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P15-56: Photographs depicting cytologic features and nesting patterns in material from 1993 (left) and 2000 (right) are available for comparisons. The cells are more spindle shaped and patterns more fascicular in
the material from 2000. For either pattern, an unqualified diagnosis of melanoma would be arbitrary. On the left, the lesion is clearly “nevoid;” there is mild atypia and the patterns of rounded nests in the deeper
portion of the dermis would be unusual in a common nevus. On the right, the nesting pattern is fascicular. The spindle cells are monotonous and nucleoli are inconspicuous. The fascicles sit among collagen bundles
without inducing a tumor stroma. The designation, minimal deviation melanoma, has application for a lesion of this type (spindle cell variant) but has been marginalized by a large group of pathologist. As an
alternative, the lesion might be characterized as spindle cell melanocytic neoplasia of indeterminate malignant potential. Perhaps, some pathologists might favor a diagnosis of either Spitz nevus or deep penetrating
nevus. The patterns, however, are characteristic of neither of the latter two processe.
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