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c11t3P1: To begin at the beginning, this is a lentiginous dysplasia. This spread of melanocytes in the basal unit of epithelium is abnormal in regard to degree of cellularity, and in regard to cytologic detail. There are too many melanocytes per unit area, and the cells individually show nuclear atypia with enlargement of nuclei and nuclear hyperchromatism. The lentiginous spread defines the domain of the developing dysplasia (cytologically premalignant dysplasia); it even involves the hair follicle. There is papillary dermal fibrosis, and there are mild infiltrates of lymphoid cells in the perivascular spaces.
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c11t3P2: Progression is manifested by the presence of prominent junctional components at the dermal-epidermal interface. There is loss of cellular cohesion in the junctional nests. Some of the nests have pulled away from the epidermis. This is not a “Spitz variant;” clefting in this manner is not peculiar to “Spitz nevus.” The papillary dermis is widened and fibrotic; the fibrous tissue is laminated with most of the bundles arranged parallel to the surface of the skin. Scattered nests of atypical cells are present in the fibrotic dermis; the patterns are relatively random in the dermis. Vessels are ectatic; they are surrounded by mild infiltrates of lymphoid cells. The degree of dysplasia is moderate (low grade dysplasia). Centrally, several nests are stratified in the dermal component.
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c11t3P3: The degree of atypia is moderate. The cytologic features are not those of a Spitz variant. The dermis shows lamellar fibrosis.
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c11t3P4: A portion of the column of stratified nests of cells as seen in the dermis in fig. c6t3P3 is represented. The stratified nests produce a pattern which might be characterized as arrested (a characterization which gives recognition to the lamellar fibrosis) variant (a characterization giving recognition to the loose, but regular, spacing of the nests in the column) vertical growth-like pattern (the pattern is insufficiently developed in regard to number of nests and strata to be confidently characterized as arrested variant vertical growth, as opposed to arrested variant vertical growth-like.).
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c11t3P5: This lesion shows progression in regard to cytologic atypia and epidermal patterns; it lacks a dermal component. This is moderately severe dysplasia. There is variation in nuclear size and staining. There is upward migration of atypical cells into the overlying epidermis. The epidermis shows a characteristic pattern of acanthosis with hyperplasia of both the basal, and the superficial units of the epidermis. Inflammation is mild in the dermis.
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c11t3P6: There is lentiginous and junctional moderate melanocytic dysplasia. A nest of slightly atypical, pigmented nevus (or nevus-like) cells showing dense nuclear chromatin is present in the papillary dermis. The papillary dermis shows prominent lamellar fibrosis with melanophages. Prior to the definition of the premalignant melanocytic dysplasias, I classified this type of lesion as sheath cell nevus.
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c11t3P7: This is pigmented spindle cell melanocytic dysplasia showing moderate dysplasia. Nests and fascicles of cells extend into the papillary dermis, but the dermal patterns do not qualify as a vertical growth pattern. To the left, the lymphoid infiltrates at the interface between the papillary dermis and the reticular dermis are band-like. The lesion has halo nevus-like qualities.
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