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 1892 - 29 Aug - Dr Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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34 year old woman with mole with central hyper-pigmentation on left superior rib cage. Would you recommend a re-excision?


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Raul Perret

Posted (edited) · Report

The nature of the melanocytic lesion is hard to determine due to the heavy lymphocytic host response. The description and the age are consistent with a halo nevus, but as there is little left of the lesion for assessing its true nature and that there seems to be compromise of one of the margins (fig 3) I would reccommend a re excision. Also, a nuclear marker of melanocytes can be helpful in situations where the infiltrate obscures the lesion

Edited by Raul Perret

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vincenzo polizzi

Posted · Report

I partially agree with Raul, as I'm thinking of a Halo Nevus too. However there is a clinical(referred)-pathological hyperpimentation of the central area, with darkening rather than lightening of the central nevus; here an interesting link. So I had to rely on a good CPC, and I would say to the clinical equipe that I favour a benign lesion. 

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Robledo F. Rocha

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Pseudomelanocytic nests in the setting of a bona fide lichenoid dermatitis. There is extensive vacuolization of basal keratinocytes with formation of Caspary-Joseph space, and grouping of hyperpigmented vacuolated keratinocytes mimics atypical melanocytic proliferation. Then, I wouldn't recommend re-excision.

Reports of cases like this one can be read here and also here.

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Robledo F. Rocha

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1 hour ago, dermpath1 said:

Dear Robledo F. Rocha, can you explain the difference between Caspary-Joseph space aand Max Joseph space?

Dear dermpath1, Caspary-Joseph space and Max Joseph space, these two eponyms designate the same microscopic finding, to wit, the cleft at the dermoepidermal junction secondary to severe vacuolar damage of the basal layer. I prefer to use Caspary-Joseph space in order to give credit to Julius Caspary, who first report on his observations of these spaces in 1888. Max Joseph only did it nine years later.

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Uma Sundram

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These are great comments and I am so glad you all commented on re excision recommendations; just as important as the diagnosis. MITF highlights actual melanocytic nests so this is an example of a halo nevus. The lymphocytic infiltrate is pretty hefty and there is asymmetry of the lesion, so I too recommended a re excision. Totally agree that if this was a lichenoid rash, no need to re excise. Great ddx!

 

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