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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 1830 - 2 June - Dr Richard A Carr 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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Clinical History: M70. Mid back. 15 x 15mm pigmented irregular pigment and white veil ?melanoma in situ.

Case Posted by Dr Richard A Carr


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Admin_Dermpath

Posted

Catchup Time... a great case from Dr Richard A Carr

 

Geoff Cross - DermpathPRO Projects

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vincenzo polizzi

Posted

Looks like a recurrent nevus, but there’s an atypical deep dermal component and atypia seems exorbitant...so I go with Melanoma ( partially regressed ).  

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Robledo F. Rocha

Posted

Favor recurrent nevus until review of the original biopsy specimen, if available, proves otherwise.

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Raul Perret

Posted

Agree, had the same differential. Difficult case just based on this morphology. CPC needed

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Dr. Mona Abdel-Halim

Posted

Difficult, favor regressing melanoma

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Arif Usmani

Posted

Agree. Melanoma with regression versus persistent/recurrent nevus. Favor melanoma as in the non-fibrosed area the lesion shows considerable architectural atypia. An elastic stain may also help in differential diagnosis. In regressed lesion clumping of elastic fibrous is usually seen at the base of the biopsy. 

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Josie Bisi

Posted

70yo, male, back, history of previuos ressection not informed. Epidermal atrophy, epidermal consumption, irregular nests, pagetoid cells, wide lentiginous component, fibroplasia, atypical cells, linfocitary infiltrate. I go --> melanoma.

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Dr. Richard Carr

Posted

Apologies for the late post (entirely my fault). I think on the images here you have all done well. I think this is actually a good example of the small cell malignant melanoma, a variant of naevoid melanoma. Some years ago I submitted it to a national and international melanocytic slide club which I organise and amazingly there was 90% agreement for the diagnosis of melanoma although clearly the differential does include traumatised naevus. Continuation of the atypical lentiginous process, fairly typical for "in situ" melanoma, into the areas of preserved rete and growth down the sweat duct are helpful clues. These lesions are invariably radial growth phase (lacking dermal mitotic activity) and complete excision should be curative.

Reference: Blessing et al J Clin Pathol 2000, 53(8):591-595.

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Dr. Richard Carr

Posted

Incidentally I don't think there is any significant pagetoid spread of the atypical melanocytes here. Just perinuclear vacuoles around the keratinocytes in the epidermis. Be careful to look for the rim of cytoplasm around true pagetoid melanocytes. The confluent, mildly atypical lentiginous proliferation is quite sufficient for a melanoma in situ component in this clinical context.

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