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Fig. c5t3P1: In the subsequent photomicrographs, a common feature is an expansile nodule in association with cytologic atypia. This combination was basic to the diagnosis of MDM variants, including the Spitz-like type. The expansile nodule in this example shows a level III pattern; it is confined to a widened papillary dermis. Focally, the nodule is associated with lymphoid infiltrates. To the right, the patterns in the widened papillary dermis do not contribute to the nodule; a remnant of a earlier stage of neoplasia is represented in this area.
Note: In the definition of MDM, a vertical growth component of typical type was a requisite. Subsequently, some lesions with high grades of nuclear atypia, but showing variant and migrant vertical growth-like patterns, were also included in the “Spitz-like” category. Atypia generally is more prominent in the “Spitz-like category” than in the other MDM categories.
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Fig. c5t3P2: The lesion of fig. c5t3P2 is represented at higher magnification. The area to the right more closely resembles a classical “Spitz nevus.” In the nodule to the left, atypia is more prominent than in the component to the right; comparisons between the nuclear qualities of the two sites establishes discordance. This is classical MDM of “Spitz-like” type.
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Fig. c5t3P3: My monkeying around with the colors have exaggerated the cytoplasmic qualities of the cells in the expansile nodule. The cytoplasms are lavender; this is a common quality in the category of MDM of “Spitz-like” type. Nuclei vary in size and outline; chromatin is dense. There are scattered multinucleated giant cells. Lymphoid infiltrates are mild.
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Fig. c5t3P4:The cytologic features are just awful. Atypia is marked. There is nuclear pleomorphism. The lesion has nodular qualities. This is a recurrence of the lesion represented in fig. c4t3P7. Commonly, recurrent “Spitz nevi” are more atypical than the primary lesion.
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Fig. c5t3P5: This lesion is sufficiently atypical and tumoral to qualify as MDM of “Spitz nevus-like” type. Lymphoid infiltrates are moderate. Fascicles are loosely spaced but the overall configuration was expansile.
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Fig. c5t3P6: Away from the dermal-epidermal interface, the tumoral qualities are better defined.
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Fig. c5t3P7: In this example of classical MDM of “Spitz-like” type, the nests of cells are closely spaced in a specialized, inflamed stroma. Lavender cytoplasms are a prominent feature. The dermis beneath the lesion is scarred. There are occasional multinucleated giant cells.
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