Diagnosis: Clear cell acanthoma (Pale cell acanthoma)

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Comment: A benign, slow growing nodular or plaque-like hyperplasia of the epidermis.

Location/age: Lower extremities/middle aged and elderly.

Histologically, a sharply demarcated epidermal proliferation of glycogen-rich keratinocytes. Acanthotic epidermis is composed of cells with pale-staining cytoplasm. Parakeratosis with neutrophilic keratitis. Lesional epidermis is sharply demarcated from adjacent normal epidermis. Neutrophilic infiltration in the pale lesional squamous cells.

Deba P Sarma, MD, Omaha