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c26t3P1 (case 780 cont.): In the fascicles and nests near the dermal-epidermal interface, atypia is moderate to moderately severe. Green arrows point to mitotic figures. The cells are spindle shaped and rounded. Some of the cells are pigmented.

c26t3P2: There is nuclear atypia with scattered mitotic figures; one figure is atypical. There are focal areas showing nuclear pleomorphism.

c26t3P3: Clefts have formed between some of the junctional fascicles and the epidermis. A tripolar mitotic figure is present to the right above the center of the field. The close spacing of nests of cells in the papillary dermis is a feature that deviates from the pattern of classic Spitz “nevus.”

c26t3P4: The pattern is level III. Halo nevus-like phenomena are represented. The aggressive lymphocytes have also involved follicular epithelium to produce lichenoid patterns. The lesion was excised, and a regional perfusion was performed. At 38 months, the lesion recurred. It was excised, and a re-perfusion was performed. The lesion qualifies as a MDM of Spitz-like type. It might also be characterized as juvenile melanoma (variant of MDM, typical vertical growth, level III, halo nevus-like phenomena, melanocytic neoplasia of indeterminate malignant potential, 1.5 mm in vertical dimensions). In size, this lesion was at the limits which were set in initiating the search for metastasizing, or recurrent, thin melanomas.

c26t3P5: The degree of nuclear atypia is moderately severe; Chromatin is marginated to produce the pattern of a “heavy” nuclear membrane. Nucleoli are prominent. In the nests, there is loss of cellular cohesion. The nests are closely spaced in a scanty fibrous stroma. Cells are plump and somewhat polygonal; they have dendritic processes.

c26t3P6: In this field, the lesion shows crowded nests and fascicles. The nuclear features are pleomorphic; there are tumor giant cells, and the giant cells show variation in nuclear size. This lesion measured 1.5 mm in vertical dimensions. It recurred locally in the scar at 38 months. At the time of the excision of the recurrence, a re-perfusion was performed. When last seen ( at the time this material was collected), there was no evidence of recurrence or metastasis.

[Thin Melanoma  (c1t1)] [INDEX PAGE (indext2)] [Interpretations  (c2At2)] [Anatomic Levels (c3t2)] [Dropping Off (c4t2)] [Histologic Patterns (c5t2)] [Vertical Growth (c6t2)] [Types of Melanoma (c7t2)] [Variant Melanomas (cA8t3)] [Thin Melanoma1 (c8t2)] [Borderland (cA9t2)] [Thin Melanoma2 (C9t2)] [MDM, homologies (cA10t2)] [Thin Melanoma3 (c10t2)] [Thin Melanoma (c25t3)] [Thin Melanoma (c26t3)] [Thin Melanoma (c27t3)] [Thin Melanoma (c28t3)] [Prognostication (c11t2)] [Histologic Grade (c12t2)] [Uncommon Melanomas (c13t2)] [Metastases (c14t2)] [Summary (c15t2)] [References (cA15t2)]