Whithers 1

Whithers 2

Whithers 3

Desmomela

BWEEMS

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MDMLMM

Nevoid MDM

MDMhalo

Nearneoplasia

MDMhalo, metastasizing

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Pictorial 1

Pictorial 2

Pictorial 3

Pictorial 4

C6P3-1: The epidermis is thin and rete ridges are effaced. A thin subepidermal defect contains extravasated red blood cells. A sheet of pale, nevus-like cells define the lower margin of the field. The interface between this population and neoplastically more advanced cells in nests is defined by green arrows. The nests of atypical cells are widely but regularly spaced in a widened, fibrotic papillary dermis. Clusters of heavily pigmented histiocytes and loose infiltrates are present among the nests of melanocytic cells. The patterns in the area of regularly spaced nests qualifies as variant vertical growth; this pattern is generally associated with lentiginous and junctional components in the overlying epidermis and might be characterized as a marker for a neoplastic process in which progression in bulk is dependent on the delivery of nests of neoplastic cells in sequence from the dermal-epidermal  interface into the dermis; as a consequence such growth components are often stratified with most atypical cells near the dermal-epidermal interface and the least atypical (and neoplastically  least advanced) cells in the deepest strata of the vertical growth component. Variant vertical growth components are common in the setting of minimally deviant melanocytic neoplasia. The cells forming the nests have rather scanty cytoplasm and as a consequence the nuclei are crowded; they are irregular in outline and hyperchromatic.

C6P3-2: Here is variant vertical growth in minimally deviant cytologic patterns. Some of the nuclei are enlarged and generally chromatin is uniformly dense (not stippled). The nuclear features have a halo nevus-like quality. They mark a distinctive stage of neoplasia that is likely to be associated in any remnant of precursor with halo nevus-like phenomena; one follows the other.

C6P3-3: The boundary between a portion of variant vertical growth component above and nevus-like component below is represented (green arrows). The two uppermost arrows on the left identify a nest at the boundary. Its features are such that it might be characterized as transitional in character (it is at the border both physically and neoplastically (i.e., cytologically)..

C6P3-4: On one section, the lesion was represented in lentiginous and junctional patterns with only an occasional atypical melanocytic cell in the slightly widened, inflamed papillary dermis. This radial extension of the junctional component would offer support for the interpretation that the vertical growth component had its origin in an atypical halo nevus.