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c20t3P1(case4969-339 ): This biopsy was taken in 1960. The epidermis shows acanthosis and elongation of rete ridges in irregular patterns.The patterns at the dermal-epidermal interface are lentiginous and junctional. The junctional nests are rounded. The cells of the nests are spindle shaped; they have pale, acidophilic cytoplasm. The cells of the junctional nests are loosely attached to their neighbors. Clefts have formed at the interface between some of the nests and the overlying epidermis. The papillary dermis shows lamellar fibrosis. There are perivascular infiltrates of lymphoid cells.
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c20t3P2: At higher magnification, the cells of the junctional component are plump; they show variation in nuclear staining. Some of the cells are multinucleated. One multinucleated cell is present in the fibrotic papillary dermis near the right margin of the field. Individual neoplastic cells, and nests of neoplastic cells have migrated upward into the epidermis. The cytologic features provide a Spitz-like quality to the patterns.
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c20t3P3: Near the top of the field, cells of the junctional component show variations in nuclear staining. In this area, the papillary dermis shows a prominent degree of lamellar fibrosis.
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c20t3P4: In the area that is outlined by red arrows, nests of neoplastic cells are clustered in the dermis to form a nodule (vertical growth pattern). There are clusters of heavily pigmented melanophages among the nests of neoplastic cells. Lymphoid infiltrates are moderate.
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c20t3P5: The cytologic features provide a Spitz-like quality. Nuclei vary in size, and have “heavy” membranes” (marginated chromatin). Nucleoli are prominent. Cells are spindle shaped and rounded; they are variably pigmented. Some of the cells are multinucleated. The cells are loosely attached to their neighbors.
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c20T3P6: In the “vertical growth” component, the cells form rounded nests. In areas the nests are closely clustered. Overall, the cells form a compact nodule in the pattern of typical vertical growth. The pleomorphism provides a Spitz-like quality to the cytologic features. Lymphoid cells intermingle among the nests (I wonder if the patterns might be acceptable to some observers as those of Spitz nevus with halo nevus phenomena?). The pattern is level III type.
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c20t3P7: In this area, the lamellar fibrosis is extensive in the absence of neoplastic cells in the dermis. The pattern might be characterized as partial regression.
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c20t3P8: Over the vertical growth component the junctional component is interrupted. The relationships might be interpreted as evidence that the cells of the dermal nodule are independent of phenomena at the dermal-epidermal interface. This lesion qualifies as a MDM of Spitz-like type (or of juvenile melanoma type). It measure less than 0.75 mm in vertical dimensions. There was a metastasis to a regional lymph node. At 5 years, the patient was free of disease.
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