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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 2626 - 30 July 2020 Posted By: Saleem Taibjee

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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60F, Changing pigmented lesion. (anatomical site not provided).


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Looks like compound Spitz nevus, but the patient’s age worries me.

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Spitzoid tumor, probably Spitz Nevus. 
 

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Dr. Mona Abdel-Halim

Posted

Looks Spitz nevus (beautiful Kamino bodies). For age purposes and the history of changing lesion, I think I will do P16 and I may consider FISH too. 

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2 hours ago, Dr. Mona Abdel-Halim said:

Looks Spitz nevus (beautiful Kamino bodies). For age purposes and the history of changing lesion, I think I will do P16 and I may consider FISH too. 

Agree.

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Meenakshi Batrani

Posted

Looks like compound spitz nevus. 

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Saleem Taibjee

Posted

Interesting discussion, it seems that it was worthwhile posting this case.

For me this is a typical Spitz naevus histologically. Various supportive features; nice lateral demarcation, transepidermal elimination of nests, good maturation with depth, no dermal mitoses.

And to top it all, perhaps the best example of Kamino bodies I have personally come across.

So then the question/discussion arises, how much does / should age alter our approach and management? I must admit that I have signed this case out without any ancillary investigations (e.g. p16 immunohistochemistry, FISH, etc). Bearing in mind that there are examples of typical naevi with loss of p16 on IHC, etc, and there is a cost associated with FISH which becomes relevant for our National Health Service with limited resources.

For those who wish to re-visit Kamino bodies, please refer to the original description. Kamino H, et al. Eosinophilic globules in Spitz’s nevi. Am J Dermatopathol 1979;1:319-24, and the interesting editorial article LeBoit PE. Kamino bodies: What they may mean. Am J Dermatopathol 2001;23:374-7. In the latter, Phil LeBoit challenges the readership to find a clear-cut melanoma with genuine Kamino bodies (as opposed to dyskeratotic keratinocytes). I am yet to see such a case myself.

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Fully agree with Saleem. I’m an old general pathologist and in the pre-immunohistochemistry age I made a Spitz Nevus diagnosis in similar cases feeling comfortable. We should not overdo the modernity. 

 

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