Case Number : Case 2192 - 2 November 2018 Posted By: Dr. Richard Carr

Difficult to interpret!! I can see some dermal fibrosis and an empty space in the superficial dermis. Everytime I see some empty space in the dermis I think about basal cell carcinoma. The external border of this space is corrugated wich is odd. Wating for more comments.

dermal myxoid and fibrosis.perifollicular fibrosis and mixed inflammation and eosinophils seen. the empty space has villi like projections, may be some parasitic 

The empty space indicates that something must have popped off during processing. Eosinophils in the mixed infiltrate suggest that it could be a foreign body,  may be an artificial hair fiber used for treating alopecia? 

Agree that its difficult. But I dont think in BCC because i dont see any signs of solar damage.

I favor some foreign body material or some kind of parasit infection.

Dilated ectatic vessels superficially and compressed vessels with some hemosiderin in deep dermis--->why not a Hobnail Hemangioma/alias hemosiderotic targetoiod hemangioma?

Igor SC was right, a BCC that has popped off!

So I was completely off side!!! Very interesting case! I often saw these empty spaces in the superficial dermis, as marker of popped off BCC, but this time I did not really think about it. Congrats to Igor!!!

Yes well done IgorSC. I remember well a similar case from many years ago that came to review at a skin meeting. Amazingly if was from the dorsum of the foot (not common for a BCC). The pathologist had described a cyst and mentioned a "carry-over" of basal cell carcinoma. The problem was the "cyst" had no lining cells and the "carry-over" was the same shape as the hole! The "cyst" wall often looks a little loose and myxoid as here. The first batch of images don't show it but there is quite a lot of solar elastosis in this case (extra images - 3rd down on the right).