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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 2796- 25 March 2021 Posted By: Saleem Taibjee

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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54F incisional biopsy left breast, suspected haemangioma/vascular lesion


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Richard Logan

Posted

I wonder if this is the early inflammatory phase of a lesion of extra-genital lichen sclerosus.

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Saman Fatah

Posted

I entirely agree with you Richard about your suggestion of extra-genital LS, the haemorrhagic plaque with eminent blistery surface clinically complete the picture when correlated with the histology. 

Was this patient on any anti-coagulants or anti-platelets? the mechanism of upper dermal haemorrhage is not clear in such cases and not all the them are on those medication. If anybody know, it will be useful to educate us.

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Bullous and haemorrhagic lichen sclerosus

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Krishnakumar subramanian

Posted

bullous LSA

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Saleem Taibjee

Posted

Yes, this is haemorrhagic / purpuric / bullous extragenital lichen sclerosus. It is always a good feeling to come up with a histological diagnosis which was completely unsuspected by the clinician! When we scrutinise the clinical images with the benefit of hindsight, we can appreciate some subtle white sclerotic change above the haemorrhagic area. As far as know, the patient does not have any predisposition to haemorrhage, anticoagulants, etc. This phenomenon is presumably directly related to the dermal and vascular fragility caused by LS. I have not previously come across such a striking haemorrhagic example in an extragenital location. As we know, haemorrhagic changes are not so uncommon in vulval LS, and indeed have led to concerns of sexual abuse in some cases.

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