Jump to content
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 2164 - 25 September 2018 Posted By: Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
   (0 reviews)

80 year old man with lesion on chin.


  • Like 1
  Report Record

User Feedback


Desmoplastic melanoma,  S100 and SOX 10 for confirmation. 

Share this comment


Link to comment
share_externally

I believe this is a dermoplastic melanoma as well. My differential diagnosis would be with desmoplastic nevus but some clinical and histological aspects help differentiating between them. Desmoplascit nevus is a small tumor not common on the face, nor in this age. It would be positive for Melan-A, the oposite would be expected for desmoplastic melanoma, wich is more common on sun exposed skin (like this case). The inflamatory infiltrate seen in picture 4 also favors desmoplastic melanoma, so this is my diagnosis (but I would perform immunostains).

Share this comment


Link to comment
share_externally

Is it desmoplastic or sclerosing /  sclerotic. To me desmoplastic is kind of a fibroblastic reaction and looks 

bluish cellular in H&E. The background in this melanocytic lesion is hypocellular and pinkish, which I usually associate with a sclerotic / sclerosing process.

Share this comment


Link to comment
share_externally

Uma Sundram

Posted

Great to see this range of answers. It's one of the most difficult cases I've encountered. Anh asked an excellent question as well.

The differential diagnosis includes desmoplastic melanoma, desmoplastic blue nevus, and sclerosing nevus. The lesion is sox10 and s100 positive. MART1 was not performed. We were able to perform Myriad testing which placed the lesion in the benign category. However, this doesn't negate an atypical diagnosis, so if on morphology desmoplastic melanoma is favored (or cannot be excluded), that has to be part of the differential, regardless of Myriad results. The age of the patient, site of lesion, and morphology are all concerning features in this case.

I agree with Anh's interpretation of sclerosing vs desmoplastic, and would put this in the sclerosing category. 

We did call this desmoplastic melanoma and did not change our diagnosis even with the 'benign' Myriad result. One feature of the lesion that we learned after we released our report was that the patient had had this lesion 'all of his life' and it was unchanging and stable. Myriad testing in desmoplastic lesions is also somewhat uncharted territory.

Unlike courses and tests, in a real life scenario like this one, there are no right and wrong answers. i find in the course of my practice that if there is something unusual about a melanocytic process, it's best to have it removed.

I hope you all found this case as instructive as I did.

Share this comment


Link to comment
share_externally

Dr. Richard Carr

Posted

Belated comments. I'd looked at it blind of clinical and thought it was a desmoplastic naevus. I'd be interested in the MelanA staining which would not be expected in DMM. We usually run panel of MelanA, HMB45, p16 & Ki67 on "MELTUMPS"

Share this comment


Link to comment
share_externally



Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Add a comment...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...

×
×
  • Create New...