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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 2721 - 10 December 2020 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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78F, Pink brown scaly plaque on the lower leg.


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David Llorca

Posted

Pigmented Bowen disease. clinical and histological 

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Richard Logan

Posted

The cells involved in the Pagetoid spread have a rather bubbly cytoplasm.  I wonder if this is In-situ sebaceous carcinoma, but of course at this anatomical site pigmented Bowen's disease would be far more likely.  IHC needed.

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Meenakshi Batrani

Posted

Pagetoid Bowen's disease. Also, extamammary Paget's disease has rarely been described on unusual location other that perineal region. IHC will help. 

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Sebaceus carcinoma x pagetoid Bowen´s x extramammary Paget disease. IHQ

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Saleem Taibjee

Posted

Yes, well done, this is pigmented and pagetoid Bowen's. I picked out the most pagetoid areas for the Spot Diagnosis, but there were more conventional Bowen's areas also (see below). It is a recent case where it was nice to have the clinical and dermoscopic images to correlate with the histology. The pigment is quite striking on the dermoscopy, but notably there is no true pigment network, and the vessels are arguably 'glomeruloid', all in keeping with Bowen's. Of course, a histological clue that this is Bowen's and not melanoma with pagetoid spread is that there is preservation of the basal layer which rims the pleomorphic cells, and that any apparent nesting is not actually junctional. At a higher power, one is able to discern the desmosomal attachments. I agree that the cells are a bit bubbly, but the cells lack the indented/crenalated nuclei for true sebaceous differentiation, and this would be an odd anatomical site for sebaceous carcinoma. Hence I did not run immunos, and indeed it might be difficult to conceive an immunopanel which would reliably distinguish Bowen's from sebaceous carcinoma. I do not have access to adipophilin at our lab. I have wondered about using PRAME as a surrogate for sebaceous differentiation, but have been discouraged by others' more extensive experience (e.g. Klaus Busam).

BW, Saleem

08380_10.0x.jpg

08380_20.0x.jpg

 

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Victor Delgado

Posted

Beautiful case, tks for sharing. SCC in situ

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