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c7t3P1: a portion of a polypoid tumor is represented on the left; it is ulcerated. To the right of the polypoid lesion, the epidermis is hyperplastic with a prominent superficial unit. Rete ridges are elongated. There is lentiginous and junctional melanocytic dysplasia. The combination of patterns include vertical growth and radial growth. The radial growth is a remnant of the dysplasia from which the vertical growth had its origin.
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c7t3P2: This is a portion of a radial growth component showing the pattern of a lentiginous and junctional moderately severe dysplasia; atypical cells in lacunar patterns have migrated upward into the epidermis. In the junctional nests, the cells are spindle shaped and pigmented. There are mild perivascular infiltrates of lymphoid cells in the dermis. The papillary dermis shows lamellar fibrosis.
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c7t3P3: In this radial growth component, the lentiginous component shows some degree of pleomorphism. Focally, the neoplastic cells collect in irregular defects in the epidermis; the cells appear to be in cavities in the epidermal domain. These cavitary patterns differ somewhat from the symmetrically rounded, junctional nests of classic SSM. The neoplastic cells are loosely attached to their neighbors. The epidermis shows prominent hyperplasia of the superficial unit. The papillary dermis is widened and fibrotic. It contains mild to moderate infiltrates of lymphoid cells. The degree of dysplasia is severe (marked).
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c7t3P4: Detail is not sharp, but this is a common pattern of level IV invasion in ALM. The nests of cells are closely aggregated; this might be mistaken for a pattern of deep level III invasion. At the advancing margin, fascicles of neoplastic cells extend into the reticular dermis among pre-existing collagen bundles (pattern of migrant vertical growth). As is often the case, there is little inflammation at the advancing margin in level IV lesions; this is migrant vertical growth; although, the solid patterns complicate the appreciation of diffuse infiltration of the reticular dermis. The band of inflamed fibrous tissue which usually defines the deep margin of level III lesions of SSM is not represented.
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c7t3P5: At higher magnification, the cells are spindle shaped; cytologically, they are rather monotonous. The cells form closely aggregated, interlacing fascicles. Thin fascicles of neoplastic cells extend irregularly into the reticular dermis among collagen bundles. Lymphoid infiltrates are mild. Spindle cell patterns are more common in ALM than in SSM.
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c7t3P6: In some vertical growth components, either as the dominant pattern, or as a regional variation, broad fascicles are loosely spaced in a fibrous matrix. This variation in patterns seems to be intermediate between an earlier stage in which fascicles are thin, and cells are less atypical, and a later stage in which fascicles become more closely spaced, and atypia more advanced. The fibrous matrix is rather patternless; at the advancing margin, the changes suggest that the matrix is an alteration of the collagen of the reticular dermis, rather than an altered papillary dermis. The matrix is relatively free of inflammation.
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c7t3P7: this is a solid pattern of vertical growth in which nests of cells are closely spaced. In this example, neoplastic cells are rounded (“epithelioid”), and nests of cells tend to be rounded. There is scanty stroma among the nests. There is little evidence of “tumor infiltrating lymphocytes.”
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c7t3P8: Neoplastic cells are rounded or polygonal in outline. The cells have pale cytoplasm. Nuclei have marginated chromatin and central nucleoli. Some cells have convoluted or deeply notched nuclei; these cells may be dendritic histiocytes among the neoplastic cells. Nests of cells are back to back.
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