GENERAL  INDEX

c25t3P1: Fascicles of cells extend into the reticular dermis; there is maturation at the advancing margin. There are mild, spotty, perivascular infiltrates of lymphocytes and histiocytes. Focally, in the papillary dermis, fascicular patterns are ill-defined; the fascicles in areas are confluent. The lesion is relatively small and compact. Of the features which might be selected to construct a  “truth table,” the most prominent and consistent are nuclear atypia and pleomorphism. Mitotic rate would not be a strong (+). For this example, cytology rather than histology would be emphasized. The designation, juvenile melanoma or MDM of Spitz type, would provide a system of logic that is more accommodating for unexpected biologic phenomena than does the current logic that is associated with the  designation, “nevus.”

Fig. c25t3P2: A diagram from the “Whithers” has been borrowed and modified. Some “Spitz” lesions have qualities of premalignant melanocytic dysplasias; they are represented by the plane to the left of the diagram. Between the plane and the sphere there is a cone; this cone might be characterized as the domain of the minimal deviation melanomas, including the Spitz types. In this presentation, the cone is also representative of juvenile melanoma. The light gray portion of the cone might be characterized as step I type (classical patterns) and the dark gray portion of the cone might be characterized as step II type (atypical patterns, including  typical, variant, and migrant vertical growth patterns, cytologic atypia, and cellular pleomorphism).

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