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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 1034 - 10th June 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 64 year old woman with shave biopsies of an irregular macule taken from the left scapula.

Case posted by Dr. Mark Hurt.



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Robledo F. Rocha

Posted

I favor lentiginous nevus, too. Nevertheless, as pigmented lesions on the back of an old man are always source of concern, immunostains are required to rule out definitively the possibility of melanoma in situ.

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Mark A. Hurt MD

Posted

Here are the special stains:

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1034_Image%2005.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1034_Image%2006.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1034_Image%2007.jpg[/img]

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Dr. Mona Abdel-Halim

Posted

I can not perceive nests actually neither on H&E nor on Melan A, just lentiginous proliferation mainly along the tips and sides of rete ridges. The supra papillary plates r involved very focally with single non contiguous cells. I do think the lesion is an innocent simple lentigo. Waiting for the experts!!

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Eman El-Nabarawy

Posted

Lentiginous melanoma.

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Guest Jim Davie MD

Posted

Agree with opinion of a hyperpigmented lentiginous junctional nevus. Depending on the overall architecture, this could alternatively qualify as a low-grade dysplastic nevus, as there is the hint (on low power) that this may be a poorly circumscribed lesion with some possible rete bridging, in the context of a clinical irregular macule and sun-damaged skin.
In my opinion, there is some tangential orientation that may be contributing to the increased (perception of) suprapapillary single melanocytes. No high grade atypia or significant pleomorphism, no significant epidermal attenuation or intraepidermal pagetoid scatter.

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Mark A. Hurt MD

Posted

My diagnosis was lentigo simplex. Some might interpret this as a junctional lentiginous melanocytic nevus. My justification is the lack of discrete theques (epidermal nests). Some have used the term "jentigo" for such lesions, but, still, I like to see theques for the diagnosis of a nevus.

The pigment complicates the diagnosis by H&E, but the red chromogen Melan-A stain clarifies the position of the melanocytes, which are mainly in the tips of the retia, sparing the suprapapillary plates (arrows). I find this sparing effect especially useful in such cases.

The Ki-67 marker shows sparing of the basal layer, where melanocytes are located, and the marker stains the suprabasal layer (with a few exceptions).

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