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c22t3P1 (case 713): This is a remnant of the pre-existing, or precursor dysplasia. The degree of atypia is moderately severe; there is upward migration of individual cells; focally, the epidermis is hyperplastic. If associated with a vertical growth component, the patterns in this field would be compatible with a “radial growth” component. To the right, the papillary dermis is fibrotic and laminated (host immune response). There are mild perivascular infiltrates of lymphoid cells.
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c22t3P2: The epidermis shows large junctional nests with loss of cellular cohesion in the nests. The cells of the junctional nests are plump; there is cellular pleomorphism. Some of the round cells are large. The cells are variably pigmented in the junctional nests. There are scattered multinucleated giant cells. Nest and fascicles are closely spaced in a widened papillary dermis. The cells of some of the dermal nests are uniformly, and heavily pigmented. Some of the heavily pigmented cells of the dermis are melanophages. There is maturation from the superficial to the deep portion of the dermal component. At the deep margin, the cells are small; they have small round nuclei with dense chromatin; some of the small cells are pigmented; some of the small cells extend into the upper portion of the reticular dermis. In the deep component, it is difficult to exclude a remnant of a pre-existing common nevus. Inflammation is not a feature of the lesion at its deep margin. The lesion shows patterns that provide a common nevus-like quality.
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c22t3P3: The common nevus-like qualities are well represented in this field. the lesion qualifies as a MDM of common nevus-like type. The lack of inflammation, and host immune response reinforces this interpretation. For a nevus-like variant of this type, I would include the small cell population in the evaluation of the lesion by Breslow’s criteria.
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c22t3P4: From the superficial component near the dermal-epidermal interface to the deep component near the bottom of the field, the variations in size of nests, as well as the size of cells forming the nests, qualify as “maturation.” There are spotty mild lymphoid infiltrates. The degree of atypia varies from moderately severe to moderate. In the junctional nests, there is loss of cellular cohesion. Perhaps, some observers might find Spitz-like qualities in the cytologic and histologic features.
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c22t3P5: Maturation is less prominent in this area at a deeper level in the block. There is loss of cohesion in some of the dermal nests.
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c22t3P7: Near the dermal-epidermal interface, the cells are large and “epithelioid;” again, I wonder if the epithelioid qualities might lead to a lingistic interpretation of the lesion: It is epithelioid; therefore, it is a Spitz-like variant? At least one nucleus, to the right near the bottom of field, contains an inclusion of cytoplasm. Cytologic atypia is marked. One cell is multinucleated.
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