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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 2385 - 20 August 2019 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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85 year old male with lesion on back.


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last picture appear to show vascular invasion. Malignant melanoma

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Nodular melanoma, with angio-lymphatic growth ( fig 4,5,6 ).

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Uma Sundram

Posted

Yes. In figure 4, do you all think this is a microsatellite lesion?

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I think there is an intralymphatic infiltration, but not sure for microsatellitosis...not far enough!

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Dr. Richard Carr

Posted

If it's separated by "normal demis" it's is a microsatelite. Most microsatelites are intra-lymphatic.

I'd say suspicious for a microsatelite in this case. It's of major importance as it is classified as pN2c. From the practical point of view the re-excision should be examined carefully by serial TS (normally we only embed one central block from re-exicisons) and the pathologist warned to look carefully for possible microsatelites.

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Uma Sundram

Posted

We did call this a microsatellite; several dermatopathologists had this opinion. I have not seen one this subtle so wanted to share it with all of you. There are also intralymphatic foci, as pointed out by vincenzo. As pointed out by Richard, this is of major staging importance and I think, easily missed on a biopsy by a busy pathologist. The surgeons plan their surgery differently based on this information. 

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