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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 2892 - 06 August 2021 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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F70. Lifelong papular naevus on check. On half has become darker in last 3/12.


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vincenzo

Posted

Left--> Melanoma, balloon cell type, sprung by a Lentigo Maligna. Right--> nevus. 

Melanoma has an expansive nodular growth and pushes the elastic fibers, while nevus has an infiltrative one, between collagen and elastic fibers. 

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Eman El-Nabarawy

Posted

Beauty!!

The DD here is balloon cell change in a nevus (with overlying junctional component) vs balloon cell melanoma. Age of the pt, nuclear pleomorphism, lack of (maturation, pigmentation, intervening stroma) and prominent nucleoli favor the 2nd. Also atypical mitosis, if present.

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Meenakshi Batrani

Posted (edited)

There appears to be expansile nodule with cytological atypia. Loss of p16 in this zone compared to the rest. I would favour nodular melanoma arising in a nevus. 

Edited by Meenakshi Batrani

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volha

Posted

Looks like a different clone, melanoma (p16 loss) arising in nevus (p16 preserved )

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Krishnakumar subramanian

Posted

AGREE MELANOMA IN A NEVUS

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HENRY

Posted

agree with melanoma in a nevus.  also curious to know what is the BAP-1 status? it does have that BAPoma look of those epithelioid melanocytes with binucleation and lymphocytes response.

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Dr. Richard Carr

Posted

Agree with melanoma in a naevus. p16 was helpful for assessing the depth. Nice example of a background Miescher type naevus with exaggerated elastic fibres not seen in the melanoma part. p16 null and a small lateral SSMM were present (not shown) so I did not do BAP1 but agree worth considering in all biphenotypic naevi (although the "sptizoid" component here is a little too pleomorphic with quite irregular chromatin). 

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