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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
Case are uploaded each week day by 10 am UK time with the correct diagnosis will generally be posted at 8 pm UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 684 - 28 Jan Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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66 years-old male, lesion on foot
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Go to records January 2013

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Guest Hazem Hamed

Guest Hazem Hamed

Posted

Acral lentigenous melanoma.

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Robledo F. Rocha

Robledo F. Rocha 336

Posted

This lesion has two distinct cellular populations. On the right side one can see lentiginous and nested cells with vesicular nuclei and prominent nucleoli. On the left side there are lentiginous cells with hyperchromatic nuclei. Both of them have widespread cytological atypia and show disordered pagetoid spread. At least one mitotic can be found, in the Picture #3. So, I think it’s in-situ acral lentiginous melanoma.
“Maniac” is expected to occur in younger patients and to have spotty cytological atypia.

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Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim 508

Posted

Acral Lentiginous Melanoma, In situ phase.

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Sasi Attili

Sasi Attili 85

Posted

I think this is a tricky one (MANIAC vs MIS). This is a relatively small and circumscribed lesion. The lack of significant atypia/ cohesion in my opinion is more in favour of MANIAC

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Guest Jim Davie MD

Guest Jim Davie MD

Posted

Agree with Dr. Rocha 100% on all observations. The hyperchromatic and epithelioid populations intermingle at their juncture, so not dismissable as a crush/histology artefact. In-situ acral lentiginous melanoma.

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Guest Dr Engin Sezer

Guest Dr Engin Sezer

Posted

I couldn't observe marked polymorphism at melanocytic cells which are in approximate size with med-dermal keratinocytes. Upper migration appears to be centrally located, hence I considered of acral naevus (special site)

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Guest Dr Engin Sezer

Guest Dr Engin Sezer

Posted

Sorry mid-epidermal keratinocytes would be the correct spelling..

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Dr. Phillip McKee

Dr. Phillip McKee 130

Posted

The importance of clinicopathological correlation. MANIAC occurs in young people and regretably as I approach 65 years, 66 years cannot be regarded as a "spring-chicken"!!! The correct diagnosis is [i]in situ [/i]acral lentigious melanoma. Mind you, I have seen examples of MANIAC where the features have been pretty well indistinguishable from [i]in situ [/i]melanoma. The dermal component however has been bland.

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