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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 2532 - 20 March 2020 Posted By: Dr. Richard Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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M-80. Left temple. Atypical pigmented lesion. Shave from anterior (darker pigmentation). ?SEBK, ?LM


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The alternate para and ortokeratosis with atypical interadnexal keratinocytes and the poorly attenuated rete ridge, with lentiginous growth of atypical melanocytes and prominent adnexal involvement, make me think of a lentigo maligna arisen in a actinic keratosis/solar lentigo.  

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Dr. Mona Abdel-Halim

Posted

25 minutes ago, vincenzo said:

The alternate para and ortokeratosis with atypical interadnexal keratinocytes and the poorly attenuated rete ridge, with lentiginous growth of atypical melanocytes and prominent adnexal involvement, make me think of a lentigo maligna arisen in a actinic keratosis/solar lentigo.  

Agree

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Eman El-Nabarawy

Posted

18 hours ago, vincenzo said:

The alternate para and ortokeratosis with atypical interadnexal keratinocytes and the poorly attenuated rete ridge, with lentiginous growth of atypical melanocytes and prominent adnexal involvement, make me think of a lentigo maligna arisen in a actinic keratosis/solar lentigo.  

Agree.

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Victor Delgado

Posted

if you have this kind of melanocytic confluence with a few asymmetrical nests, over sun exposed skin and elderly patient, it should be called Lentigo Maligna, with or without IHC. In this case with AK associated. Agree with Vincenzo. Nice case, thanks for sharing.

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Dr. Richard Carr

Posted

Thank you for your responses but on this occasion I beg to differ.

My report: Actinic keratosis, pigmented, with hyperplasia of enlarged dendritic melanocytes of doubtful clinical significance.

Discussion: No confluence and this sort of dendritic melanocytic hyperplasia can be seen in seborrhoeic keratosis, pigmented bowen's, BCC, melanocytic matricoma etc. etc. I'd be very wary about diagnosing lentigo maligna in the setting of pigmented actinic keratosis without more firm evidence. Of course I may be wrong hence my "..of doubtful clinical significance".

Please stay safe during these challenging times (Covid 19).

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