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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
Case are uploaded each week day by 10 am UK time with the correct diagnosis will generally be posted at 8 pm UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 2957 - 05 November 2021 Posted By: Dr. Richard Carr

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M90 Shoulder lesion. ?BCC ?Basosquamous

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Krishnakumar subramanian


BerEP4 negative and EMA is positive, p16 negative. p63 and p53 positive

Poorly differentiated carcinoma also do sox 10/HMB45 not miss a melanoma. p16 cannot be used for melanocytic lesion



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Dr. Richard Carr


Thanks for the stalwart responders. This case was c/o Dr Domenico Mesiano. S100 and MelanA were performed and negative. I regarded this lesion as a lymphoepithelioma-like carcinoma. I reviewed the literature on them a while back now but it appeared there was a metastatic rate in the region of ~25% of reported cases and I've seen a couple of cases metastasise myself. They may have an adnexal origin but as you're probably aware I think most cutaneous SCC are follicular "de novo" SCC. p16 here is highly aberrantly null and p53 is highly aberrantly weak / negative. The staining is probably mainly in the inflammatory cells. In contrast to some H&N SCC they are negative for EBV studies and I suppose it's always worth considering the possibility of a metastasis from an underlying primary in the H&N in particular. 

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