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c22t3P1: This is a spindle cell lesion with some degree of symmetry in regard to overall configuration. There is, however, some lentiginous and junctional spread in the epidermis to the left away from a central expansile nodule. In the nodule, the patterns are typical vertical growth-like; a MDM should be considered in the differential diagnosis. Fascicles in the deeper portion of the dermis are widely spaced among collagen bundles; there is some degree of maturation but cytologic features are fairly constant at all levels. Lymphoid infiltrates are mild.
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C22t3P2:To the left, there fascicles of cells which extend into the dermis. In this area, the fascicles are variable in distribution. A blue arrow points to a Kamino body. To the right of this area, the fascicles of cells are broad and closely aggregated to form a nodule (typical vertical growth-like). Focally, the papillary dermis is edematous.
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c22t3P3: The nodule is represented in the upper portion of the field. The cells of the nodule generally have less abundant cytoplasm than the cells of classical “Spitz” variants. Below the center of the field, the fascicles are thinner; they infiltrate the reticular dermis among the collagen bundles.
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c22t3P4: There is lentiginous and junctional spread in the epidermis away from the dermal nodule; this combination of features in a lesion measuring less than 1 mm in vertical dimensions would, by the criteria in the logic associated with the concept of MDM, qualify the lesion as an atypical melanocytoma of borderline type.
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c22t3P5: Individual cells and nests of cells have migrated upward into the epidermis. There is some degree of atypia in fascicles to the left of the center of the field.
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c22t3P6: On the opposite side of the nodule, the lentiginous and junctional component extends in the epidermis away from the nodule.
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c22t3P7: In the nodule to the right, the broad fascicles are closely spaced; the patterns are typical vertical growth-like. A blue arrow points to a Kamino body.
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c22t3P8: In the nodule, nuclear characteristics are fairly uniform. The designation, juvenile melanoma (MDM of Spitz type), seems to put the patterns of this lesion in perspective.
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