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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 2956 - 04 November 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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75M, punch biopsy from pigmented lesion frontal scalp


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Anil Patki

Posted

I am torn between pigmented actinic keratosis and melanoma-in-situ mainly because of lack of expertise as we rarely see these cases in India. IHC for melanocytes will help. 

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sfwenson

Posted

PIgmented AK/early SCCIS. Would get a MART-1 or SOX-10 just to rule out MMIS.

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vincenzo

Posted

Pigmented Actinic Keratosis

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Richard Logan

Posted (edited)

I think the dysplasia and dyskeratosis  are rather too much for a solar keratosis.  Also the parakeratotic hyperkeratosis is more suggestive of a keratinocyte dysplasia than melanoma.   I would call this pigmented Bowen's disease.

However, I would agree that it would be prudent to do MART-1 or SOX.

Edited by Richard Logan
Grammar

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Looks like clonal lesion- my differentials Bowens and MM (pigment dropping down , macrophages with pigment -according to Akerman it is can be clue to MM)

A lot of sun damage under the lesion 

I would want to do p16, p53, Melan A

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Krishnakumar subramanian

Posted

actinic keratosis

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Saleem Taibjee

Posted

Here are the immunos which help clarify .....

 

55296_10.0x Melan-A labelled.jpg55296_20.0x p53 labelled.jpg

 

 

 

55296_10.0x Melan-A labelled.jpg

55296_10.0x p16 labelled.jpg

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Saleem Taibjee

Posted

Yes, well done. As confirmed by the immunos, this is a nice example of pigmented and pagetoid Bowen's. The p53 is particularly impressive.

BW

Saleem

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