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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 2327 - 17 May 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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M85. Lower leg. Keratotic nodule. r/o SCC

Edited by Admin_Dermpath


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Krishnakumar subramanian

Posted

keratoacanthoma

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vincenzo

Posted (edited)

Difficult...a verrucous ( ptychotropica ) porokeratosis?

 

Edited by vincenzo

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John Zhang

Posted

Ki67 is low. P16 is negative. p53 is neither null or strong positive - the staining patter looks benign, maybe a wart. But I am not sure that it is not a squamous cell carcinoma given the patient's advanced age. I would send for HPV typing. If positive, I am okay reporting as a wart. In which the dermatologist will probably freeze it to death, which will probably kill it even if it were SCC since most of the lesion is out. Otherwise I want to call it SCC. Waiting for the real answer...

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Meenakshi Batrani

Posted

Verruca- Myrmecia type

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The immunostaining is fun to look at, but from practical standpoint, probably I would just call it a SCC and recommend additional treatment as John said.

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Krishnakumar subramanian

Posted

bowenoid wart due to actinic induced and may be caused by non oncogenic HPV strain

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dermpath1

Posted

Take it Richard , It is just warty dyskeratoma.

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Dr. Richard Carr

Posted

Great discussion. Remember not all cases have an answer! If one wanted to to give a descriptive label it is indeed a "warty dyskeratoma" (but lacks the acantholytic and basal budding of that already recognised entity). My report as follows:

Well differentiated squamoproliferative lesion with endophytic pushing borders.  The lesion lacks frank dysplasia, but shows rather striking dyskeratosis.  I cannot render a definitive diagnosis.  Complete excision may be advisable if the lesion were to recur.

Personal notes: Ki67 basal, p53 & p16 wild. I guess you could label this lesion descriptively as "benign verrucous/warty acanthoma with prominent dyskeratosis"

It's sometimes nice to show these everyday problems and lesions that have not read all the pages of the textbook!

I agree this may be a non-high risk HPV lesion. It probably falls into the spectrum of lesions called "benign verrucous keratosis" seen in patients who are on BRAFi and I use a similar term for sporadic lesions. 

See Case 1746: 

Myrmecia wart is somewhat different

See case 1242:

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Krishnakumar subramanian

Posted

thanks a lot sir useful learning points

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