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cbt3Pb1: along this rete ridge, the lentiginous component has produced junctional cavitation of the epithelial domain. The neoplastic cells are loosely attached to their neighbors.
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cbt3Pb2: thin fascicles of neoplastic, spindle shaped neoplastic melanocytes are loosely but regularly spaced in a widened papillary dermis to produce the pattern of a vertical growth component. Cytologic atypia is moderate (minimally deviant) and the epidermis is hyperplastic. Perhaps, some observers might qualify the lesion as a spitzoid melanoma, or even “Spitz nevus.”
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cbt3Pb3: the papillary dermis is widened and fibrotic. Fascicles of atypical spindle cells, showing moderate to moderate severe cytologic atypia, are loosely but regularly spaced; the patterns qualifies as variant vertical growth. The entrapment of the nest in a dense fibrous matrix qualifies as “arrested” variant vertical growth. The inflammatory infiltrates are mild. Multinucleated giant cells are present in some of the fascicles. In the upper 1/2 of the field, the neoplastic cells are pigmented. Would some observers find spitzoid features in this field?
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cbt3Pb4: the nests and fascicles of atypical spindle cells are closely spaced to produce a nodular component; the patterns are those of typical vertical growth; spindle cell patterns are common in the dermal components of ALM. There are spotty lymphoid infiltrates. Atypia is moderately severe.
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cbt3Pb5: at the top of the field, a portion of a vertical growth component is represented; the interface with the dermis is sharply defined in this field; the changes are compatible with deep level III invasion. In this nodule, nests and fascicles are loosely spaced in a fibrous matrix; the patterns are those of variant vertical growth. At the bottom of the field, there is a portion of a second nodule that is within the domain of the subcutaneous fat. It has typical vertical growth qualities (closely spaced nests and fascicles), but is a separate, independent nodule; it could be characterized as a micrometastasis. The red arrows identify a small muscular vessel (probably a vein) that shows fibrous obliteration of its lumen. Tumor cells are individually isolated in the newly formed fibrous matrix occluding the lumen of the vessel (blood vessel invasion) (see also c14t3P1-4)
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