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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 2604 - 30 June 2020 Posted By: Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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63 year old male with new lesion on the right lower eyelid.

Edited by Admin_Dermpath


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Difficult for me. MAC is a good differential. ?An odd MAC, mostly solid and ductal type, without follicular (keratinous) cysts. Or ?a Squamoid Ductal Carcinoma, given my impression of some atypias in last pic. 

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Richard Logan

Posted

As a non-pathologist I am struggling with this. It is clearly an infiltrative malignant tumour.  The growth pattern looks very squamoid from the epidermis, but more basaloid deeper down and there appears to be mucin in the stroma as well.  Obviously the ductal structure has to be accounted for.  It doesn't look like a typical MAC, but I can't explain it any other way.  Looking forward to hearing the final diagnosis.

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Dr. Mona Abdel-Halim

Posted

Eccrine ductal carcinoma?

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Krishnakumar subramanian

Posted

Eccrine Differentiation in Basal Cell Carcinoma 

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Uma Sundram

Posted

I like all of your assessments. MAC would be unusual, because it is relatively superficial and shows cytologic atypia. Eccrine ductal carcinoma and BCC with eccrine differentiation are good thoughts. We were unfancy w this one, and called it early invasive SCC. It's on the eyelid and the surgeon had clear margins. I think the pictures make the tumor look more basaloid than I initially thought.

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Uma Sundram

Posted

I mean this tumor is more superficial than a typical MAC, and shows more Cytologic atypia.

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vincenzo

Posted

Thanks Uma. These are very useful cases. 

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