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H&E stain showed a normal epidermis, increased thick collagen bundles in the dermis, and dermal thickening. Trichrome stain showed haphazardly arranged thick collagen bundles in the dermis and orcein stain showed dense collagen fibers with diminished elastic fibers.

The cutaneous changes were present since birth and had been slowly increasing in size. The rest of the physical examination was normal and she had and no family history of similar dermatoses.

Can you guess the diagnosis? . . An 8-year-old girl presented with asymptomatic sclerotic flesh-yellowish colored papules and nodules in a linear distribution over her right popliteal space, not following a specific dermatome. #dermtwitter #dermatology #diagnosisoftheday

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Histopathology demonstrated an epithelial neoplasm in the dermis, formed by nests of clear cells with prominent vasculature in the stroma.

Of note, the patient had a history of RCC that was treated 7 years prior with a nephrectomy and inferior vena cava thrombectomy with no evidence of recurrence.

Because this nodule continued to grow, she presented to dermatology with a pink exophytic friable nodule overlying a fluctuant but firm subcutaneous nodule on the right chin.

Can you guess the diagnosis? . . A 45-year-old woman presented with a four-month history of a painful, bleeding chin nodule previously treated with warm compresses, antibiotics, and incision and drainage.

Of note, the patient had a history of RCC that was treated 7 years prior with a nephrectomy and inferior vena cava thrombectomy with no evidence of recurrence.

Can you guess the diagnosis? . . A 45-year-old woman presented with a four-month history of a painful, bleeding chin nodule previously treated with warm compresses, antibiotics, and incision and drainage. Because this nodule continued to grow, she presented to dermatology.

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Histopathology of an upper lip lesion showed an irregular proliferation of basaloid cells in anastomosing strands and cords with peripheral palisading and cysts with trichilemmal keratinization. Immunohistochemistry was positive for BerEP4.

Medical history and physical examination were otherwise unremarkable. Her father had similar lesions but had never been biopsied or diagnosed. Remaining family history was negative.

Can you guess the diagnosis? . . A 38-year-old woman presented with a 5-year history of multiple small, asymptomatic, follicular, skin-colored papules over the face, particularly in the periorbital region and the upper cutaneous lip.

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Biopsy was notable for a dense infiltrate consisting of monomorphic lymphocytes oriented around superficial and deep vascular and adnexal structures. Epidermal change, plasma cells, and dermal mucin were absent. IHC confirmed the presence of a predominantly T cell population.

He noted that the first episode of this eruption occurred after starting IVIg treatments. The rash had occurred predictably after every IVIg treatment, always within one week.

He reported that he had developed the eruption at least five times previously, which predictably resolved several weeks after initial appearance. The patient’s only major medical issue was myasthenia gravis, which had necessitated recent initiation of IVIg infusions.