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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 1982 - 09 Jan 2018 Posted By: Dr. Richard Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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RAC7822

Clinical Details: M70. Mid back. SCC


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Arif Usmani

Posted

DD: IBR, LYP, Lues ("sexy slender rete")

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John Zhang

Posted

adding excoriation to the differential diagnosis.

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Dr. Richard Carr

Posted

Given that this was a solitary lesion on the back I called it in keeping with a (lymphomatoid) lichen planus-like reaction (lichenoid keratosis). I did not do any additional work-up beyond requesting some levels and a melanA. Lymphoma is exceedingly unlikely and for me not a practical consideration.

"IBR" ?

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Arif Usmani

Posted

An excoriated regressed melanocytic lesion is a great thought.  There is focal excoriation near a hair follicle (where usually insects bite) with spongiosis and exocytosis which may have been a punctum. Rarely lichenoid tissue reaction is seen in insect bite reaction. Could be a lingering IBR. 

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my reasons for considering excoriation:

serum crust; jagged elongation of rete ridges - pseudoepitheliomatous hyperplasia; pagetoid dyskeratosis in pic 7 - related to irritation. IBR can be an underlying cause, but not necessary.

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Dr. Richard Carr

Posted

My guess is the crust is more likely what's left of whatever lesion induced the lichenoid reaction. Most frequently solar lentigo but can of course be SEBK or another superficial lesion (even melanocytic). As you say insect bites are not lichenoid and generally have eosinophils. Lymphomatoid lichenoid keratosis is the best fit and in my experience can be over-worked up for lymphoma.

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Dr. Mona Abdel-Halim

Posted

Lymphomatoid lichenoid keratosis was my though too

 

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