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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 2619 - 21 July 2020 Posted By: Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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55 year old female with lesion on chin, r/o prurigo nodularis.


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Richard Logan

Posted

This is a superficial shave biopsy which doesn't get to the bottom of the lesion.  It's a bit like trying to name everyone in a room by looking through the keyhole, an exercise fraught with danger!  Nevertheless, I see hyperkeratosis overlying acanthotic epidermal downgrowths which look neoplastic rather than reactive i.e. not prurigo nodularis.  The downgrowths show peripheral palisading, but no retraction artefact or mucin.  There are also small horn cysts.  I think this may be a solitary trichoepithelioma.

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What about a fibrous papule with follicular induction?

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Uma Sundram

Posted

I like the comment about the keyhole! We are called upon to engage in this exercise every day as practicing dermatopathologists. I often post cases like this, to see what others would do if confronted with this scenario. I did favor a small trichofolliculoma. I like FP w follicular induction as well. The clinician wanted a second opinion, which is why getting other opinions on cases like this is a good idea.

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Dr. Richard Carr

Posted

Fibrous papule was my first thought but I suppose a glancing blow of of trichofolliculoma could be a possibility too. Agree with Richard's and Uma's comments.

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