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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 2061 - 1 May 2018 Posted By: Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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90 year old man with 4 x 3 cm patch on his right cheek, grew over 2 months.


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vincenzo polizzi

Posted

A difficult case! ?metastatic Merkel cell carcinoma(lymphovascular infiltration in pic1)...? metastatic prostatic carcinoma ( lymphovascular infiltration in pic1 )...?Sebaceous carcinoma(poorly differentiated type)...?metastatic melanoma(last but not least).

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Anil Patki

Posted

Very difficult to come to a single diagnosis. The list of small blue cell tumors is too exhaustive!

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Uma Sundram

Posted

Agreed that this is tough. I favored merkel cell carcinoma because: 1) it was a cohesive, rather than discohesive, infiltrate, which somewhat argues against melanoma and lymphoma; 2) no real squamous differentiation was seen; the histologic features of BCC were not present (although that can be tricky); 3) on high power examination, it seemed more like a neuroendocrine tumor. The pictures don't project well but Figure 2 seems particularly convincing. Sebaceous carcinoma, an unusual cutaneous adnexal carcinoma, and metastatic adenocarcinoma were all in the differential.

The tumor cells express both CK20 and CKAE1 in a perinuclear 'dot like' pattern, suggesting Merkel cell carcinoma. TTF1 and CK7 were negative.

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vincenzo polizzi

Posted

Well done Raul. 

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Dr. Mona Abdel-Halim

Posted

Late, but I thought too of Merkel!

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Arash Daryakar

Posted

Nice case!

looks quite small round/blue cell tumor.

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