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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 3006 - 13 January 2022 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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40F excision left arm – bizarre reddish lesion which appeared past few months ?melanoma


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IgorSC

Posted

Not easy this one. I think this is a pagetoid compound Spitz nevi. Looking for HRAS alteration or kinase-fusion (Alk, ROS1 or NTRK) would be of great help.

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vincenzo

Posted

PERSISTENT/TRAUMATIZED NEVUS. 

Atypical nests are limited art the cicatricial area. Abrupt border together with the scar below. Kamino bodies (maybe this was/is a Spitz nevus ). 

 

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Meenakshi Batrani

Posted (edited)

Spitzoid features and scarring. May be traumatized spitz nevus. 

Edited by Meenakshi Batrani

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msofopoulos

Posted

Lots of Kamino bodies. I am thinking of Spitz

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Saleem Taibjee

Posted

Yes, there seems to be good agreement here on Spitz lineage. I did find this a tricky lesion, particularly given the Pagetoid spread, fibrosis and inflammation. But the lesion is small and well-demarcated.

I am increasingly requesting additional immuno in such cases. A single IHC stain will not provide a definitive answer, but as a panel we can add to the pieces of the puzzle and help to either substantiate our impression from the H&E in subjective cases, or see if there are any alarm bells/signals. In particular, BRAFV600E should be negative (as it was in this case) if Spitz lineage (and thus rules out a Spitzoid 'conventional' superficial spreading melanoma mimic). PRAME was also negative. Furthermore NTRK was nicely positive in this case, supporting Spitz lineage.

There is undoubtedly some over-diagnosis of melanoma occurring, and I think that these are the sorts of cases which might be diagnosed as early melanomas at some centres, the clinician then congratulating themselves on picking up that early melanoma, but the patient left with a label that he/she has to live with.

It can definitely help to share such cases amongst colleagues. It makes it easier to 'come off the fence'. The clear consensus was Spitz with some atypical features, perhaps reflecting trauma, but falling short of criteria for malignancy. 

BW, Saleem

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