Case Number : IM0010 Dr. Richard Carr

Vincenzo Polizzi - A post-inflammatory melanosis is my first thought...but not sure...

Nitin Khirwadkar - Epidermal acanthosis, hyperkeratosis and increased basal pigmentation, along with pigment incontinence within the superficial dermis. Possible, pulling up of the fat. I am not sure what this is, and how to explain a lump.
  
Dr. Mona Abdel-Halim - I find the clinical description as lump a bit odd !! I am worried about the third and last images, as if there is subtle Bowen or maybe melanoma in situ. Melan A, Ki67?? 
 
Arti Bakshi - Like Mona's suggestion of a subtle (pigmenetd) Bowens! I think the melanocytes are probably fine. Image 3 and 6 do show disordered maturation of keratinocytes and subtle atypia (particularly if one compares with normal adjacent epidermis in other images). p53 and Ki67 needed. Not sure how this ties in with lump on thigh, though!!

Dr. Mona Abdel-Halim - I think Dr Carr is still hiding the images of the real lump and showing us only the margins now !!!
  
Dr. Mona Abdel-Halim - My suspicion was correct, Bowen, pigmented type as Arti said. But still did not know why lump??!!!
  
Nitin Khirwadkar - Definitely points towards Bowen's. Spent too much time trying to find a lump, and missed the epidermal atypia.
 
Dr. Richard Carr - Unfortunately the colleagues who put the cases up sent you a curve ball by giving you the exact same history to this Monday's case - surprised none of you spotted that error!.
The correct history was as follows:
F60. Grey area on vulva, very itchy!
Diagnosis: Subtle undifferentiated VIN & (about as subtle as it gets so well done Mona for; questioning the stated history!).