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 2042 - 04 April 2018 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 :
   (0 reviews)

M80. Lesion right external auditory canal x 2 months.

Edited by Admin_Dermpath


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Anil Patki

Posted

Islands of basaloid cells with sebaceous differentiation and ductal structures- sebaceoma.

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Mani Makhija

Posted

its ulcerated and shows asymmetry and mitosis. Sebaceous carcinoma.  Any loss of MMR / family history suggestive of MTS?

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Uma Sundram

Posted

I'm concerned about sebaceous carcinoma too. There are certainly sebaceous units in the external auditory canal. It's  an unusual location for this tumor, and makes one think even more of Muir-Torre. 

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nick turnbull

Posted

Sebaceous carcinoma but I think super rare location. Doesn't look like bcc  with seb differation to me.

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Arif Usmani

Posted

The architecture appears to favor a sebaceoma in terms of not being infiltrative. However cellular crowding and atypia suggest malignancy. This combination of findings are suggestive of a well-differentiated Sebaceous carcinoma in the setting of MTS.

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Admin_Dermpath

Posted

Diagnosis: Sebaceous, rather mitotic!

H&Ex6; IHCx4 at 6pm

On behalf of Dr Richard Carr.

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Dr. Richard Carr

Posted

Okay I called this an "atypical" sebaceoma and recommended complete excision. Good discussion. Lesion appeared to have pushing only borders. I was impressed by the nice abrupt transition from germinative to mature sebocytes typical for sebaceoma but like you all was concerned by the high mitotic rate. The IHC pattern for BerEP4 and EMA was similar to that we saw in sebaceomas (published a few years back in Histopathology). I think mentioning Muir Torre is also mandatory even if you say it in a way that might indicate a low risk. e.g. Solitary lesions on the head in older patients have a low prediction for Muir Torre but please consider the possibility.  I have not follow-up as yet.

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