Case Number : Case 1809 - 04 May - Dr Arti Bakshi Posted By: Guest

Dr Arti Bakshi has got a great case c/o Dr Naveen Sharma for your Thursday Spot Diagnosis Case.

Don't miss out on the HOTTEST date in town...

http://us13.campaign-archive2.com/?u=ad4b959aee887bce8b61dcb23&id=c71f0aaa69&e=[UNIQID

Geoff Cross - DermpathPRO Projects

I am away for an event so I can only see the case on my phone, but I thought of MELTUMP in this case, we should definetely try to do some inmunos  including BAP-1 (even if the lesion has a junctional component). To be honest my gut tells me  that this lesion is biologically benign

I favor benign, I agree with the previous comment and do BAP. Another consideration would be nevoid melanoma. Not sure if the epidermis shows some scatter. Didn't see dermal mitoses. I would also add MelA, HMB45 and maybe p16

A banal melanocytic nevus showing some intradermal nests of type A melanocytes in the deeper reaches of the lesion, and those intradermal nests are surrounded by type B melanocytes. Inverted type A nevus, clonal nevus, and nevus with atypical dermal nodules are some names, but multiple levels may show this lesion represents a combined nevus or a deep penetrating nevus.

Nevoid melanoma in the diferential 

Worried about nevoid melanoma.

Agree with Robledo - benign with some clinal nests. Would like to see mitoses before considering naevoid melanoma. There is good maturation of nuclei even in areas of colonial nests.

I'm away with only my iPhone, but  

not sure about benignity.  Agree with Mona and Fernando. 

I went for benign. I called it a 'proliferative nodule- like lesion' within a benign compound naevus (a clonal naevus is equally appropriate).  Although the dermal nests are expansile, they merge with the surrounding naevocytes, are not particularly atypical cytologically and are mitotically inactive. (there were no mitoses at all in the dermal component in the levels.).

For what its worth, Ki67 fraction was low and p16 was retained throughout the lesion. I did not do a BAP1, I have to admit, mainly because there was a florid junctional component. But i think we have had the discussion before on this forum that in some series, BAPOMAS can be compound lesions, so maybe worth a try!

Extremely difficult case.  Initially though, just a proliferation nodule. But am not so sure after looking at it again. The nests are a bit large even at the deep dermis. I guess this is one I would ensure complete excision and recommend long term follow-up (i.e. treat as a MELTUMP). .