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 2144 - 28 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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22 year old woman with lesion on right arm.

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User Feedback


Krishnakumar subramanian

Posted

 ? Merkel cell carcinoma with epidermotropic component 

IHC needed

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John Zhang

Posted

To me this lesion is very difficult to interpret. My differential diagnosis includes a clonal nevus or an invasive melanoma. The worrisome part is that the lack of maturation is not just limited to one area, it's throughout the lesion. There are also other structure disorders such as asymmetry, large irregular junctional nests and coalescing of the junctional nests. But part of the challenge is the patient's young age, which is unusual for a melanoma. Overall I favor an invasive melanoma.

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Uma Sundram

Posted

Melanoma, arising in a nevus. While the patient's young age is a challenging feature, it's the only unusual thing about this lesion. The lesion itself is quite concerning; it's broad, asymmetric, has a focal sheet like dermal proliferation, has large dermal nests within the lower aspects of the lesion, and has deep pigment. The junctional component is confluent as well. Overall a concerning lesion, and should be treated as a melanoma, even if the trigger isn't pulled. Nevoid melanoma is a good thought. S100 and MART1 are positive.

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