Richard Carr
@RACARR51
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Dermatopathologist, Warwick Hospital UK.
Leamington Spa, England
Joined December 2017
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Link to the paper that should help everyone diagnose keratoacanthoma with greater confidence.
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2024 Wk26 RAC9114 Bonus. M60 ish, thigh, firm subcutaneous lump. Spot diagnosis.
#TooCloseToDiagnose
??
#Dermpath
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2024 Wk29 RAC9131 F10 ish. Calf lesion. Rare but still a
#SpotDiagnosis
#TooCloseToDiagnose
#Dermpath
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Dermpath Case for the Day No.2: M75. Scalp, vertex: Pigmented lesion ?LM ?SEBK. I'll probably wait for a couple of responses on this one! Amar far too quick last time.
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Dermpath Case of the Day. F80 Scalp nodule. Feel free to have a go even if you're not expert just make some comments or share with colleagues. Happy Thursday!
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RAC9114: Some great responses to this TRICHOGERMINAOMATOUS variant of TRICHOBLASTOMA (only one nice papillary mesenchymal body noted). H&E diagnosis for me. Molecular Abn.??
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2024: Wk29 RAC9142 F30s Cyst Rt forearm (from today outsource case - this is not a joke): Should I do IHC for fun? - I think this is benign & c/w perineurioma. Please bear in mind 45% shortage of pathologists, similar for lab staff, health system in crisis. Thanks. 😇🙏😇
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2024 Wk2 Friday Case: M50 (ish) Shoulder ?BCC ?KA.
#dermpath
#WHOSkin5th
Please have a go no matter if you're beginner or world expert (or both) @😇
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2024 Wk29 RAC9132: F70s. Multiple Red crusty patches ?Bowen's ?AK to exclude SCC. C) From Elbow.
#Dermpath
#ImportantMessageCase
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2024 Wk 27 RAC9125. F70s. Abdomen. Rapid growth ?SCC ?KA 5mm biopsy. Bisected.
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Monday Muddle RAC8851: M80s. Nodule. Slowly enlarging over 18 months. Non-tender, firm consistency, slightly mobile. No bleeding or discharge.
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2044: Wk 12 Tues RAC9073:
#TooCloseToDiagnose
#dermpath
Nice case from the levels and specials pile. Nothing in the 1st 3 levels.
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2024 Wk1 Friday RAC8997: M80s Left neck. ?SCC ?PG Macro: exophytic tumour 39mm diameter.
#dermpath
Low power is best & common things are uncommon on X
@DanGrahamMD
🤣😇
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2024 Wk 3 Friday: Now ONLY use of megablocks slides in skin cut-up.
#savetheplanet
#stoicpholosophy
#mindfulness
#dermpath
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Tuesday Basic: Solar (freckle) lentigo is NOT a lentiginous melanocytic proliferation but overlaps with thin SEBK. Textbook case has bulbous rete "mister-men fee" but can be challenging with flat rete and lichenoid keratosis (reaction pattern) obscuring the lesion.
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2024 Wk 12 Fri: F70s, 2 years lesion on the heel ?Calcified Cyst. For trainees today (first). We'll let experts have a go if you don't get it😇
#TooFarToDx
#ItsNeverACyst
#dermpath
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Dermpath Case RAC9020 for your thoughts & opinions. Any IHC might help?
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2024 Wk14 RAC9083: Hm! F60 ish. Cheek ?epidermal cyst?
#ItsNeverACyst
#TooCloseToDx
#Dermpath
Having mixed feelings about this case?
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2024 Wk13 Thurs: M~70. Longstanding mole lower back, has changed, clinically slightly variegated colour. 4 opinions & sharing
#dermpath
@david_terrano
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MP1: Brain cortex: Nearly every capillary RBC infected by unpigmented parasites (P. falciparum) - rare. Sparse malaria pigment from previous schizogeny. MP1: Liver with haemozoin in sinusoids, lack of parasitised RBC in sinusoids.
@BloodScientist
@ttmalawi
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RAC91111: The patient had another fibrous papule (angiofibroma). Our first thought was EFH but I remembered the epithelioid cell variant of fibrous papule and given location this was our fav'd Dx. Some more images👇See also: PMID: 30028760
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RAC9120: This was a example of a nodular BCC with a nice infudibulcystic pattern in areas. IFCBCC can be indistinguishable morphologically from BFH altho latter typically has reactive MC & is limited to expanding from single follicles (never deep).
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Wednesday Wee-wowzer: F60s Rt lower eyelid. 2/3mm lesion, 18 mths.
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2024 Wk 3 Friday: Cut-up approach 2 skin WLE = careful exam & ltd block selection. Worked in Malawi in youth. 1 block per case max. Most memorable case: post-gravid (PPPH) uterus with cervix & ovarian tumours. Used thin slithers & sampled everything 😇
#NoMegaBlocksRequired
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2024 Wk 5 Friday RAC9041: M90s scalp - same patient as Tuesday. We discussed u can have different patterns of p16/p53 aberrancy. Here SCC, subtle AK, & two BAK all within 7mm have 4 different highly aberrant p16/p53 patterns. Don't assume background AK related to inv cSCC😇
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Dermpath Case for Next Week. F68. Right Jawline. BCC? Opinions & thoughts? Happy Saturday!
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Dermpatholoyg case for interest (dipping my toe in here!) M55. Multiple lesions previously and now 3 more all look similar, two on thigh and one on lower leg. Representative H&Ex4. What is the diagnosis? What IHC stains might be helpful? Any other interesting facts?
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Wednesday RACer: RAC9015. 70s, Neck. Lesion. For opinions & sharing.
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Dermpath Case of the Day: F65. Shoulder. BCC excised with 2mm margins. For opinions and comments.
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2024 Wk32 RAC9145 F60s Tip of nose. x2 BCC nose & brow & actinic keratosis on brow.
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2024 Wk6 (Sickie) Monday RAC8983. M60s Inner canthus, nodule 3 years, ?BCC. Is the first Monday in February really the day that most employees will call in sick?
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Dermpath Case of Day: Clinical: M77. Rapidly growing keratotic nodule, 14 x 12mm in clinic (but 20mm at excision 8 weeks later) ?SCC ?KA. Widespread Grover's disease. h/o BCCs, SCC, AK, & h/o KA right upper ear settled without treatment. Happy Friday!
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Happy Friday: RAC9012 M72. Cheek BCC. For thoughts & sharing.
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2024 Wk 20 RAC9099: A new X
#dermpath
rule. When you see this take a picture!!! Better than molluscum IMO but is
#TooFarToDiagnose
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Post on Gottlieb bodies being under-recognised made me think of my personal observation of intra-epithelial mucin as a clue to follicular lesions (follicular mucin), mainly FSCC but some SEBK, IFK & tricholemmoma. Missed by everyone as far as I'm aware (could be wrong again!)🤣😇
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2024 Wk 3 Friday RAC9046: IHC as requested (colleagues case). My diagnosis H&E: Suspicious for lentigo maligna. MelanA in keeping with LM (Sox10 and PRAME are options). PRAME negative case.
#dermpath
@Dermpathl
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2024 Wk 22 RAC9104: Hm! I missed Wk 21 (another new years resolution up the spout):
#TooMuchGolf
#TooCloseToDiagnosis
#Dermpath
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Monday Mayhem Bonus Case from Prof Sebastian Lucas (my mentor). Any suggestions?
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2024 Wk19 (just!) Sunday RAC9095. It will have to be blind of clinical as I seem to be slipping and forget to add to my database! Just a recent bench case.
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Thursday Thought Provoker: RAC9006. F71. Left neck. 6/12 h/o indurated erythematous plaque, slowly enlarging. For opinions & sharing.
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V excited (published in reverse order): 1. follicular SCC common tumour can closely mimic KA (23Apr24); 2. p16 & p53 highlighting KA is NOT cSCC, fPEH in FSCC also v KA-like (Nov23); 3. WHO adopts KA NOT cSCC & recognises common FSCC (Feb23)!
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