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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 944 - 4th February 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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The patient is a 76 year old woman with a shave biopsy taken from the left temple.

Case posted by Dr. Mark Hurt


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Eman El-Nabarawy

Posted

Melanoma with balloon or clear cell changes.

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Dr. Mona Abdel-Halim

Posted

Melanoma with focal clear cell change...

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Guest havva gökçe

Posted

favour baloon cell melanoma, ihc needed.

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Baloon cell melanoma. I think the lentiginous proliferation and the focal cellular nests speaks against Sebaceous carcinoma, but this is a good differential diagnosis. I would perform IHQ. Probably amelanotic (no pigments and the shave procedure).

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Robledo F. Rocha

Posted

Both sebaceous carcinoma and clear cell melanoma may show pagetoid spread and bubbly cytoplasm, but I favor the latter because the lentiginous pattern of growth along the dermoepidermal junction.

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Guest Maria George

Posted

Similar to yesterday game.SCC vs AX vs melanoma. In this case you may add Seb. ca for IHC.

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Guest Jim Davie MD

Posted

I favor invasive clear cell SCC.

The left images on the 2nd, 3rd, and 4th rows show clear intraepidermal cells with linear vs. elongated nested distribution along the junction, but to my eye, they seem placed suspiciously above (rather than below) the epidermal basement membrane. Some cells in my opinion show subtle features of keratinocytes.

I agree with the differential of clear cell melanoma, vs. Seb Ca. Immunostains will differentiate; PAS +/- diastase for assessment of glycogen content may be of additional utility.

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Guest Engin Sezer

Posted

S100, adidophilin and MNF-116 for Dx. Probably balloon cell melanoma

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Mark A. Hurt MD

Posted

Here are the immunostains. My diagnosis at 20:00 GMT

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE944_Image%2009.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE944_Image%2010.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE944_Image%2011.jpg[/img]

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Mark A. Hurt MD

Posted

Yes, this is melanoma. I think this case is a real challenge because of the differentials that were raised here. Can you imagine what the diagnosis would have been prior to the emergence of IHC as a viable technology?

Thanks to everyone for participating.

MAH

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