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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 1478 -23 February 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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Case History: 9 year-old female with biopsy of scalp lesion.

Case posted by Dr Uma Sundram


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Epithelioid blue nevus. There´s a odd basophilic colagen that looks like solar elastosis. If this is a solar elastosos, maybe the age of the patient is wrong or the slides are from other patient. If this blue colagen in fact is not colagen, but a myxoid matrix, this may be an associated myxoma in the context of the Carney complex.

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Arti Bakshi

Posted

Cellular Blue naevus.

Agree with Igor's comment about solar elastosis.

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Nitin Khirwadkar

Posted

Cellular blue naevus. Yes, the amount of solar elastosis is certainly odd for the age!

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Guest Romualdo

Posted

In an epithelioid blue nevus I would expect marked pigmented epithelioid melanocytes. I think this biphasic pattern, with nests of pale cells compartmentalized by septa rich in melanophages is more in keeping with a cellular blue nevus.

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Raul Perret

Posted

Agree with the blue nevus type of lesions, if someone called this either deep penetrating nevus or cellular blue nevus I would accept it, I think there is morphological support for either of these lesions. From my point of view it is myxoid change of the stroma that we see. Bothers me that the deep limits are compromised....

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vincenzo polizzi

Posted

I see an entirely intradermal melanocytic lesion below an elastotic actinic wrap, with two cellular populations: one with non nested heavy pigmented spindle or round cells; and the other with nested less pigmented, epithelioid melanocytes with clear large cytoplasm. Some cell show a egg-fried appearance...I favor an  Epithelioid Blue Nevus.

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Guest Tiberiu Tebeica

Posted

Cellular blue nevus. I also found the blueish look of the dermis odd...

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Uma Sundram

Posted

Hi everyone, for some reason the wrong history was uploaded. Here is the correct history:

74 year old man with a pigmented lesion of the left nose clinically thought to be a blue nevus. I'll leave it up for one more day to see if anyone has any new thoughts before posting our diagnosis.

My apologies for the tardy update--bad winter storm in Michigan has everyone going crazy!

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Dr. Richard Carr

Posted

I was thinking DPN on the original history (I was not sure it was elastosis or mucin!) now I want to see a melanA to rule out lentigo maligna. I would express a some uncertainty and have it fully excised.  Did not think it had the classical cytology of epithelioid blue / pigmented epithelioid melanocytoma / pigment synthesising melanoma / low grade hypermelanotic dermal melanoma etc. so I would probably say DPN-like lesion of uncertain malignant potential but favouring benign behaviour.

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Uma Sundram

Posted

Given the age of the patient, we too were very cautious about the diagnosis. Our final diagnosis was atypical melanocytic proliferation with deep penetrating nevus-like features; we asked that the lesion be fully excised. No residual was present on the re-excision and the patient is currently being followed. We did not do any further stains as the biopsy was very small.

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