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 2154 - 11 September 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 man with lesion on left ear.


User Feedback


Anil Patki

Posted

Actinic keratosis. Would like to do Melan A, just in case....

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vincenzo

Posted

Malignant Melanoma, sperficial spreading type, II Clark level. 

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Alice Roberts

Posted

LM or LMM.  Obscured by inflammation.  Sox10 to assess dermis

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John Zhang

Posted

Thanks for posting this case Uma! Nevi on the ear are very confusing to me. Some publications suggest that benign nevi on ear can have very atypical features, while some authors believe that these are probably melanomas (can quote exactly when I access David Elder's AFIP book on melanocytic lesions when I get to my office tomorrow). I often send these cases for more studies such as gene-expression based Mypath melanoma test by Myriad Genetics. Without such tests I would classify the above lesion as a melanoma, because of its architectural disorders and upward spread.

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Uma Sundram

Posted

This is a very difficult case. My biggest concern would be the atypical features on the ear in a 65 year old male. Lesion is MART1 and SOX10+. My former mentor, Sabine Kohler, used to have a very high threshold for calling melanoma in special sites, and would call them all nevi, even in older individuals. I, on the other hand, had one of these lesions recur, so am convinced that if the atypia is striking, these lesions should 1) never be called nevi and 2) always be treated conservatively. This is especially true of individuals over the age of 50. Sun exposed sites, such as the ear, are particularly problematic, which is why I chose this case. In this case, because of the size of the lesion (it was less than 0.5 cm), we stopped short of melanoma, but suggested conservative treatment to ensure complete removal of this markedly atypical lesion.

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