c20t3P2: There is an occasional small, junctional nest but most of the nests are not attached to the epidermis. The cells of the nests are spindle shaped and variably pigmented; there are scattered collection of melanophages. The cells of the nests are spindle shaped; there is some variability in nuclear outlines; chromatin is dense. Cells of the nests are loosely attached to their neighbors. In the nest near the left margin (between rete ridges), the cells are more polygonal in outline and there is variability in nuclear outlines, size, and staining. Having introduced the qualities of spindle and epithelioid cells, some observers might impose the virtual images of a “Spitz” nevus. In this field, the papillary dermis is edematous (a Spitz-like quality).

c20t3P3: The nests near the dermal-epidermal interface are large; the cells of these nests are spindle and polygonal in outline; they are cytologically atypia. The papillary dermis is not appreciably widened or involved beneath the level of the dermal papillae. Some of the fascicles extend into the reticular dermis among collagen bundles (migrant vertical growth-like pattern). There is maturation from the superficial to the deep margin of this field. Perivascular lymphoid infiltrates are not a prominent feature. The patterns are “nevoid,” but are not of a common nevus-like type; they are of a spindle cell type. Is this a Spitz type or a non-Spitz (pigmented spindle cell) type? Is the lesion benign or malignant; perhaps it is best characterized as melanocytic neoplasia of indeterminate malignant potential (pigmented spindle cell variant)?

c20t3P4: In this field, the fascicles are thin and closely spaced in a delicate, activated fibrous matrix. There is a suggestion of nuclear palisades in some of the nests. The patterns are relatively solid and have a vertical growth-like quality; I would favor the interpretation that the pattern is typical vertical growth-like. There are rare multinucleated giant cells.