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c11t3P1: This is high grade dysplasia of ALM type; there is prominent upward migration of cells into the hyperplastic epidermis. The papillary dermis is widened, and shows lamellar fibrosis. Inflammation is mild. The patterns are prominently lentiginous. Lacunar patterns are prominent.
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c11t3P2: this is variation in patterns that may be seen in ALM; it has nevoid qualities and may be seen in thin lesions (lesions early in their evolution). The pattern may be seen in combination with solid patterns in more advanced lesions. In this example, the pattern was a variation in association with solid, high grade patterns. Patterns of this type have a minimal deviation nevoid quality.
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c11t3P3: the rounded nests and pigmented cells provide a “type A” quality to the patterns. Many of the nests are defined at their margins by flatterned pigmented spindle cells. There is cytologic atypia. Cells of the nests have pulled away from their neighbors; this quality also might be cited as nevus-like. The matrix is delicate and fibrous.
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c11t3P4: the patterns are of minimal deviation type; the lesion has nevus-like qualities. Degree of atypia is moderate.
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c11t3P5: flattened, pigmented cells define the margins of the nests in nevus cell-like patterns.
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c11t3P6: in this field, the cells form ribbons and festoons. Even these patterns might be characterized as nevus-like; they might be compared to type B patterns of a common nevus. The delicate stroma is also a nevus-like feature.
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c11t3P7: this trichrome stain breaks the monotony. Fascicles of uniform spindle cells extend from the epidermis into the reticular dermis. At the advancing margin, the neoplastic cells become individually isolated in a fibrous matrix; the lesions takes on a desmoplastic quality near the deep margin of the field.
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