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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 2627 - 31 July 2020 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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M80 Jawline lesion.

Edited by Admin_Dermpath


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Dr. Mona Abdel-Halim

Posted

Of course melanoma should be excluded, but I also thought of atypical cellular neurothekoma? Definitely needs IHC. 

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Meenakshi Batrani

Posted

I would also consider cellular neurothekeoma. There are also seems to be some biphasic pattern under low magnifciation, with peripehral light areas and central dark zone, which makes me include myofibroma as a differential.  IHC needed. 

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Victor Delgado

Posted

My first thought goes with Clear Cell Sarcoma, 2º choice Clear Cell Melanoma. Same IHC but CCS has t(12;22) (q13;q12): chimeric EWSR1/ATF1.

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?Clear Cell BCC...

Merkel Cell Carcinoma could be BerEp4+ also, but it’s usually EMA+  

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Dr. Richard Carr

Posted

This is a clear cell BCC with desmoplastic tricholemmoma-like features. The combination of moderately strong BerEP4 and COMPLETELY NEGATIVE EMA in the BASALOID epithelium is practically pathognomic of BCC. I did not do melanocytic or myoepithelial markers after seeing this IHC pattern. You can see focal CD34 in these types of BCC (not in this one). BerEP4 can be reduced in clear cell BCC and the EMA, completely negative in the BASALOID component is very typical for BCC in such cases.

I've added to the discussion in last weeks case following Anh's helpful points.

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Krishnakumar subramanian

Posted

Sir no words, thanks a lot for this case

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