Melanoma (c18t3P)




c18t3P1 (case 2): This as close as the reader will come to a common melanocytic lesion in this collection of photomicrographs. The epidermis is hyperplastic in the classic pattern as seen in SSM. There is upper migration of atypical cells into the epidermis (for some observers, “melanoma-in-situ”). There are scattered nests of atypical cells in the dermis and, focally, near the center of the field, the nests are clustered to form a small, typical vertical growth pattern.


	c18t3P2: To the right of the center of the field, rounded nests of atypical cells are closely spaced in a “typical” vertical growth-like pattern. Some of the nests are isolated in the lymphoid infiltrates. The atypia is of classic SSM type.

GENERAL INDEX


	c18t3P3: The vertical growth-like component is better represented in this field.


	c18t3P4: A portion of the vertical growth-like component is represented. Atypia is of the type seen in lesions of SSM.


	c18t3P5: In this field, thin fascicles of pigmented, atypical cells infiltrate the reticular dermis. The pattern is level IV and, in addition, qualifies as migrant vertical growth-like. In this area, inflammation is mild.

c18t3P6: Near the dermal-epidermal interface, the dermal component shows a pattern of early (young) vertical growth. Focally, to the right, the lymphoid infiltrates are dense and band-like. Below the center of the field, clusters of histiocytes are represented; the deeply pigmented cells are melanophages. The less pigmented cells are also histiocytes. In this field, the patterns are compatible with an area of focal regression.


c18t3P7: Lentiginous components are spotty in distribution; some of the atypical cells have migrated upward into the epidermis. Nests of similar atypical cells are present in the widened papillary dermis near the dermal epidermal interface. The cells forming the nests are spindle shaped, pigmented, and loosely attached to their neighbors. A zone of fibrosis between the nests of atypical cells and the interface with the reticular dermis contains infiltrates of heavily pigmented histiocytes (melanophages); the changes are compatible with an area of regression.



c18t3P8: For many of you, this field is all that would be required for the diagnosis of melanoma; you are home free in regard to any additional interpretation, other than to evaluate the dermis for nests of tumor cells. This pattern might be characterized as melanoma praecox; it is the product of an observer who cannot endure the anxieties of a histologic evaluation of all patterns; observers who utilize this approach, ejaculate a diagnosis before they have penetrated the secrets of complex histologic patterns.

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