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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 4089 - 22 September 2022 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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76M recurrent lesion left cheek


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Trichilemmoma with reactive atypia vs SCC with trichilemmal differentiation. Favour former. 

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Eman El-Nabarawy

Posted

Favor irritated/inflammed trichilemmoma.. 

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Meenakshi Batrani

Posted

Trichilemmoma. There seem to be some atypia, not sure if it is reactive change in irritated/ inflamed lesion or signify trichilemmal carcinoma in situ

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Madhavi Maheshwari

Posted

Trichelemmoma with some reactive changes

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vincenzo

Posted

Yes. Trichilemmoma with reactive changes. 

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Saleem Taibjee

Posted

I can see that you are all in the same ballpark. I also reported the original histology (shave procedure) on this case which was very similar. I think it is noteworthy that this is a recurrent lesion. In my experience benign trichilemmomas virtually never recur. The additional immunohistochemistry was interesting in this case (see below). There is some tumour staining with CD34 which supports genuine trichemmal lineage. However, there is also marked upregulation of p53. Of course, p53 is not proof of dysplasia, but given the overall context is perhaps significant. Hence I feel that this could be a genuine 'low grade' trichilemmal carcinoma. The lobulated dermal profile would suggest minimal metastatic potential (in-situ versus 'pushing invasion'). However, as a precaution I have opted to follow up the patient for a couple of years as for SCC.

image.jpegimage.jpegimage.jpeg

image.jpeg

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vincenzo

Posted

Yes Saleem This is a very great case. Trichilemmal carcinoma isn’t a ghost lesion, but a reality. 

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