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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 2394 - 3 September 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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90 year old male with lesion on scalp. This is the re excision. The area photographed is near the biopsy site.


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Alex-Ventura-Leon

Posted

Nodular aggregates of epitheliod cells near to re-excision site makes me think in Melanoma.

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Something resembling juvenile xantogranuloma or solitary RCH or RDD ( but I don't like thinking of RDD without plasma cells ).

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Poorly differentiated proliferation, needs correlation with previous biopsy. IHQ can be of great help if no more clinical information is provided.

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Uma Sundram

Posted

I was trying to trick you guys. Dr Alex has it right. This was a re excision of a melanoma. I knew it was a melanoma re excision but did not have access to the prior. The large cells made me initially think of biopsy site changes, and I did a SOX 10 just in case. All of the large cells with abundant cytoplasm were both MART1 and SOX10 positive. On low power it looks like scar envelopes the infiltrate which is very lymphocyte rich and circumscribed. So, always stain if in doubt! I'm glad I did in this case.

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