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 2045 - 09 April 2018 Posted By: Iskander H. Chaudhry

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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43 year old female Right lower leg excision. Atypical mole.


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Anil Patki

Posted

Good symmetry from left to right and good circumscription at the bottom. Nests of epithelioid cells with pigment retained in the dermis. No atypia. I think this is a combination of epithelioid blue nevus and Spitz nevus- a blitz nevus

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vincenzo polizzi

Posted

Difficult. Agree with left half. But the right half of the lesion is expansive in  dermis, with deep mitosis and cellular atypia. Atypical Spitz Nevus? Spitzoid Melanoma?  I don’t know. 

Please Dr Iskander what’s the 2034’s diagnosis?

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Arif Usmani

Posted

Agree with Vincenzo. The right-half is different in growth pattern the the left which makes the lesion asymmetric. Deep mitoses and epidermal consumption are worrisome findings. Comparative Genomic Hybridization may be helpful. 

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Dr. Mona Abdel-Halim

Posted

Me too, I do not like the right half, melanoma arising in a nevus? 

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Admin_Dermpath

Posted

Many thanks for your opinions; yes we struggled with this case and finally classified it as:
 
Spitzoid Tumour of Uncertain Significance 
 
(on behalf of Dr Chaudhry)

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Admin_Dermpath

Posted

Vincenzo - 2034 Diagnosis now posted! Please find link below. : )

 

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Dr. Richard Carr

Posted

Disturbing! Not sure it's Spitz group. Suggest initial panel of IHC, p16, Ki67, HMB45, MelanA +/- BRAF IHC. If BRAF+ it's NOT a Spitz and then abnormality of p16 might swing it to melanoma. Might benefit from FISH or CGH if available depending on results of IHC.  Great meeting at St John's today mind boggling on the developments in melanocytic!

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Dr. Richard Carr

Posted

I looked again at work on a decent monitor and I'd call it a "clonal" naevus, combined naevus or naevus with phenotypic heterogeneity i.e. a background ordinary naevocellular naevus (probably BRAF mutated which would be mutually exclusive with the Spitz group). The pigmented epithelioid clone has taken a further step but is not frankly malignant in these images. Might be a DPN clone (Beta-catenin would be of interest).

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