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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 2402 - 13 September 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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M74. Anus. Ulcerated skin tag. ??SCC

Edited by Admin_Dermpath


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The nests in the dermis are too irregular to be verrucous carcinoma. Verrucous carcinoma usually has a pushing invasive borders. I do not see any in situ component, actually the superficial epithelium looks OK. I don't think I can call this SCC.

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Dr. Richard Carr

Posted

I called this an anal skin tag with pseudoepitheliomatous hyperplasia probably related to an allergic contact and / or irritant dermatitis. Striking eosinophilic spongiosis with myeloid dendritic cell clusters in the epidermis (used to be considered Langerhan's cells  but they are CD1a+, S100-, Langerin- as far as a recent paper on the eczemas). They have been called pseudopautrier's microabscesses but can also be seen in MF.

The patterns on p16 (checker-board pattern of cyto-nuclear staining) and p53 (peripheral wild type) are "reactive". EVG shows absolutely no entrapment (consistent with a non-invasive lesion in the setting of carcinoma but probably not relevant in this case).  

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