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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 2382 - 15 August 2019 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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60 year old female with multiple pigmented papules on the vulva. Rule out melanoma.


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BCC accounts for less than 1 % of vulval neoplasms.

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Krishnakumar subramanian

Posted

basaloid proliferative lesion

 

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Uma Sundram

Posted

So, can you all think of other diagnoses that share ddx with basal cell carcinoma at this site? BCC is part of the ddx. Basaloid proliferative lesion could be anything; let's see if we can narrow it down some :)

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Krishnakumar subramanian

Posted

I don't see any dermal tumor, otherwise some sort of basaloid proliferation over dermatofibroma could be another possibility

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I believe this is a basal cell carcinoma. Clinical information tell us about "multiple pigmented papules". Clinically we could all think about SK, Nevi and even bowenoid papulosis, but the histological pictures are very supportive of BCC. With such many lesions, as described clinically, this patient could have nevoid basal cell carcinoma syndrome (Gorlin syndrome). Ddx would be with follicular infundibulum tumor, but it is not common at this site.

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There is a proliferative vascular-fibroblastic change in superficial and medium dermis, resembling a dermatofibroma...It could be an atrophic DF with basaloid epidermal induction. 

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Meenakshi Batrani

Posted

I would consider basaloid follicular hamartoma

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Dr. Richard Carr

Posted

Looks like superficial trichoblastoma. CK20 and CD10 may help. The differential is superficial BCC.

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Uma Sundram

Posted

Hi everyone! Thank you Vincenzo for reminding me to come back to this one. There are many ways to go with this, and I like all of the benign recommendations. The other pigmented papules were lentigos, so I threw a curve ball there. We went with tumor of the follicular infundibulum but I also like superficial trichoblastoma, basaloid follicular hamartoma, and follicular induction over an atrophic DF (although that would be pretty unusual). I know this can be pretty subjective, but in our opinion the atypia did not warrant a dx of BCC.

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