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 1888 - 23 Aug - Dr Diwan

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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64 year-old male with right dorsal wrist biopsy


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Anil Patki

Posted · Report

Necrobiotic foci of collagen in dermis - granuloma annulare with perforation

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Raul Perret

Posted · Report

It is hard to appreciate on these pictures that look rather pink. But I thought of actinic granuloma (O'Brien).

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vincenzo polizzi

Posted · Report

I think this could be an example of granuloma annulare, despite the massive elastic dermal material, because: 1) this is a perforating lesion   2) this a well organized granulomatous lesion, unlike the actinic granuloma   3) it seems to see mucin interposed between the actinic material and between the keratin fibers ( alcianophil material in the last picture).

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Victor Delgado

Posted · Report

The pictures are too bright, but my bet is for Granuloma Actinic.

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Sasi Attili

Posted · Report

As others already mentioned- quite difficult on these pics. Agree perforating actinic GA likely. But just puzzled by the intense/ dense inflammation throughout. Usually inflammation in GA and its variants is more patchy/ less severe.

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Robledo F. Rocha

Posted · Report

Notwithstanding the difficulties created by the color imbalance, I also thought of perforating granuloma annulare.

Actinic granuloma of O’Brien is merely a variant of granuloma annulare of sun-damaged skin, in my opinion.

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Dr. Hafeez Diwan

Posted · Report

Agreed with the above.  GA vs. actinic granuloma (which may be the same thing). He had other such lesions as well.

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