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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 2477 - 2 January 2020 Posted By: Saleem Taibjee

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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84F, peri-anal skin biopsy. Previous ulcer ?related to nicorandil. Now much improved, area of erythema


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Dr. Richard Carr

Posted

Reminds me of something we published in the vulva a while ago.

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Dr. Mona Abdel-Halim

Posted

Benign mucinous metaplasia

 

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Agree, benign mucinous metaplasia. I don´t see any atypia for a bowen disease plus metaplasia. Nice case, I have never seen this diagnosis.

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Yes. Agree with Mona. I didn’t know this. 

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Eman El-Nabarawy

Posted

On 02/01/2020 at 15:10, Dr. Mona Abdel-Halim said:

Benign mucinous metaplasia

 

Agree. Never seen before.

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Saleem Taibjee

Posted

Yes, well done, this is mucinous metaplasia. The Alcian blue stain is shown below.

I first became aware of this from a case which Richard Carr had co-authored: Extensive mucinous metaplasia of the vulva
arising within Zoon’s vulvitis. British Journal of Dermatology 2007;156:748–91.

This has also been reported on the penis. However, this is the first such case which I have come across on perianal skin. I reported the case as a backlog case for another hospital, but have not heard further from the clinician.

Funnily enough, after submitting this case, just last week I came across another example of focal mucinous metaplasia arising in a background of balanitis xerotica obliterans the in my routine pile! Some images also follow below.

BW Saleem

19BTNB37939 -- 19B022650 -- Dacey -- A1 -- AB DPR -- Taibjee_40.0x alcian blue.jpg

01851_2.0x.jpg

01851_20.0x.jpg

01851_40.0x.jpg

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Saleem Taibjee

Posted

Here is another useful reference which I forgot to include earlier:

Boer-Auer A, et al. Benign mucinous metaplasia of the genital mucosa: histomorphological and immunohistochemical features and criteria for differentiation from extramammary Paget disease. British Journal of Dermatology 2011 165;1263–1272

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Dr. Richard Carr

Posted

I guess this is a progression from Zoon's. Needs a dermatologist to assess for underlying irritant or lichenoid dermatosis including lichen sclerosus & lichen planus etc.

Nice case Saleem and nice to see the paper getting a mention!

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