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c27t3P1 (case 8440): The epidermis is represented in the pattern of a hyperplastic superficial unit. There are lentiginous and junctional patterns; individual neoplastic cells, and nests of neoplastic cells have migrated upward into the epidermis (pattern of common final pathway). The papillary dermis is widened and fibrotic. It contains loose infiltrates of lymphoid cells, and clusters of heavily pigmented melanophages. The red arrows identify a small nodule in which nests of atypical cells are arranged in the pattern of a vertical growth component. The pattern is level III.
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c27t3P2: The pattern in the epidermis is that of the common final pathway; atypia is marked. The dermal component is stratified with variation in size of nests, and degree of atypia depending on the stratum selected for evaluation. In the dermal component, near the dermal-epidermal interface, The atypia is comparable to that of the epidermal component. At all levels, the nests of neoplastic cells are rounded. In the deeper portion, the degree of atypia is mild to moderately severe. Lymphoid infiltrates at the advancing margin are mild, and spotty in distribution. The pattern of loosely spaced nests in a laminated fibrotic matrix is one that qualifies as arrested variant vertical growth at level III. Most observers would classify this lesion as superficial spreading melanoma; they would (I assume) also characterize the pattern as level III. Most observers probably would not be familiar with distinctions as to type of vertical growth.
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c27t3P3: The epidermal pattern in this field is that of the common final pathway. Many observers would characterize this pattern as melanoma-in-situ. With such a concession, problems regarding variable patterns in the dermis, levels of invasion, and distinctions as to types of vertical growth mostly can be avoided.
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c27t3P4: The pattern of the common final pathway is represented in the epidermis. A defect at the dermal-epidermal interface contains loosely aggregated, atypical melanocytes; the degree of atypia in the epidermis, and in the defect is marked. The close spacing of small rounded nests of cells in the fibrotic dermis beneath the cleft is a pattern that qualifies as thin typical vertical growth. Beneath this component, the cells form loosely spaced nests and fascicles in the pattern of variant vertical growth. The cells of the fascicles are deeply pigmented. The pattern is level III.
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c27t3P5: The epidermis shows the pattern of the common final pathway.To the right beneath the epidermis, there is a thin band of fibrous tissue. The patterns in this suggest that the lesion may have been recently traumatized. Beneath this zone of fibrous tissue, the pattern qualifies as a small, typical vertical growth component. The pattern is level III.
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c27t3P6:This is a portion of a typical vertical growth component. The degree of nuclear atypia is marked. The stroma is activated. At the time of diagnosis, there was local satellitosis; a femoral lymph node contained metastatic tumor. This lesion is easily dismissed as SSM at level III; it measured 1.25 mm in vertical dimensions. In the absence of the satellitosis, and femoral lymph node, it would have qualified as intermediate melanocytic neoplasia of uncertain malignant potential; the satellite lesions, and the femoral metastasis takes uncertainty out of the evaluation (but retrospection provides this confidence).
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