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 2301 - 9 April 2019 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)

44 year-old female with a 7 mm, erythematous blanching papule on the back


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Alex-Ventura-Leon

Posted (edited)

No images available

Edited by Alex-Ventura-Leon

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Admin_Dermpath

Posted

Apologies - images did not upload properly the first time.

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John Zhang

Posted

Malignant (cellular atypia, infiltrative borders) epithelioid neoplasm. My differential diagnoses include metastatic carcinoma (due to limited connection to the epidermis), primary cutaneous squamous cell carcinoma (I can almost see a hint of intercellular bridges), or a melanoma. I would obtain history, p63, S100 and Mart1. Other opinions please.

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Alex-Ventura-Leon

Posted

Agree with the differential.

I favor Melanoma because there is an intraepithelial component (i think). Also, de dermis look quite fibrotic. Could be a recurrence?

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Meenakshi Batrani

Posted (edited)

Cells have spitzoid morphology- I would consider BAP-1 inactivated melanocytic tumor

Edited by Meenakshi Batrani

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Uma Sundram

Posted

Great comments! We too favored melanoma but thought it was a difficult case. The patient has no other history of melanoma and this is not a recurrence to our knowledge. CGH had a complex series of chromosomal changes, and BAP1 was retained.

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Uma Sundram

Posted

S100 and MART1 were both positive.

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Dr. Richard Carr

Posted

I'd be holding back as I can't see dermal mitosis. There is a slightly lentiginous prolieration in the junction. STUMP, p16, HMB45, patterns of melanA, Ki67, BRAF VE1. If these don't resolve may have to consider the next steps as a patient would get a SLNBx if its not Spitz Group. MBAIT are usually combined but would be reasonable to consider. 

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Dr. Richard Carr

Posted

Apologies to Uma I think I must have mis-read the comment about CGH which is clearly supportive of malignant diagnosis. Although I'm also wondering if we were posting simultaneously!

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