Jul 9, 2026 · 13 min · 5 segments
Send me a derm question or story through text or voicemail! Is allergen-specific immunotherapy the closest thing we have to changing the course of…
But first, let's get to our Weekly Itch Inquiry, and this Itch Inquiry comes from South Dakota, and the question is: How can you tell the difference between autoimmune disease and neoplastic disease on a nasal planum? Um, e- of course biopsy, but what are other things that will give you an indication? So this is probably coming a bit off of the episode we recently did with the German shepherd nasal planum, and of course you cannot definitively say without a biopsy.
But what are some things that can just give you hints? Um, certainly we think of lymphoma when we think of neoplasia, but there are other things that can affect the nasal planum.
Um, so for example, squamous cell carcinoma is something I've recently seen on a German shepherd nose.
Um, it was more focal, um, not diffuse like we tend to see with nasal planum disease.
Not a specific pattern like we talked about that recent ALR, arteropathy episode with the German shepherd, um, but just more of a unilateral thickening ulcerative disease to the nose, which when I usually see autoimmune diseases like DLE, it tends to be more of a diffuse loss of cobblestone appearance to the nose, um, or depigmentation to the nose.
So if you're going to have something like a more solitary tumor, obviously it tends to be more unilateral.
Um, of course lymphoma can very much mimic some of these other autoimmune diseases when we talk about epitheliotropic lymphoma.
Obviously one of the big hallmark things with that would be actually, uh, age.
So looking at the signalment, is this a patient that has, you know, is 12 and all of a sudden is developing depigmentation to the nose versus a four-year-old developing depigmentation to the nose? And then I really wanna evaluate other lesions.
So do we have depigmentation, loss of cobblestone appearance just to the nose but the rest of the body is not impacted? Um, you know, maybe I'm a little bit more suspicious of something like DLE, though again, you don't know for sure without biopsy, versus a dog that has depigmentation to the nose, the lips, silver, you know, thick silver scales all over the body, um, crusting ulceration.
Of course, autoimmune diseases like pemphigus can do that, but if an older dog that's developing those other lesions, depigmentations other places, um, then I would probably be worried about something like epitheliotropic lymphoma.
The, you know, unilateral obviously would be something we don't tend to see with autoimmune diseases.
But these diseases really can mimic each other, especially when you talk about a more diffuse cancer like lymphoma versus a solitary tumor.
So you can get indications based on lesions on the other parts of the body, the age of the patient, but unfortunately nothing can really definitively tell you without histopathology, and I mean, I have been completely wrong on cases where I feel like it's gonna go one way and it's completely the other way.
So that is why we biopsy just to get that confirmation and know, but those would be the hints you can think about.
But first, let's get to our Weekly Itch Inquiry, and this Itch Inquiry comes from South Dakota, and the question is: How can you tell the difference between autoimmune disease and neoplastic disease on a nasal planum? Um, e- of course biopsy, but what are other things that will give you an indication? So this is probably coming a bit off of the episode we recently did with the German shepherd nasal planum, and of course you cannot definitively say without a biopsy.
But what are some things that can just give you hints? Um, certainly we think of lymphoma when we think of neoplasia, but there are other things that can affect the nasal planum.
Um, so for example, squamous cell carcinoma is something I've recently seen on a German shepherd nose.
Um, it was more focal, um, not diffuse like we tend to see with nasal planum disease.
Not a specific pattern like we talked about that recent ALR, arteropathy episode with the German shepherd, um, but just more of a unilateral thickening ulcerative disease to the nose, which when I usually see autoimmune diseases like DLE, it tends to be more of a diffuse loss of cobblestone appearance to the nose, um, or depigmentation to the nose.
So if you're going to have something like a more solitary tumor, obviously it tends to be more unilateral.
Um, of course lymphoma can very much mimic some of these other autoimmune diseases when we talk about epitheliotropic lymphoma.
Obviously one of the big hallmark things with that would be actually, uh, age.
So looking at the signalment, is this a patient that has, you know, is 12 and all of a sudden is developing depigmentation to the nose versus a four-year-old developing depigmentation to the nose? And then I really wanna evaluate other lesions.
So do we have depigmentation, loss of cobblestone appearance just to the nose but the rest of the body is not impacted? Um, you know, maybe I'm a little bit more suspicious of something like DLE, though again, you don't know for sure without biopsy, versus a dog that has depigmentation to the nose, the lips, silver, you know, thick silver scales all over the body, um, crusting ulceration.
Of course, autoimmune diseases like pemphigus can do that, but if an older dog that's developing those other lesions, depigmentations other places, um, then I would probably be worried about something like epitheliotropic lymphoma.
The, you know, unilateral obviously would be something we don't tend to see with autoimmune diseases.
But these diseases really can mimic each other, especially when you talk about a more diffuse cancer like lymphoma versus a solitary tumor.
So you can get indications based on lesions on the other parts of the body, the age of the patient, but unfortunately nothing can really definitively tell you without histopathology, and I mean, I have been completely wrong on cases where I feel like it's gonna go one way and it's completely the other way.
So that is why we biopsy just to get that confirmation and know, but those would be the hints you can think about.
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