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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
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Case Number : Case 1419- 1 December Posted By: Guest

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Case History: 41 year old woman with suspicious lesion on right cheek, 0.9 x 0.9 cm, changing in size and color for the past six months. Immuno photo micrographs all represent MiTF staining (figures 6-8).

Case posted by Dr Uma Sundram


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Dr. Mona Abdel-Halim

Posted

Lentigo maligna (in situ phase of LMM)

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Dr. Mona Abdel-Halim

Posted

A question to Dr Uma, do u usually prefer MiTF in melanocytic lesions over Melan A or only for certain cases? I will appreciate if you enlighten me in this area :-) Thanks in advance :-)

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Raul Perret

Posted

I see a flat lesion composed of a proliferation of melanocytes distributed both singly and in a nested pattern with areas of bridging. No clear pagetoid spread is seen but the lesion is rather large and the peripheral margins are compromised. Cytological atypia is rather moderate to severe. The dermis show marked solar damage as well as a moderate lymphocytic infiltrate, I dont see fibroplasia. I would diagnose this lesion as a junctional nevus with severe displasia and reccommend re-excision with 0,5 cm. security margins.

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vincenzo polizzi

Posted

I see an atypical proliferation of single and nested melanocytes in a actinic skin: i agree with Dr. Mona.

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Arti Bakshi

Posted

The predominant lentiginous pattern of proliferation (nearly continuous as seen on MITF), favours lentigo maligna over a dysplastic naevus. There is also spread down adnexal structures, also typical of LM (plus sun damaged skin as rightly pointed out by Vincenzo)

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vincenzo polizzi

Posted

Hello, everibody, i'm a general pathologist, from Italy. All of you are very very good dermatopathologist and i'm learning a lot in this website.

Thank you so much ( sorry for my english )

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Raul Perret

Posted

Buongiorno Vincenzo! it is indeed a nice webpage where we can all learn from each other.

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Arti Bakshi

Posted

Welcome on board Vincenzo! Nice to see new people joining in.

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Uma Sundram

Posted

This is the usual question regarding cases like this: severely dysplastic nevus or malignant melanoma in situ, lentigo maligna type? The presence of sun damage, location on the face, and large nature of the lesion all favor MMIS, lentigo maligna type, over a nevus. In a case like this the age of the patient takes a ‘back seat’ to the clinical and histologic features. Regarding MiTF use, for atypical lesions such as this one, I prefer to use a nuclear stain (MiTF, Sox 10, S100) rather than a cytoplasmic stain (HMB-45, Melan A).  I have seen Melan A overstain quite a bit so have tended to use this stain by itself in lower-stakes cases or in conjunction with other stains, preferably a nuclear stain. I have strayed away from S100 due to its tendency to stain interdigitating cells (which tend to be plentiful in damaged, inflamed skin). Sox10 often doesn’t work well in my lab-hence I have started using MiTF by itself or in conjunction with Melan A. Welcome Vincenzo!

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Uma Sundram

Posted

Just to clarify use of Melan A: I rarely use it by itself and usually in low stakes cases (i.e., regular nevus or nevus with mild dysplasia?). In high stakes cases, such as this one, i tend to use a nuclear stain (MiTF rather than sox 10) so that I can see the circumscription of melanocytes better. If your sox10 works better than mine, that's a good one to use too! 

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Arti Bakshi

Posted

Thanks Uma, that's useful. Our Sox10 works but shows rather weak nuclear staining, so not too fond of it! Guess its a question of getting used to the stain and avoid tendency to over diagnose on melan-A and under diagnose on sox10. Will try MiTF.

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Nada Macaron

Posted

Can anyone please comment on melan-A or MiTF staining melanophages as a pitfall in evaluating dermal invasion?

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