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c24t3P1(case 7279-703): The epidermis is hyperplastic; it shows irregular rete patterns. Some of the rete ridges have pointed extremities. The epidermis shows lentiginous and junctional, moderately severe dysplasia. Centrally, small, rounded nests of atypical cells are closely spaced in a widened papillary dermis (variant vertical growth pattern). To the right, there are focal band-like infiltrates of lymphoid cells associated with a dermal component. There are scattered collections of melanophages.
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c24t3P2: In both the junctional and the dermal components, the degree of atypia is moderate to moderately severe. Focally, in the widened papillary dermis, the nests of cells are loosely, but regularly, spaced. The fibrous tissue is activated; there is hyperplasia of fibrocytes. There is some evidence of maturation from the superficial to the deep portion of the dermal component. There are spotty, mild lymphoid infiltrates. The atypical melanocytes have pale cytoplasm.
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c24t3P3: The papillary dermis is widened and fibrotic. It contains an increased number of vessels. There is a junctional nest to the right of the field. A lentiginous component is not a feature in this area. There is a small tumor nodule in the dermis to the left of the center of the field. Some observers might characterize this as a single nest, but it actually seems to be a compact cluster of several nests in the patterns of early typical vertical growth. Concentric fibrous lamellae are condensed about the small nodule. There are clusters of melanophages in the fibrotic dermis.
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c24t3P4: The epidermis shows closely spaced junctional nests to the left side of the field. The widened papillary dermis is fibrotic; focally, in a delicate fibrous matrix, there are stacks of dense fibrous lamellae. Vessels are increased in number.There are focal collections of melanophages. To the right, the epidermis shows effacement of the rete ridges; the melanocytic component of the epidermis is interrupted in this area. This field qualifies as focal regression. Having found this area, an observer is likely to assign primacy to this pattern; he will caution the clinician that in the face of regression of this type the patient may be at risk for metastasis. In c24t3p3, the patterns focally qualify as typical vertical growth. On this basis, the possibility of regressing halo nevus seemingly can be excluded. A variant vertical growth component is represented in c24t3p1; it could be measured by Breslow’s criteria to provide a rough estimate of biologic potential: the measurement for this lesion was recorded as 0.84 ( the intermediate range but less than 1mm; hence, a borderline lesion). This lesion qualifies as a borderline melanocytic neoplasia of indeterminate malignant potential. This interpretation, in the face of regression, should be characterized as conservative. This lesion metastasized to regional lymph nodes. Additional follow-up is not available.
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