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 920 - 31st December Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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The patient is a 14 year old boy with a punch biopsy taken from the right temporal scalp.

Case posted by Dr. Mark Hurt


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Guest Romualdo

Posted

I think this is just an intradermal melanocytic nevus from one of the special sites, to know, the scalp.

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Sasi Attili

Posted

I would go for a compound naevus with architectural atypia in junctional nests- benign. Complete excision however advised if clinical suspicion persists.

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Robledo F. Rocha

Posted

Compound melanocytic nevus of so-called special site with secondary trichostasis spinulosa.

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Guest Amira Tawdy

Posted

Atypical pigmented spindle cell nevus ( vertically oriented nests of spindled shaped cells, the nests are irregular in size, few are confluent, fusion of the rete riges in some foci, many dermal melanophages)

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Dr. Richard Carr

Posted

Although I am not overly worried by the appearances here in practice I would be very reluctant to give anything more than a descriptive report (e.g. dark, junctionally active melanocytic lesion, relatively bland but further comment is limited by lack of clinical information). In my view punch biopsy of a pigmented lesion in the absence of any useful clinical information are the perfect scenario for litigation!

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Guest Romualdo

Posted

I meant to say "compound", not "intradermal" melanocytic nevus from one of the special sites.

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Dr. Mona Abdel-Halim

Posted

Agree with Dr Carr... I hate commenting on punch biopsies of pigmented lesions!!!!!! Agree that nothing is worrying here but without clinical information and without seeing the whole lesion, I can not say a definite diagnosis.

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Robledo F. Rocha

Posted

Yes, Dr. Carr and Dra. Halim are right. This is only a part of the whole lesion. Maybe an unpleasant surprise is hidden. Excisional biopsy ir required for definitive diagnosis.

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Mark A. Hurt MD

Posted

Thanks, everyone for your preliminary diagnoses. What follows is the Melan-A staining. Does it sway you to a specific diagnosis? I will post my diagnosis at Noon central time (18:00 London time), so that everyone can prepare for the New Year's activities!

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE920_Image%2007.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE920_Image%2008.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE920_Image%2009.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE920_Image%2010.jpg[/img]

[img]https://dermpathpro.com//uploads/spot_diagnosis_comment_img/CASE920_Image%2011.jpg[/img]

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Mark A. Hurt MD

Posted

My diagnosis was lentiginous melanocytic nevus. I do have sympathy for this as a pigmented spindle cell nevus or a "special site" nevus. I thought that Melan-A was particularly helpful by showing how the suprapapillary plates are spared uniformly throughout the lesion.

Best wishes to everyone for the New Year, from

Mark

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