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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 2779 - 2 March 2021 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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85 year old male with lesion on cheek.


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vincenzo

Posted

Not enough images, or too difficult case for me. ? Sebaceous Carcinoma. 

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Alex-Ventura-Leon

Posted

Difficult for me too. But let´s try: What about a Trichilemmal Carcinoma?

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Anil Patki

Posted

Squamous cell carcinoma with clear cell change

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Richard Logan

Posted

3 hours ago, Anil Patki said:

Squamous cell carcinoma with clear cell change

Yes, that's my impression too.

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Victor Delgado

Posted

Agree with clear cell squamous cell carcinoma, but why is neither a Sebaceous Carcinoma nor Trichilemmal Carcinoma to me?
Well, in SC the cells have microvacuolated cytoplasm and central nuclei, irregular, spiculates and kind of scallopated with a lot of mitotic figures and even necrosis;  TC is well difenid with periferall palisaded, lobulated, there is more atypical squamoid cells, bright eosinofilic citoplasm with clear cell changes as well, the nuclear atypia is moderate to severe, mitotic figures incresed a few of them atypical and of course... trichilemmal like keratinization

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Uma Sundram

Posted

Clear cell SCC. I thought the type and amount of clear cell change was striking. I will ask Trevor about the images. They have a lot of compression artefact.

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vincenzo

Posted

20 hours ago, Victor Delgado said:

Agree with clear cell squamous cell carcinoma, but why is neither a Sebaceous Carcinoma nor Trichilemmal Carcinoma to me?
Well, in SC the cells have microvacuolated cytoplasm and central nuclei, irregular, spiculates and kind of scallopated with a lot of mitotic figures and even necrosis;  TC is well difenid with periferall palisaded, lobulated, there is more atypical squamoid cells, bright eosinofilic citoplasm with clear cell changes as well, the nuclear atypia is moderate to severe, mitotic figures incresed a few of them atypical and of course... trichilemmal like keratinization

Yes. Well done. And useful description about differential. Thanks Victor. 

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Josie Bisi

Posted

On 03/03/2021 at 20:19, Victor Delgado said:

Agree with clear cell squamous cell carcinoma, but why is neither a Sebaceous Carcinoma nor Trichilemmal Carcinoma to me?
Well, in SC the cells have microvacuolated cytoplasm and central nuclei, irregular, spiculates and kind of scallopated with a lot of mitotic figures and even necrosis;  TC is well difenid with periferall palisaded, lobulated, there is more atypical squamoid cells, bright eosinofilic citoplasm with clear cell changes as well, the nuclear atypia is moderate to severe, mitotic figures incresed a few of them atypical and of course... trichilemmal like keratinization

Agree

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