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Melanocytic Slide ClubCase 202
Dr Richard A. Carr
M73. Pigmented lesion L cheek ?melanoma. Nov 2009
Results (N=28)• BENIGN 0
• MALIGNANT 28– LMM 19– SSMM 1– Nodular 1– Min. Dev. 1– Spitzoid 1– Unclass. 2
Results (N=28)• Clark
– I 0– II 3– III 10– IV 5– V 1
• Breslow– Median (range): 0.8 (0.3 to 1.7)
• Growth Phase: R = 1; V = 21
• Regression: Y = 0; N = 20
• Mitoses: Absent = 8; Low = 11
“Difficult definite LMM, ?deep dermal component”
“Melanoma arising in LM mitoses 2/mm²
“Favour LMM over unclassifiable”
“Pigment synthesising melanoma / animal type - cell type similar to that described in pigmented epithelioid melanocytoma.”
“Atypical proliferation of epithelioid cells in the epidermis with similar cells in the dermis. “
Expert Comments
Other Section (not circulated)
At 2 months: Wider local excision. Sampled in 2 TS. No Tumour
At 6 Months: Revision of Scar (keloidal)
At 18 Months: Local Recurrences x 3
Dermal Pigmented Epithelioid Cell Component (Dermal Nodule)
Ball and Gorlitz 1994 Jam Acad Dermatol: 73 cases
• Clinical: 6.2mm mean dia. with central 1-5mm dark brown or black macule or papule of recent onset
• Ordinary acquired or congenital naevus• Central focus or foci of large epithelioid melanocytes in
variably sized nodular aggregates• Heavily pigmented• Cytologically bland or atypical• Occupying 5 to 80% of naevus• Associated melanophages• Often transition of surrounding naevus• Differential Diagnosis: Melanoma, Combined naevus
Melanocytic naevus with phenotypic heterogeneity (Atypical Dermal Nodule)
v’s Melanoma• Symmetrical v’s asymmetrical• Size: often <6mm v’s often >1cm• Lateral borders: Sharply v’s poorly defined• Focus: present well demarcated v’s variable• Atypia: absent or mild v’s moderate to severe• Mitoses: Absent or minimal v’s frequent• Lymphcytic reaction: Uncommon v’s frequent
Learning Points
• Beware of the epithelioid / pigmented clone in sun-damaged skin of the elderly!!
• Not all malignant lesions have a prominent host inflammatory reaction
• Mitotic figures may be sparse!