Blues revisited and a leg lesion

Some of the cases since we started back have been quite challenging! Three cases today that are back to basics. Case 2 might be a problem but everything is there and I have histology for all three.

Case 1, Lesion on the back. No previous history of skin cancers. Female aged 55.

case 2, Elderly male with this lesion on his lower back.

Case 3 Lesion on the lower leg in a male aged 65

Case 3

What would be your preferred diagnoses for these three lesions?

Dr Ian McColl said...
The histology for case 1 was no surprise. It was a BCC. I think the bit shown corresponds to that big blue clod. When I first looked at this clinically I thought it was a combined nevus but the dermatoscope helped.

Dr Ian McColl said...
Case 3 was a pig IEC. I have put up the histology of case 2. There are two ? lesions in the dermis and one at the dermepidermal junction. Cliff will work them out. Note the two different cell types in the dermal part. As far as I am aware nothing has previously been done to this lesion.

Dr Ian McColl said...
I have put up the histology of case 2 for Cliff.

Dr Cliff Rosendahl said...
I think I need a pathologist here! There is a proliferation of melanocytes at the DE junction with I guess a separate proliferation in the deep dermis of very mature looking melanocytes. ? Blue naevus with overlying invasive melanoma or reactivated naevus? The dermal part of the DE junction proliferation is not showing maturation. Not confident at all.

Dr Ian McColl said...
Well done Cliff. Case 2 was reported as a melanoma, clark level 2, 0.25 mm arising in association with a combined nevocellular nevus and a blue nevus. The blue nevus bit is the pigmented spindled cell area and the blue regular nevus cells in the dermis is the common nevus. The pathologist thought there was a bit of scarring above this deep cellular component and wondered if it was regression or if it had been shaved before but I certainly did not do it!