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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 983 - 31st March 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 70 year old woman with an excision taken from the left lateral 5th toe.

Case posted by Dr. Mark Hurt


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Dr. Mona Abdel-Halim

Posted

I am not comfortable. Fourth image shows long dendrites extending high up in the spinous layer. Melan A shows very contiguous melanocyte proliferation. I think this is early ALM in situ.

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Robledo F. Rocha

Posted

Lentiginous melanocytic proliferation sparing suprapapillary plates, favoring acral lentiginous nevus.

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Dr. Richard Carr

Posted

Age is a slight concern. Based on pigment in the furrows likely to be benign! Dermoscopy is said to be very helpful in acral lesions and we are given no clinical features so cannot really report on what we have.

It has been recommended we examine the specimen perpendicular to the skin markings to show this useful feature. I am guessing most of the brown on MelanA is melanin but would be nice to see a red chromagen or pre-bleach.

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Eman El-Nabarawy

Posted

Acral lentiginous melanocytic nevus.

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Mark A. Hurt MD

Posted

My diagnosis was acral junctional lentiginous melanocytic nevus.

My reasoning centered on the fact that the lesion:

1. Is symmetrical
2. It has a stereotyped periodicity of melanocytes at the tips of the retia
3. There is melanocyte sparing in the suprapapillary plate regions (seen on Melan-A)
4. Pigment is eliminated in periodically spaced vertical columns in the cornified layer (seen on Melan-A)

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