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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 1974 - 22 Dec 2017 Posted By: Dr. Richard Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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No Clinical History given

Edited by Admin_Dermpath


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Dr. Mona Abdel-Halim

Posted

Subepithelial conjunctival nevus?

 

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That was my first impression too: some kind of melanocytic lesion of the conjunctiva. But upon close inspection of the epithelial lining, I thought I saw umbrella cells on top and I don't really appreciate goblet cells in the lining as commonly seen in the conjunctiva. So I would suggest a melanocytic lesion of the urethra or ureter as an alternative.

As what the melanocytic lesion represents, it is very difficult just tonmake the diagnosis on these figures. I do not see any melanoma in situ component in the epithelium. The nodule of melanocytes is quite cellular and pigmented. I can't tell whether there are mitoses or not. The melanocytes are quite monotonous without clear cut maturation. If this is a conjunctival lesion, I do not see any epithelial cysts that we usually see in benign nevi. So I'm kind of worried that this could be a melanoma of the urethra? A cellular blue nevus also crossed my mind but I need to rule out melanoma first, particularly in this location. Clinical impression might help.

 

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vincenzo polizzi

Posted

Agree with above. I was thinking of some association between urethral female caruncle and melanocytic pigmented nevus ( but maybe he is a men, who knows...)

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Dr. Richard Carr

Posted

It's bladder and there is a history of ocular/retinal melanoma 3 years previously. Patient underwent cystoscopy for haematuria. We reported as most likely metastatic melanoma. Well done Anh!!

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Dr. Richard Carr

Posted

I've posted the answer to 1969 (last Friday's). Seasons greetings.

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3 hours ago, Dr. Richard Carr said:

It's bladder and there is a history of ocular/retinal melanoma 3 years previously. Patient underwent cystoscopy for haematuria. We reported as most likely metastatic melanoma. Well done Anh!!

Thanks

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