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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 1044 - 24th June 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 38-year-old white woman with an excision of a pigmented lesion on the nasal tip.

Case posted by Dr. Mark Hurt.


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Eman El-Nabarawy

Posted

Amelanotic cellular blue nevus.

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Arti Bakshi

Posted

Wedge shaped intradermal melanocytic proliferation with an admixture of spindle and dendritic cells. There is variable pleomorphism, but no mitoses.
Benign, probably a variant of blue naevus.

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nick turnbull

Posted

Agree, hypopigmented blue nevus

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Dr. Mona Abdel-Halim

Posted

Hypopigmented blue nevus

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Robledo F. Rocha

Posted

My first impression was a benign fibrous tumor, but the presence of a few pigmented cells with bipolar or dendritic processes drove me to the diagnosis of hypopigmented blue nevus.

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Guest Dr Gonzalo de Toro

Posted

The lesión is wedge shaped, with some dendritic melanocytes with elongated and neurofibroma-like featues. I favor a hypopigmented blue nevus.

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Mark A. Hurt MD

Posted

Here are the immunos:

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1044_Image%2008.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1044_Image%2009.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1044_Image%2010.jpg[/img]

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Dr. Richard Carr

Posted

Agree with hypopigmented blue naevus. Most of the lesional cells are S100 negative as expected. Nice internal control in Langerhan's cells and nerves.

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Guest Jim Davie MD

Posted

Agree with hypomelanotic blue nevus (possibly congenital).
The bland histology (slightly hyperchromatic senescent nuclei with small to inconspicuous nucleoli), non-expansile architecture (that surrounds and does not significantly disturb/displace arrangement of adnexa), sparse evenly distributed interspersed melanophages, absence of mitotic activity, and absence of inflammatory reaction help support the diagnosis; the immunostains are similarly congruent (no Ki67 or PHH3 detectable proliferative / mitotic activity, and expected positive staining for Melan-A and S100.)

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Mark A. Hurt MD

Posted

My diagnosis was blue nevus, diffuse, neurofibroma like, hypomelanotic.

I was particularly impressed by the sparing of the adnexa. Often, because of the fibrosis in a blue nevus, I find that it distorts the adnexa somewhat. In this example, it doesn't occur; thus, it has a neurofibroma-like quality about it.

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