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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 1785 - 31 March - 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: Bleeding pigmented lesion in natal cleft.

Case posted by Dr Richard A Carr


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Raul Perret

Posted

I thought of melanoacanthoma in this case

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Raul Perret

Posted (edited)

forgot to ask if the patient is an adultal although I would still think of melanoacanthoma

Edited by Raul Perret

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vincenzo polizzi

Posted

I have another impression, but waiting for newbies/trainees comments first...

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msofopoulos

Posted

I see hyperplasia of  keratinocytes without atypia and abundance of dendritic melanocytes. I think it is a melanoacanthoma, I am just not sure if it occurs in this location often. Am just waiting for Vincenzo's opinion!

Another thing: Will any of you attend melanoma course in Paris next month?

 

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Robledo F. Rocha

Posted

Epidermis shows psoriasiform hyperplasia due to proliferation of dendritic melanocytes interspersed among keratinocytes with pale-staining cytoplasm, except those keratinocytes of the basal layer and the adnexal epithelium. Pigmented clear cell acanthoma is my opinion.

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Dr. Mona Abdel-Halim

Posted

Glad to see that Robledo has posted my exact opinion!!! I also thought of it as a pigmented clear cell acanthoma .. 

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Sasi Attili

Posted

A bit late. I favour  pigmented clear cell acanthoma too...

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vincenzo polizzi

Posted

I was thinking of Pigmented Clear Cell Acanthoma, too. Typical alternating pattern of involved rete pegs and acanthotic uninvolved adnexal epidermis in fig 1. 

Good week to you all!

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Raul Perret

Posted

2 hours ago, msofopoulos said:

I see hyperplasia of  keratinocytes without atypia and abundance of dendritic melanocytes. I think it is a melanoacanthoma, I am just not sure if it occurs in this location often. Am just waiting for Vincenzo's opinion!

Another thing: Will any of you attend melanoma course in Paris next month?

 

I am a bit away from pathology until september due to a master so cannot go to Paris. However I will be attending ISDP meeting in september as we mentioned before It would be nice to meet you and the rest of colleagues

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msofopoulos

Posted

I will be (probably) attending the Glasgow meeting! It would be nice to meet you and the colleagues too!

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Josie Bisi

Posted

Ok, we have a lesson today! I thougth melanoacanthoma, but now... pigment clear cell acanthoma. Congratulation, Robledo.

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Nitin Khirwadkar

Posted

Would go for a pigmented clear cell acanthoma.

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Admin_Dermpath

Posted

7 hours ago, msofopoulos said:

I see hyperplasia of  keratinocytes without atypia and abundance of dendritic melanocytes. I think it is a melanoacanthoma, I am just not sure if it occurs in this location often. Am just waiting for Vincenzo's opinion!

Another thing: Will any of you attend melanoma course in Paris next month?

 

You should get them to get me to record it  :-)

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Dr. Richard Carr

Posted

Thanks, Vincenzo (for delaying but contributing), Robledo et al for correcting my original diagnosis of melanoacanthoma. I just pulled the slides and agree pigmented clear cell acanthoma fits best. There are neutrophils in the epithelium as well, too much to just be explained  by the anatomic location / surface irritation I think. Surprised I did not appreciate this features at the time (photography often makes one scrutinise sections in greater detail than normal).

Well an even better case than I expected! 

Some regard clear cell acanthosis as a reaction pattern that can  be seen in other lesions and conditions with clear cell acanthoma being a recognisably distinct clinicopathological entity.

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