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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 2035 - 22 March 2018 Posted By: Dr. Richard Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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F58. Right forearm. spindle cells with atypia , presence of aggregates and intratumoral lymphoplasma cells plus diffuse positivity of S-100 is reassuring.


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vincenzo polizzi

Posted

When I see a dermatofibroma like melanocytic lesion my first spot is desmoplastic Nevus(spitzoid).  There isn’t any convincing cellular atypia , instead the cells look like spitzoid cells. Forearm are frequently involved by DSN. MelanA support my spot.  But I find this a difficult case. 

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Although been rare on desmoplastic melanoma cases, positivity for Malan A can be seen in some cases. The presence of inflammation best seen on the right sided pictures favors desmoplastic melanoma. It is a difficult case, but I believe this tumor has a malignant behavior.

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anh

Posted (edited)

Desmoplastic Spitz nevus? 

The cells in desmoplastic melanoma are usually spindle in shape with hyperchromatic nuclei and almost no cytoplasm, just look like fibroblasts in my experience. The melanocytic cells in this lesion appear epithelioid with clear cut eosinophilic cytoplasm. The stroma appears rather sclerotic than desmoplastic in my eyes. The vascular pattern is also kind of unusual for a desmoplastic melanoma. I therefore woud favor a Spitz nevus.

Edited by anh

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Dr. Richard Carr

Posted

For the reasons outlined by Vincenzo & Anh, I called this a angiomatoid & desmoplastic Spitz naevus.

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