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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 1822 - 23 May - 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: 50 year old woman with erythematous lesion, right rib cage.

Case Posted by Dr Uma Sundram


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Raul Perret

Posted

There seems to be two independent melanocytic neoplasms. The junctional one is for me a melanoma in situ with irregular nests with prominent confluent growth and adnexal compromise. On the other hand, the dermal component looks more like a dermal melanocytic nevus as we do not see mitotic figures and there seems to be some maturation in pic 4 and 6. 

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sfwenson

Posted

Hmm, looks like superficial dermal scar to me.  My guess is compound congenital nevus with recurrent/traumatized nevus phenomenon.  Can't really tell if the junctional component goes far past the dermal component at the edges in these photos though.

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vincenzo polizzi

Posted

Looks like a recurrent/traumatized phenomenon...agree with sfwenson.

 

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IgorSC

Posted

I think there is a zonal disposition in this lesion that represents a recurrent nevus. There is also an activation of the lentiginous/juncional melanocytes.

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Dr. Mona Abdel-Halim

Posted

Recurrent nevus (pseudomelanoma) to me more than melanoma? Would HMB45 help?

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Mariantonieta Tirado

Posted (edited)

I think it is all benign. Agree with possible recurrent nevus (pseudomelanoma). I don't see epidermal upward scatter. No dermal mitoses. I would like to see better how the epidermal component behaves laterally beyond the "scar". A melan A would help to see easier symmetry and demarcation  . 

Edited by Mariantonieta Tirado

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Robledo F. Rocha

Posted

Agree with recurrent/persistent nevus. There is an architecturally disordered junctional melanocytic proliferation restricted to the underlying band area of dermal scar, with residual banal intradermal nevus at the bottom and on the sides.

I think reviewing the glass slide of the initial shaving biopsy is the best way to rule out melanoma. HMB-45 is useful when the initial biopsy is not available, with the caveat that recurrent/persistent nevus can lack obvious immunohistochemical maturation with this immunomarker, a pitfall that could be misconstrued as evidence of melanoma.

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Raul Perret

Posted

Yeah probably you guys are right, have to be very cautious with this kind of dx without CPC though

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Nitin Khirwadkar

Posted

Recurrent naevus/pseudomelanoma overlying a dermal scar. A banal intradermal naevus is present beneath the scar.

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Fernando Cabo

Posted

I'd like to see the borders. nested>>single. Only a few melanocytes above DEJ. Some pulverocytes.  traumatized nevus > melanoma on nevus 

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Uma Sundram

Posted

Recurrent nevus.  The lesion was laterally transected but we favored nevus over melanoma for all the reasons suggested. The lesion was re-excised.

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