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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 2881 - 22 July 2021 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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48M Excision left ear ?BCC


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vincenzo

Posted

Combined Nevus ( DPN + Common Nevus ). Useful Beta-catenin. 

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Eman El-Nabarawy

Posted

Combined nevus (common and dermal  Spitz nevus).

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Victor Delgado

Posted

Angiomatoid Spitz Nevus

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vincenzo

Posted

Spit’z Nevus is usually a Kinase-mutated lesion ( like HRAS, ALK etc ), and this genetic pathway should be mutually exclusive with BRAF mutation of the common nevus. Beta catenin of DPN fits best with BRAF.  But this is only a my speculation. I was thinking of a mixed Common+ DPN because of the morphology. 

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Saleem Taibjee

Posted

Here is the BRAF V600E immunostain (negative) below:

24109_5.0x BRAF.jpg

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Saleem Taibjee

Posted

Well done, Vincenzo.

Yes, this is a combined naevus. The beta-catenin is shown below. This demonstrates nuclear staining within the more epithelioid component (1st image), in contrast to cytoplasmic only in the more conventional naevocellular component (2nd image). I was somewhat perplexed by the negative BRAFV600E as above. But I am grateful for the review by Arnaud de la Fouchardiere who confirmed my impression of combined naevus with deep penetrating naevus-like clone, and Arnaud also indicates that most, BUT NOT ALL, such lesions have a BRAF background. The Ki67 is reassuringly low throughout, and p16 preserved.

BW, Saleem

E0D51_20.0x beta-catenin labelled.jpg

E0D51_20.0x beta-cateninb labelled.jpg

E0D51_5.0x Ki67 labelled.jpg

E0D51_5.0x p16 labelled.jpg

E0D51_20.0x beta-catenin.jpg

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Krishnakumar subramanian

Posted

thanks for wonderful case sir, based on morphology we must not diagnose it as melanoma

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HENRY

Posted

beautiful case!

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HENRY

Posted

On 27/07/2021 at 08:49, Saleem Taibjee said:

Well done, Vincenzo.

Yes, this is a combined naevus. The beta-catenin is shown below. This demonstrates nuclear staining within the more epithelioid component (1st image), in contrast to cytoplasmic only in the more conventional naevocellular component (2nd image). I was somewhat perplexed by the negative BRAFV600E as above. But I am grateful for the review by Arnaud de la Fouchardiere who confirmed my impression of combined naevus with deep penetrating naevus-like clone, and Arnaud also indicates that most, BUT NOT ALL, such lesions have a BRAF background. The Ki67 is reassuringly low throughout, and p16 preserved.

BW, Saleem

E0D51_20.0x beta-catenin labelled.jpg

E0D51_20.0x beta-cateninb labelled.jpg

E0D51_5.0x Ki67 labelled.jpg

E0D51_5.0x p16 labelled.jpg

E0D51_20.0x beta-catenin.jpg

The BRAF negative also puzzles me. what review by  Arnaud de la Fouchardiere are you referring to? Thanks Saleem,

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Saleem Taibjee

Posted

Arnaud directly reviewed this case (I'm not referring to a review article).

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