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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 2066 - 8 May 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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36 year old male who had a 1 cm pigmented nodule of his right ankle.


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Anil Patki

Posted

Agree with Vincenzo. It's supposed to be a controversial entity. Cannot be distinguished from epithelioid blue nevus. 

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vincenzo polizzi

Posted

There aren't well designed features of PEM ( istiocytoid macronucleolated cells ), but this spot could fit better the silhouette, the pigmentation and the spindle cell nests of this lesion.

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Raul Perret

Posted

For me there is phenotype heterogeneity, cellular blue nevus and banal? I would favour benign

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Uma Sundram

Posted

Great ddx; I think cellular blue nevus, PEM/epithelioid BN, and epithelioid melanoma all come into the differential in this case. Ultimately we decided that cellular blue nevus may be a better fit; there are areas that raise the possibility of 'ancient change' within a CBN, a pattern that mimics melanoma. Sclerotic entrapment of melanocytic nests is a pattern often seen in CBN with ancient change. The lesion was completely excised and the patient had no adverse events 5 years later.

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