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c23t3P1 (case 713, local recurrence in scar): The epidemis is hyperplastic and focally (to the left) shows effacement of the rete ridges. The dermis is fibrotic in the pattern of a scar. A small cluster of pigmented, atypical cells hugs the epidermis. The cells are similar to those seen focally in the primary lesion. There are mild to moderate infiltrates of lymphoid cells at the deep margin of the clustered atypical cells.
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c23t3P2: In this field, the patterns are similar, but the nodule in the dermis is not in contact with the epidermis; the lesion lacks a “primary configuration.” The small keratin-filled cyst qualifies as a milium.
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c23t3P3: In the dermal nodule, the atypical cells form nests and fascicles. The cells are uniformly pigmented. Lymphoid cells intermingle among the nests and fascicles of neoplastic cells (i.e., pattern of tumor infiltrating lymphoid cells). The lymphoid infiltrates might alternately be characterized as a halo nevus-like reaction. The lesion lacks a “primary configuration.” Atypia is uniform and marked.
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c23t3P4: At the deep margin of the nodule, the cells infiltrate the scar. In the nests, there is a loss of cohesion. In the primary lesion, the vertical growth component measured 0.69 mm in vertical dimensions. A local recurrence was noted 2 months after excision of the primary lesion. At 22 months, axillary metastases were noted. Ten months later, the patient had CNS metastases. Distant metastases were noted at 37 months after the excision of the primary lesion.
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