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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
Case are uploaded each week day by 10 am UK time with the correct diagnosis will generally be posted at 8 pm UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 2459 - 5 December 2019 Posted By: Saleem Taibjee

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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“This is a routine case from last week: 75F scalp, the GP suspected sebaceous cyst”

Edited by Admin_Dermpath

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Krishnakumar subramanian


dermal round tumor cells and also intraepithelial spread

Merkel cell carcinoma

does not look like sebaceous gland carcinoma

IHC needed sir

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Dr. Mona Abdel-Halim


MCC is my first thought vs. metastasis (small cell carcinoma of the lung)

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Saleem Taibjee


Well done guys. Yes this is probably metastatic small cell carcinoma. The tumour is positive for neuroendocrine markers (CD56, chromogranin and synaptophysin), negative for CK20, and strongly positive for CK7 and TTF1 (the latter is shown below).

Of course, the patient requires imaging.

The caveat is that there are examples of CK20 negative, TTF-1 positive, Merkel cell carcinoma, in the literature. Below are links to a couple of pertinent articles.

BW Saleem



53232_10.0x TTF1.jpg


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