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 1894 - 31 Aug - Dr Arti Bakshi

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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55/M lump neck. Recently diagnosed spindle cell melanoma of nose. ?mets


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Raul Perret

Posted · Report

As dermpath1 my spot diagnosis is also nodular fasciitis. Nevertheless, we have to perform a small panel of immunos in cases like this one (CD34, S-100, EMA, SMA) in order to discard common differentials

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vincenzo polizzi

Posted · Report

I agree with my Colleagues, despite my difficulty in distinguishing between myxoid variant of fibromatosis(there are many clear perivascular spaces with vessels standing out in the background) and keloidal/fibromatosis-like variant of nodular fasciitis ( feathery ganglion like myofibroblasts and extravasated red cells win!). 

I think we can discard the mets hypothesis.

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vincenzo polizzi

Posted · Report

I was wrong!!!

We can't discard metastatic melanoma, desmoplastic, fibromatosis-like!!! I analyzed better the fig 4/5.

So welcome a S100 and other immunomarkers.

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Robledo F. Rocha

Posted · Report

My first thought also was nodular fasciitis duo to extravasation of erythrocytes and due to the feathery appearance. Nevertheless, given the recent history of spindle cell melanoma, immunomarkers for rule out a metastasis are mandatory.

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arti bakshi

Posted · Report

The final diagnosis is :  FIBROMATOSIS.

The tumour cells showed diffuse nuclear positivity for Beta Catenin. SMA showed patchy positivity. Desmin, S100 and melan A were all negative.

Well done to Vincenzo for considering this diagnosis in his differential!

The foci of RBC extravasation were indeed misleading for a nodular fascitis. The spindle cell melanoma on his nose was morphologically different (more cellular, pleomorphic and mitotically active) as well as showed a different immunoprofile (S100 and melan A positive)

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