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Fig. c7t3P1: In this area, a poorly defined nests of spindle and polygonal neoplastic cells press upon the endothelium of a dilated lymphatic vessel. The lavender quality of the cytoplasm of the tumor cells is somewhat better preserved in this reproduction.
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Fig. c7t3P2: This is a section of the regional lymph node. There are irregular parenchymal deposits of tumor in the cortex. Focally, the peripheral sinus is involved.
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Fig. c7t3P3: In nodal deposits, it is more difficult to appreciate “Spitz nevus-like” qualities. Commonly, atypia is greater in nodal deposits than in the primary lesion; this is true of the nodal deposits of lesions of “Spitz nevus-like” type as well as those of common melanomas.
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Fig. c7t3P4: The patterns are “Spitz nevus-like.” The cytologic features are pleomorphic and atypical. Giant cells are a prominent feature. There is “loss of cellular cohesion” in the nests of neoplastic cells. Prominent hyaline deposits (Kamino bodies) are present in many of the junctional nests. Lymphoid infiltrates are mild.
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Fig. c7t3P5: In this field, it is tempting to ignore the “Spitz nevus-like” qualities and simply characterize the lesion as an evolving common melanoma. A nucleus to the right contains a prominent inclusion of cytoplasm.
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Fig. c7t3P6: In the logic associated with “Spitz nevus,” this pattern in a thin lesion is acceptable. In that associated with intermediate neoplasia (minimal deviation melanoma), the patterns are at least variant vertical growth-like, and on the basis of some of the qualities might be characterized as early typical vertical growth-like. At the interface between the papillary dermis and the reticular dermis, the lymphoid infiltrates are band-like. Focally, the relationships between the lymphoid cells and the neoplastic cells has “halo nevus-like” qualities.
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Fig. c7t3P7: The degree of atypia is troublesome. The relationship between lymphoid infiltrates and neoplastic cells provide a “halo nevus-like” quality. This pattern can be accommodated in the logic associated with minimal deviation melanoma of “Spitz-like” type (intermediate neoplasia, step II type).
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