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?

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Case Number : Case 2139 - 21 August 2018 Posted By: Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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50 year old woman with new lesion on left breast.

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Alice Roberts

Posted

I do not like the looks this new breast lesion.  I considered spitzoid features but not sold on that.  Could be dysplastic nevus, modérate to severe.  However, I am worried that this could be a melanoma.  Not sure based on these photos. Depending on what deeper cuts and/or intradepartmental consultation yields, I might do Myriad Mypath study for extra data.

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2 hours ago, Alice Roberts said:

I do not like the looks this new breast lesion.  I considered spitzoid features but not sold on that.  Could be dysplastic nevus, modérate to severe.  However, I am worried that this could be a melanoma.  Not sure based on these photos. Depending on what deeper cuts and/or intradepartmental consultation yields, I might do Myriad Mypath study for extra data.

 

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Alice,

Heard a lot of Myriad mypath testing from you. Is that something that you use when you have a difficult melanocytic lesion?  I guess you send tissue to the lab for genetic testing. How is the billing?  Do the insurances pay for the test?  And how helpful it is based on your personal experiences?

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Alice Roberts

Posted

They bill the patient, I believe.  We don’t have any financial involvement with them and only use on consensus difficult lesions.  It’s more data but doesn’t trump histology case by case.  Occasionally a lesion will test indeterminate and warrant FISH analysis.  The company (Myriad) representatives  are pleasant to deal with and very reasonable. You can call and talk to them.  We do a few a month probably.  

This is the test:

https://mypathmelanoma.com/about-mypath-melanoma/

Ordering page:

https://mypathmelanoma.com/about-mypath-melanoma/ordering-process/

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Anil Patki

Posted

Large bizzare nests of melanocytes with nuclear atypia. I think this is nested melanoma.

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Uma Sundram

Posted

We were quite concerned about melanoma as well. Given the location on the breast, we were not sure as to how much of the atypia was site related, so fell short of a definitive diagnosis. We recommended a complete excision with follow up of this atypical lesion.

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Dr. Richard Carr

Posted

I'd certainly withhold a firm diagnosis as this is a partial biopsy of a challenging lesion on a special site without important clinical details size, dermoscopy, suggested clinical diagnosis etc. If it was clinically concerning it should have been excised fully with a clear margin (I always suggest 2 to 3mm beyond any faint pigmentation whenever possible). Given that it's very thin I don't think there is any risk for metastasis so I'd put it in the  SAMPUS (superficial atypical melanocytic proliferation of uncertain significance)  group.

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