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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 1777 - 21 March - Dr Uma Sundram 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: 60 year old male with 1.5 x 1 cm pigmented lesion on left lower leg-shin/calf.

Case Posted by Dr Uma Sundram


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Raul Perret

Posted

Would perform a nuclear marker like sox-10 or MITF to better see the presence of a dermal component. However this does not change the fact that there is quite some confluence, disorganization, irregular pigmentation and detachment of cells as wells as prominent lymphocytic infiltrate (Sutton's nevus-like). For me this is melanoma to determine if in-situ or not by IHC (I favor in situ based on the images). I am not sure if there is also a junctional nevus component (pic2).

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Sasi Attili

Posted

Agree- looks like a melanoma. Suspicious of invasion

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vincenzo polizzi

Posted

Agree with Mona, Raul and Sasi

Right half shows more worrisome lentiginous and confluent wrecking of basal epidermis than left one ( asymmetry ) leading towards melanoma.

 

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Robledo F. Rocha

Posted

The low-power silhouette shows an asymmetric melanocytic proliferation, and the high-power view captured on the last image reveals nests apparently located in the papillary dermis. Those nests are composed by melanocytes with nuclei that are hyperchromatic and pleomorphic. Some melanocytes appear as multinucleated giant cells. Brisk mitotic activity can be found. All those microscopic findings, taken together to the clinical history of a suspicious (if it were not suspicious, it would not be excised) pigmented lesion on the lower limb of a middle-aged to elderly women, make me favor melanoma in vertical growth phase.

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Nitin Khirwadkar

Posted

Agree, melanoma. A rather untidy junctional component, inflammatory response. Would do a Melan-A to delineate the dermal component better.

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Arti Bakshi

Posted

Agree...favour in situ melanoma, not convinced there is a dermal component, but would do a melan A.

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msofopoulos

Posted

Melanoma. I cant distinguish an invasive component from these images. 

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Uma Sundram

Posted

Melanoma in situ. We did an MITF and there was no dermal component. I would add a caveat about Melan A staining on its own, as this stain tends to highlight degenerating keratinocytes too, especially in lichenoid lesions like this one. I included this case as lichenoid MMIS is not well reported in the literature (please see below).

Lichenoid tissue reaction in malignant melanoma: a potential diagnostic pitfall.

Dalton SR, Baptista MA, Libow LF, Elston DM.

Am J Clin Pathol. 2002 May;117(5):766-70.

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