March 2015 | Case of the month - gain CPD points

History

A 74 year old lady presented with a six month history of an enlarging lesion on her left shin. There was no history of trauma. The lesion was non-tender and had not bled. There was no other significant history.


Examination

Examination revealed a red, slightly scaly plaque


Investigations

  • What is the diagnosis?

Images

Diagnosis

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The diagnosis is a clear cell acanthoma.

  • A clear cell acanthoma of Degos is an uncommon benign epidermal lesion containing clear cells with a glycogen-rich cytoplasm
  • Lesions are normally solitary, with the lower legs being the most commonly affected site   
  • They present as a pink-red plaque or nodule with a diameter of 3-20 mm. Lesions have an abrupt margin, and thin surface scale that is adherent peripherally and leaves a moist or bleeding surface when removed
  • The dermoscopic ''string of pearls'' appearance is characteristic
  • Lesions are often excised for diagnostic purposes


For more information refer to the clinical chapter on clear cell acanthoma.

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