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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 1117 - 3rd October 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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25 years old female, Pigmented lesion on breast enlarged and got darker (Case c/o Dr Monica Ahluwalia).
Case Posted by Dr Richard Carr


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Looks like a special sites nevus. There's atypia, but not out of the norm for nevi of the breast/milk-line. No pagetoid spread, no dermal mitoses. If it's out there's no need for additional excision. If it goes to a margin I'd recommend conservative complete removal.

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Dr. Richard Carr

Posted

I know the dermpathpro team posted my opinion inadvertantly at the beginning of the day in the history but I would really hope to get a few more comments on the case (in any case you may not agree with my opinion). I suspect there are many of you who check on cases but never post a suggestion - now is your opportunity to contribute! I will leave it open and sincerely hope you enjoy your weekends.

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Robledo F. Rocha

Posted

I didn’t read Dr. Carr’s diagnosis that was posted early, so I write my opinion blindly.
It´s a [url="http://onlinelibrary.wiley.com/doi/10.1111/j.0303-6987.2004.00159.x/abstract"]site-specific nevus from breast[/url]. Junctional melanocytic nests that are large, horizontally-oriented and coalescent may cause concern, and melanoma or [url="https://dermpathpro.com/blog/3/entry-126-dysplastic-nevus-as-a-legitimate-phrase/"]so-called “dysplastic nevus”[/url] may therefore be signed out. However, these findings are indicative of site-specific nevus within the overall context of a symmetric lesion that begins and ends with a nest, melanocytes that are bland and monomorphic, and a case history of a pigmented lesion on a breast of a young woman.

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Guest Giovanni Falconieri

Posted

Agree with all the considerations above. Irregularly shaped and spaced nests, focal epidermal consumption, mild nuclear atypia, and dust-like pigment although generically indicating "dysplasia" are pretty much consistent with a special site nevus, given the clinical context

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Mark A. Hurt MD

Posted

By the usual criteria, it's a melanocytic nevus, lentiginous. There is sparing of the suprapapillary plates with bridging of retia in some areas. There is no pagetoid pattern of melanocytes, and the melanocytes have slight variations in nuclear size. Some of them have quite a lot of cytoplasm that some might interpret as Spitz's cells, but an alternative viewpoint is that this is a “special site” quality, as it is relatively common on the breast.

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Dr. Richard Carr

Posted

Yes I also reported this as a special site naevus. She had two similar lesions excised at the same time.

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