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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 1944 - 10 Nov Posted By: Dr. Richard Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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M40. Neck. Bleeding, infiltrated, ulcerated papular plaque with arborising blood vessels.

Edited by Admin_Dermpath


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Iskander H. Chaudhry

Posted

Ulcerated skin with granulomatous inflammation - need to exclude infection! 

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Uma Sundram

Posted

I would be worried about a malignancy here as well. Some of the features resemble a basal cell carcinoma.

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Pseudoepitheliomatous hyperplasia of epidermis with central ulcer and lymphocytes, plasma cells and eosinophils in the dermal infiltrate suggest conditions like leishmaniasis, deep fungal infection or atypical mycobacterial infection

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vincenzo polizzi

Posted (edited)

Desmoplastic trichilemmoma?

Edited by vincenzo polizzi

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Dr Carr bowls either an unplayable bouncer or a deceiving googly!--:)

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Iskander H. Chaudhry

Posted

Hi All. Yes I have had another look and see why malignancy is considered! Images 4 onward show increase cellularity and mitoses. Is the lesion vaso-formative ? 

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Raul Perret

Posted

For me it looks more like SCC but I agree some areas are more basaloid

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Dr. Richard Carr

Posted

Yes it's a googly that bowled out the original reporting pathologist too. IHC should be posted soon I hope.

 

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Looks like everything I could say has already been said. Waiting to see the degree of deception!

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Dr. Richard Carr

Posted

My report: BCC with pseudoepitheliomatous hyperplasia.  Focally infiltrative. I have a very high threshold for BCC with "malignant squamous component" no more than 1% of BCC in my reporting generally.

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