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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 2124 - 31 July 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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65 year old woman with lesion on forehead.


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John Zhang

Posted

I am debating whether this should be classified as cellular blue nevus or just blue nevus. The upper cellular portion doesn't have dumbell shaped deep extensions. But maybe strictly speaking I should classify as cellular blue nevus. 

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Raul Perret

Posted

I am worried about this lesion. 65 year old, sun exposed skin, there is a continuous proliferation of melanocytes with some nuclear atypia. I would suggest complete excision, i am worried about melanoma

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Alice Roberts

Posted

I am also concerned.  We sometimes send borderline lesions for Myriad Mypath study to help us.  If this is a blue nevus, they tend to test far into the benign portion of the spectrum so might be helpful here.

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I have a hard time evaluating the epidermal component. So I would do Melan-A and SOX-10 to see whether there is an increase of melanocytes in the epidermis. If there is significant increase of melanocytes along the dermal-epidermal junction, I would call it malignant melanoma. Since I am not quite convinced there is an overlying melanoma in situ / lentigo maligna based on the available figures, I would consider the entity below:

Epithelioid and fusiform blue nevus of chronically sun-damaged skin, an entity distinct from the epithelioid blue nevus of the Carney complex.

Yazdan P, Haghighat Z, Guitart J, Gerami P.

Am J Surg Pathol. 2013 Jan;37(1):81-8

 

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My first thought: benign blue nevus in a sun damaged skin. Agree with Anh about Melan A utility to valuate the intraepidermal melanocytic growth.

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Uma Sundram

Posted

Great and extremely valuable comments. I too think this is a pre existing blue nevus on sun damaged skin. There is some atypia and given the age, I recommended excision. Mitf highlighted a small lentiginous junctional component.

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