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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 2309 - 23 April 2019 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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F65. Chest. 15mm pigmented inflamed shiny lesion well defined margins for 4 weeks

Edited by Admin_Dermpath


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Krishnakumar subramanian

Posted

interface changes with apoptotic bodies in papillary dermis with pigment incontinence with superficial and mid dermal perivascular lymphocytic infiltrate

interface dermatitis with vacuolar alteration-FDE

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Alex-Ventura-Leon

Posted (edited)

Interface dermatitis with superficial and medium perivascular infiltrate. 

Agree. Mostly Fixed Drug Eruption.

Edited by Alex-Ventura-Leon

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Anil Patki

Posted

The size is a bit small and the duration a bit too prolonged for it to be a fixed drug eruption. Moreover, there's acanthosis and patchy hypergranulosis. I would prefer LPLK over FDE. 

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Great, Vincenzo, you are probably right!

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Dr. Richard Carr

Posted

Brilliant!  I reported it as a lichen planus-like keratosis (lichenoid keratosis) with ("true") bland melanocytic nests of doubtful clinical significance. May be a reaction to solar lentigo etc.  Thanks for the reference - I was hoping you would follow this literature to it's conclusion. I was always a bit upset that MelanA was given a bad rap, for me it's been a wonderful marker and I'd never seen it in keratinocytes!  Seems the literature has now come full circle. I'm 100% sure I've given a long discussion of LPLK being a pattern not a diagnosis. 

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