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The first case in the second set of “daughter” pictorials, is a peculiar lesion with focal sclerosis, and with distinctive nesting patterns in other areas. The nests are rounded in outlines at all level with the exception of the areas of sclerosis. In the junctional component, the cells are spindle shaped and dendritic in outline; some observers might find accommodations for the junctional patterns in their collections of virtual images which have relevance for the interpretation of Spitz “nevi;” unfortunately, the manner in which the collections have been structured are liberal in regard to emphasis on degrees of cytologic atypia. Vertical growth-like patterns are represented and, if the observer as his first choice has made a diagnosis of “melanoma,” then the patterns qualify as migrant vertical growth. The cytologic features are of a type commonly encountered in the category of MDM.
The next case (case 6) is another example of a pigmented spindle cell lesion. Again, if the observer searches for, and finds a store of virtual of images having relevance for the interpretation of Spitz “nevi,” then he will be able to find some matches when comparing real images with the evoked virtual images; the match, however, will not be perfect. I will leave it to the reader to decide where along neoplastic continua he might elect to place this lesion. Case 8 presents similar problems.
The lesion in case 7 is a nevus-like process with variant cytologic features. In addition, there are vertical growth-like components. In some areas, the patterns are those of a common premalignant melanocytic dysplasia.
The lesion in case 9 is another spindle cell lesion. The cytologic features and the size of the lesion might raise questions regarding the propriety of including this lesion in the collection; it clearly deviates cytologically from all the other lesions included in this section. If interpreted as melanoma, it clearly is associated with prognostic parameters of a bad type.
The lesion in case 10 is another example of a spindle cell neoplasm. It recurred. The recurrence was excised, and it then recurred locally a second time. I have shared with you all the photomicrographs for case 10 as I discovered them; images of higher magnification were not available.
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