Posted

Islands of basaloid cells, palisading and retraction artefact- suggestive of BCC

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Raul Perret

Posted

I do not discard bcc only with morphology in this case. Although, based only on the H and E, the stroma looks quite cellular for me and the morphology more consistent with a tumor of trichoblastic origin

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Robledo F. Rocha

Posted

There is indeed a basal cell carcinoma for the reasons set out above by Mona. I am not convinced that stromal hypercellularity truly represents a dermatofibroma. Maybe the proliferation of small vessels in the fibrotic superficial dermis indicates stasis dermatitis, a condition that can be complicated by such tumor.

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vincenzo polizzi

Posted

I also thought of superficial BCC, but, after Dermpath1,s comment, looked more closely the dermal component, and now agree with an exorbitant basaloid induction by a DF.

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Saman Fatah

Posted

BCC or "BCC-like changes, basaloid hyperplasia" overlying a probable DF. Does any colleague has experience with usefulness of CK20 in differentiating between the two? Sebaceous structures at the edge of lesion is also interesting. It emphasise protean changes that can be encountered over a DF, making them concerning or confusing at least clinically &/or dermoscopically. 

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Uma Sundram

Posted

Great DDX and the reason I posted this difficult case. We finally went with BCC overlying a DF. The basaloid cells express Ber Ep4 and lack staining with CK20 (absent Merkel cells). Factor XIIIa highlights the dermal fibroblasts. I was quite swayed by retraction artifact and central necrosis, which are not features I associate with trichoblastoma or follicular induction. There was no surrounding nevus sebaceus.

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