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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 2194 - 6 November 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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21 year old female with scalp lesion.


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Lymphoepithelioma like carcinoma v/s inflamed SCC. Metastasis of LELC from other sites is also a possibility. 

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Alex-Ventura-Leon

Posted

Young patient. Difficult lesion (at lest for me). 

It seems epithelial whit connection to Epidermis and some vacuoles in the citoplasm. 

Favor SCC. I wonder if the patient have some underlying genetic alterations. 

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Spitz Nevus ( oriented fascicular pattern and vesicular monomorphic nuclei ).

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Don't really appreciate an epidermal component. So would do S-100 protein to make sure it is indeed a melanocytic lesion. Neurothekeoma sometimes can be mistaken for a melanocytic lesion.

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Krishnakumar subramanian

Posted

difficult for me, nevoid lesions with squamous morphology, but loss of polarity waiting for inputs

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Raul Perret

Posted

I would be very careful with this lesion. As Vincenzo suggested this looks like a spitzoid lesion not overtly malignant, would suggest complete excision and express the uncertainty on the report. Maybe some ancillary techniques could be useful.

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Alex-Ventura-Leon

Posted

After read your comments I think you all right. Melanocityc lesion it would fit more.

Cellular Neurothekeoma it's a great differential. 

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Uma Sundram

Posted

Love your comments. These are always challenging cases. This was S100 and Melan A positive, and cytokeratin negative. We opted for a Spitzoid lesion with atypical features and recommended re excision. Long term outcome is uncertain and the patient will be watched closely.

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Dr. Richard Carr

Posted

Agree with atypical Spitz tumour, uncertain for malignancy. Complete excision with clear margins is recommended (5mm). We'd usually run Ki67, HMB45, MelanA & p16 for STUMP/MELTUMPs. 

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