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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 1223 - 02 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 29 year old white woman with a shave biopsy of a growing lesion with irregular color and border, from the left preauricular area.Clinical Diagnosis: nevus vs MM.

Case posted by Dr Mark Hurt


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Combined, Spitz and common, naevus.

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Dr. Mona Abdel-Halim

Posted

Nevus of special sites. Nevi on and around the ears may have an epithelioid Spitzoid like morphology in their junctional component.

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Mark A. Hurt MD

Posted

Are there more opinions?

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Guest Jim Davie MD

Posted

Atypical Spitz arising in background of congenital-pattern compound nevus.

Ignoring the dermal component (which lacks mitotic activity or atypia to implicate it further), the lentiginous predominance with poor nesting, asymmetry of distribution and cellular pigmentation, and lentiginous adnexal extension is of concern for an atypical Spitz neoplasm, in my opinion. Kamino bodies are hard to appreciate. The patient is in an advanced age group (non-pediatric) that increases the suspicion level for any new onset Spitz neoplasm.

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Dr. Richard Carr

Posted

Difficult and really quite concerning superficial epithelioid clone with pagetoid spread and rather confluent across at least a x10 field if not more and also inflamed (the immune system has woken up and so should we!). Arises in a pre-existing benign compound naevus. Uncertain potential but I cannot rule out melanoma in situ arising in a naevus. If the latter extends to margins I would be tempted to advise a re-exicision as I don't really know the biological potential.

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biswanath behera

Posted

Congenital pattern compound nevus with lentigo maligna melanoma.

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If it is not a matter of special site nevus or pregnancy related changes then it is a melanoma arising on a congenital compound melanocytic nevus.

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Eman El-Nabarawy

Posted

Melanoma on top of a compound nevus.

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Mark A. Hurt MD

Posted

My diagnosis was:

Melanoma in situ in conjunction with congenital melanocytic nevus (Miescher's nevus).

Although I have sympathy with those of you who favored Spitz's nevus with a congenital melanocytic nevus, The very large "dusty" melanocytes and their haphazard pattern of growth (pagetoid focally with uneven spacing) led me to the diagnosis. The patient is not pregnant, to the best of anyone's knowledge.

Thanks to all who participated. I must admit that the photos don't do justice to the glass in this case.

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Arti Bakshi

Posted

Melanoma in situ atleast (arising on a background of a benign compound naevus). Always difficult to assess for early invasive component in such cases, but can't see obvious invasion in images provided.

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