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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 2152 - 7 September 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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M80. Left medial malleolus. ?Hyperkeratotic bowen’s

Edited by Admin_Dermpath


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Raul Perret

Posted

Looks like pagetoid diskeratosis in a setting of lichen simplex chronicus to me. The underlying cause is hard to tell on this biopsy

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In my eyes, those cells are too atypical to render a benign diagnosis on a small biopsy like this.  Agree with Bowen disease  / pagetoid Bowen disease.

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There is a vasculopathic injury in dermis, stasis-dermatitis-like, and  the intraepidermal atypical cells could be a secondary abnormal reaction. So the SCIS could be an odd superimposed event...waiting for the final sentence. 

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Krishnakumar subramanian

Posted

sir, can we have the final diagnosis here

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I also thought about pateoid dyskeratosis but the cells are too atypical for that - the nuclei are too large and not pyknotic, there is no perinuclear halo. I would also classify as Bowen's.

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Dr. Richard Carr

Posted

Thanks John. I should point out, in addition to your well made points, pagetoid dyskeratosis is very poorly named because you don't see dyskeratosis!  In this case there is quite obvious dyskeratosis - a clue to Pagetoid Bowen's. p16 should light it up and p53 is often diffuse or completely null. Ki67 will show pennies in the heaven (i.e. all levels of the epidermis and cornified layer).,

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