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c21t3P1 (case 6792-334): This lesion is somewhat out of place. It was included with the photographs of other thin metastasizing lesions, but there is no history that might document a recurrence or metastasis. By criteria of MDM, this is dermal nodule in the setting of a compound nevus (dermal component to the left and lentiginous and junctional component to the right of the nodule). The nodule is expansile; the nests in the nodule are closely spaced in a delicate fibrous matrix. The nests of the nodule are rounded; the cells of the nests are pigmented. Clusters of melanophages are present in the stroma of the nodule near the dermal-epidermal interface. There are minimal infiltrates of lymphocytes in the dermis.
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c21t3P2: The margin of the nodule is represented; the nests of atypical pigmented melanocytic cells are closely spaced in a typical vertical growth pattern. There are mild perivascular infiltrates of lymphoid cells in the adjacent dermis.
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c21t3P3: At the opposite margin of the nodule, the interface between the nodule and a remnant of nevus is well defined. There are cytologic disparities, if comparisons are made of the features in the nodules, and those in the remnant of the nevus. This is not the histology of a nodular variant of combined nevus. There is a loss of cellular cohesion in the nests forming the nodule.
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c21t3P4: The cells of the nodule are loosely attached to neighbors in the rounded nests. The cells show variations in nuclear size; nuclear chromatin is dense. The stroma is loose and focally edematous; connective tissue cells are activated. The patterns have a nevus-like quality; I would favor a diagnosis of MDM of common nevus-like type. This is a borderline lesion: it measured 0.85 mm in vertical dimensions (nevus cell component excluded). It is borderline on the basis of unusual features, and on the basis of nevus-like qualities. I have no information that would document local recurrence or metastasis but, on the other hand, there is no available evidence that the patient was free of disease. I believe this was a 14 year old boy who had progressive disseminated disease, but I don’t have documentation for this belief.
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