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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 2857- 18 June 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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F50. Back, upper central, 9 x 6 mm, dark brown dermoscopically chaotic mole – longstanding but has become darker - ? atypical, ?MM


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Krishnakumar subramanian

Posted

spindle cell nevus of Reed

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Meenakshi Batrani

Posted

Seems like melanoma arising in a dysplastic nevus. One part is very epithelioid, while the other part shows small nevic cells.  

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vincenzo

Posted

8 hours ago, Meenakshi Batrani said:

Seems like melanoma arising in a dysplastic nevus. One part is very epithelioid, while the other part shows small nevic cells.  

Yes. The left part should be a melanoma, because of a nodular-expansive intradermal growth. The spindle/epithelioid cells are very atypical. And p16 loss is in keeping with melanoma. Useful a Prame stain.

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msofopoulos

Posted

I think it is a (spitzoid?) melanoma. It is asymmetric with atypical cells and (localized) loss of p16. Can we attribute the fibrosis in pic 3 and 5 on dysplastic nevus, regression or location (back)?

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Dr. Richard Carr

Posted

I agree with a "Spitzoid" or Spitz-like melanoma arising in a dysplastic naevus. The clue in image 5 is the expansile nests that squeeze the elongated rete (umbrella sign = narrow compressed rete with thinned curving epidermis on each side) or also referred to as the puffy shirt sign (rounded expansile nests that bulge the epidermis). The null p16 is supportive of melanoma arising in a naevus and I believe is seen in around 70% of naevoid melanomas. 

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