Case Number : Case 1632 - 27 September Posted By: Guest

Another interesting case by Dr Uma Sundram.

When you have worked this one out please take a look at a new addition to the Difficult Opinion Cases (just follow the link on home page) a wonderful case by Maraya Bittencourt.

Cheers, Geoff

I would have called this lesion hyperpigmented blue nevus. I think we could argue if this is just a hyperpigmented subepithelial nevus (considering the rounded subepithelial areas seen in the second picture that are not in my experience seen in BN) but the overall architecture is for me consistent with BN. The topography is quite infrequent for any melanocytic neoplasm so should be careful and talk to the ophtalmologist just in case any other clinically relevant data.

I also think this is a combined nevus (BN + Intradermal common nevus).

Or an odd deep penetrating nevus?...this is a partial superficial biopsy so we don't see the deepest component.

This is a difficult case and I appreciate all of your opinions. We called this a combined nevus, IDN + BN, with heavy pigmentation complicating the assessment. I called the opthalmologist. The lesion is small and removed by the procedure, essentially. The patient refused further therapy at this site (surgically challenging) and both patient and clinician are comfortable with following clinically for recurrence (if any).