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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 1907 - 19 Sept - Dr Richard Carr 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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M80. 8/52 hx of squamoproliferative lesion. For newbies & trainees first please.


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Raul Perret

Posted

43 minutes ago, Dr. Mona Abdel Halim said:

Beautiful :-)

 

Agree, pictures are of extremely high quality

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Dr. Richard Carr

Posted

Thanks all for the kind comments. This is actually a "textbook" case of keratoacanthoma (KA) and a type you rarely see in practice!  In fact the rather pushing borders, lacking elastic entrapment, lacking striking cellular pleomorphism is actually more in favour of KA-like reaction in SEBK, inverted follicular keratosis and follicular squamous cell carcinoma (infundibular-tricholemmal type). Also KA are usually much larger at diagnosis and rarely fall short of the sweat gland coils as in this case. In my routine practice early to well developed proliferative KA are highly infiltrative and show much more florid cellular proliferation and cellular atypia. Features here that are typical of KA are the nice symmetry, abrupt transition/maturation in the centre of all islands, lack spontaneous acantholysis and lack of follicular mucin. I suspect this is the sort of KA that even those who rarely make the diagnosis will probably accept the diagnosis but one I don't see very often (so much so that it's taken me a while to find this one). More commonly a small lesion with pushing borders resembling KA is another diagnosis including KA-like reaction in inflamed SEBK, inverted follicular keratosis and well differentiated follicular (infundibular-tricholemmal type) squamous cell carcinoma.

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