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 2071 - 15 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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77 year old male with a few month history of a pigmented papule of left shoulder.

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User Feedback


Anil Patki

Posted

Age of the patient and big hyperchromatic nuclei of melanocytes make me think of melanoma

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dermpath1

Posted

Pigmented epithelioid melanocytoma.

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vincenzo polizzi

Posted

What about a partially regressed dermal nevus?  

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Anil Patki

Posted

It's really a maze - pigmented epithelioid melanocytoma, animal type melanoma, Epithelioid blue nevus, pigment producing melanoma etc etc... Waiting for enlightenment from the experts. 

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Raul Perret

Posted

Considering the age I would be worried about partially regressed melanoma. Would add a note in the report and talk with the dermatologist

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Uma Sundram

Posted

My apologies for the late comment. I spent most of Monday in a plane to London but am here now for the London Dermatopathology Symposium. A welcome to all those who are here, and a plug for the LDS for those who've never been - it's a very relaxed way to learn about dermatopathology from the experts with tons of new material and review of old material. Good times!

Regarding the posted case, a difficult one indeed. It's a regressing lesion; difficult to say if it's a regressing melanoma or a regressing nevus. I favored nevus because the remaining cells appear relatively bland, with mild cytologic atypia. Nevertheless, given the age of the patient, I recommended excision of any remaining lesion. While PEM and animal type melanoma are good thoughts, those tend to have larger, more epithelioid cells, whereas here, the cells really seem 'nevoid'. 

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