c25t3P2: The cells of the junctional nests are loosely attached to their neighbors. Are the cytologic features suggestive of a Spitz-like variant? A blue arrow points to a pale acidophilic body (Kamino body).

c25t3P3: The basic pattern is that of a premalignant dysplasia in this field. There are markers for host immune response with moderate lymphoid infiltrates in the widened papillary dermis. To the right, fascicles of spindle cells rain down from the epidermis. To the left, rounded nests of atypical spindle cells are loosely spaced but form a small nodule near the dermal-epidermal interface. For a pattern of this type, the nodular qualities take precedence over the loose spacing of the nests; the small nodule might be characterized as incipient typical vertical growth. Can the nuclear characteristics be accommodated in the observer’s collection of virtual images which for him define “Spitz nevus?” Again, good luck.

c25t3P4 (case 8): This lesion has polypoid qualities but the nature of the biopsy contributes to this impression; the lesion extends to the margins of the section. Lentiginous and junctional patterns are not a feature of this field; the lesion appears to be dermal in distribution and extends through a widened papillary dermis into the reticular dermis among collagen bundles. There is a central area of sclerosis. In the vertical growth-like component, nests and fascicles are closely aggregated.

c25t3P5: Closely aggregated thin fascicles of pale spindle cells rain down into the fibrous stroma. Inflammation is not a feature.

c25t3P6: In this micro-nodule, thin fascicle of spindle cells are interconnected and loosely spaced in a mucinous matrix (it should be noted that mucinous changes in the stroma are occasionally a focal feature of “classic Spitz nevus).” There are spotty, mild infiltrates of lymphoid cells.