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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 2753 - 25 January 2021 Posted By: Richard Logan

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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M70, 7 year history of pigmented lesion on glans penis and foreskin.


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Carmen Lisievici

Posted

I would consider this a dermal nevus.

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Alex-Ventura-Leon

Posted

Yes, It seems a Nevus for me too but I´ve never seen a nevus in that location. 

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vincenzo

Posted

?Combined blue and dermal common nevus. But the pigmented cells don’t look like dendritic cells. So agree with Colleagues. 

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Meenakshi Batrani

Posted

Yes. Looks like an intradermal nevus.

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vincenzo

Posted

13 hours ago, vincenzo said:

?Combined blue and dermal common nevus. But the pigmented cells don’t look like dendritic cells. So agree with Colleagues. 

Looking more carefully, it seems there are some dendritic cells...???

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Richard Logan

Posted

I think you will see from the clinical picture why we wanted to biopsy this late-onset, atypical pigmented lesion on this elderly man's glans.  if you look closely you can see an area of pigmentation involving the foreskin as well.  Why it has only become clinically obvious at this age is speculative - perhaps the lack of ultraviolet exposure (one would assume!)

This was an example of the very rare phenomenon of  "divided", benign, melanocytic naevus. It is sometimes called a "kissing naevus", a somewhat unfortunate description perhaps!

It's the only time I saw a case during my career.  The phenomenon seems to originate in fetal life.  Melanoblasts migrate to the skin during the second and third months of gestation.  Between the 11th and 14th week, two penile epithelial invaginations occur, one to form the the urethra, the second to separate the glans from the foreskin.  Presumably if a naevus has already been "formed" before this separation, it could be split into two separate foci as here, one on the glans and another on the foreskin. 

There is a more florid example of this phenomenon in the literature: Yung SJ et al, Ann Dermatol 2011, 23: 512.  The same process can occur on adjacent fingers and also the eyelids, with part of the naevus on the upper, and the rest on the lower eyelid.

 

 

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DR NADINE BURKE

Posted

great case thanks

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