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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 3037 - 25 February 2022 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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F25. Upper back. Mole. Approx. 1 year, change in size & border over last 6/12. Now irregular outline, 8mmd, prone to sunburn and has burnt in the past. No previous skin problems. ?Dysplastic naevus


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Two distinct population of melanocytes- junctional cells look Spitzoid, dermal cells are banal. Whether this is just a combined nevus or some kind of recurrence phenomenon in the context of previous sunburn... can't decide.

 

EDIT: IHC updated, loss of p16 and positive PRAME in the intraepidermal component seem to point to MIS and a dermal nevus

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vincenzo

Posted

I don’t know if it make sense calling this dysplastic nevus, but lamellar concentric fibrosis around rete ridge and a mild random atypia fit well the classic dysplastic nevus description. Anyway this is a nevus, for me. Am’I wrong?

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Meenakshi Batrani

Posted (edited)

On H&E alone was thinking more in terms of dysplastic nevus. Melan A does not show significant pagetoid spread, but there is loss of p16 and PRAME is expressed in epidermal component, although only on one  image difficult to say if it is above threshold of >75% cells. Tough one to choose between dysplastic nevus or early MIS.  

Edited by Meenakshi Batrani

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Dr. Richard Carr

Posted

It is interesting to see the quite different p16 in the bland dermal naevus and the junctional proliferation. Also agree I'd probably have signed out many lesions such as this as dysplastic naevus especially at this age. The PRAME is positive (4+, >75% of nuclei) so we favoured a melanoma in situ arising in a pre-existing naevus. Of course quite subjective how you approach these lesions but good to ensure complete excision with clear margins. 

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