|
|
| (44 intermediate revisions by the same user not shown) |
| Line 3: |
Line 3: |
| |author2= | | |author2= |
| }} | | }} |
| Suspected dysplastic nevus (also called dysplastic melanocytic nevus).
| | [[File:Histopathology of melanocytic nevus 2.jpg|thumb|350px|'''Junctional nevus''' (here seen in H&E stain and Melan A stain), where all nests are continuous with the epidermis.]] |
| | {{Comprehensiveness}} |
| | A suspected dysplastic nevus (also called dysplastic melanocytic nevus) generally presents as a [[Dark skin focalities|dark skin focality]]. |
| | {{Fixation - standard}} |
| | {{Gross processing of skin excisions}} |
| | ==Microscopic evaluation== |
| | A junctional nevus is characterized by:<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/skintumormelanocyticJunctnevus.html|title=Skin melanocytic tumor - Nevi - Junctional nevus|author=Christopher S. Hale, M.D.|website=Pathology Outlines}} Topic Completed: 1 February 2017. Revised: 4 April 2019</ref> |
| | *Rounded melanocyte nests on the epidermal side of dermoepidermal junction |
| | *Variable lentiginous melanocytic hyperplasia |
|
| |
|
| ==Evaluation== | | ===Differential diagnosis=== |
| | <gallery mode=packed heights=200> |
| | File:Histopathology of lentigo maligna.jpg|'''[[Melanoma in situ]]''', by higher atypia and dysplasia (see table in [[#Grading|the grading section]]). |
| | File:Histopathology of dermal nevus, high magnification.jpg|'''[[Dermal nevus]]''', with nevus cells enclosed within the dermis. |
| | File:Histopathology of compound nevus.jpg|thumb|'''Compound nevus''', with nevus cells in both dermis and epidermis. |
| | </gallery> |
| | *'''[[Epidermal nevus]]''', nests of nevus cells enclosed within the epidermis. |
|
| |
|
| ===Swedish approach=== | | ===Grading=== |
| Review of '''clinical information''', mainly:<ref name=KVAST>{{cite web|author=Katarzyna Lundmark, Britta Krynitz, Ismini Vassilaki, Lena Mölne, Annika Ternesten Bratel|title=Histopatologisk bedömning och gradering av dysplastiskt nevus samt gränsdragning mot melanom in situ/melanom (Histopathological assessment and grading of dysplastic nevus and distinction from melanoma in situ/melanoma)|url=https://medlem.foreningssupport.se/foreningar/uploads/L15178/kvast/hud/Histopatologisk%20bedomning%20och%20gradering%20av%20dysplastiskt%20nevus%20samt%20gransdragning%20mot%20melanom%20in%20situ-melanom%2020150330.pdf|website=KVAST (Swedish Society of Pathology)|accessdate=2019-09-18}}</ref>
| | {{Epidermal and junctional nevus grading}} |
| *Growth
| | [[File:SOX10 immunohistochemistry of normal skin (edited).jpg|thumb|center|300px|In contrast, normal skin (pictured) has a melanocyte about every 4 cells along the basement membrane.]] |
| *Abnormal visual appearance
| |
| *Size >10mm
| |
|
| |
|
| '''Microscopy'''<br>Classify into either of the following:
| | ===Report=== |
| | | *Presence or absence of atypia. |
| {|class="wikitable"
| | :{{Moderate-begin}}If atypical, low-or high grade, or degree of atypia.{{Moderate-end}} |
| !rowspan=2| Parameter !!colspan=2| Low-grade dysplasia !! High-grade dysplasia !!rowspan=2| Suspected melanoma in situ
| | *{{Comprehensive-begin}}Size |
| |-
| | *Findings included in table above if applicable. |
| | Mild || Moderate || Severe
| | *Most likely grade if possible.{{Comprehensive-end}} |
| |-
| | {|class=wikitable |
| | Delimitation || Rarely diffuse || Sometimes diffuse || Often diffuse || Often diffuse
| | | Skin, upper back, excision:<br>- Junctional {{Moderate-begin}}melanocytic{{Moderate-end}} nevus with {{Moderate-begin}}moderate{{Moderate-end}} atypia. |
| |-
| |
| | Lentiginous proliferation || Yes, along with rete pegs || Yes, along with and focally between rete pegs || Yes, along with and focally between rete pegs || Yes partially continuous, multilayered [[File:Histopathology of lentigo maligna.jpg|center|140px]]
| |
| |-
| |
| |
| |
| <!--Irregular
| |
| second distribution *
| |
| Yes
| |
| Yes
| |
| Yes
| |
| Yes
| |
| Brewing Rarely Often Often Often Often
| |
| Confluence of Almost Rarely Sometimes Often Often Widespread
| |
| Pigment Distribution Regular Irregular Irregular Irregular Irregular
| |
| Suprabasal growing up No Yes Yes Yes, multifocal
| |
| structural
| |
| abnormalities
| |
| Pagetoid migration No No Yes, for a maximum of 2
| |
| HPF centrally,
| |
| but not peripherally
| |
| Yes, multifocal
| |
| and / or i
| |
| periphery
| |
| Dominant
| |
| atypigrad
| |
| Easy
| |
| Easy-moderate
| |
| Moderate-severe | |
| Moderate-severe
| |
| cellular
| |
| atypia *
| |
| Percentage of atypical
| |
| melanocytes
| |
| <10%
| |
| about 10 - 50%
| |
| about 50-90%
| |
| Usually> 90%
| |
| Extended retelists
| |
| Yes,
| |
| regular
| |
| Yes, varying
| |
| Yes, often
| |
| irregular
| |
| Varying,
| |
| planarized
| |
| Concentric fibrosis Yes Yes Yes Varies
| |
| Lamellar fibrosis Rarely Often Often Pronounced Varying
| |
| lymphocytic *
| |
| Sparingly,
| |
| perivascular
| |
| Easy-moderate
| |
| perivascular
| |
| Varying
| |
| Varying
| |
| reactive
| |
| changes
| |
| regressive
| |
| changes
| |
| No
| |
| No
| |
| Rarely
| |
| Varying
| |
| Melanocytic atypia
| |
| No
| |
| Rarely, in superficial
| |
| part
| |
| Can be detected in
| |
| superficial part
| |
| Can be detected in
| |
| superficial part.
| |
| intradermal
| |
| component
| |
| maturation
| |
| Yes
| |
| Yes, can be
| |
| partial
| |
| Yes, can be
| |
| partial
| |
| Yes, can be
| |
| partial; if
| |
| No
| |
| ripening
| |
| recital
| |
| invasive
| |
| melanoma!
| |
| ! Further workup !! !! !! Immunohistochemistry
| |
| |}
| |
| | |
| | |
| | |
| | |
| Microscopy at low magnification (x4):
| |
| *Intraepidermal or composite lesion?
| |
| *Structural abnormalities in the intraepidermal component?
| |
| • Asymmetry?
| |
| • Boundary: well-defined / diffusely bounded?
| |
| • Shoulder phenomenon?
| |
| • Lentiginous and / or second form?
| |
| • Regular / irregular distribution of the nest?
| |
| • Bridge formation between the nest?
| |
| • Confluence of the neighbor?
| |
| • Pigment distribution in the lesion: regular / irregular?
| |
| • Suprabasal growth (in the basal 2/3 parts of the epidermis)?
| |
| • Pagetoid migration (in the upper 1/3 part of the epidermis)?
| |
| Are there reactive changes?
| |
| • Irregular and / or extended retelists?
| |
| • Fibros around retails? Concentric and / or lamellar? Ärrliknande? A sign of
| |
| past trauma or surgery?
| |
| • Lymphocyte infiltrate? Perivascular or diffuse / ligamentous? Thrifty or
| |
| pronounced?
| |
| • Regressive changes?
| |
| Enlarge (x 10-20)
| |
| Are there cellular abnormalities in the intraepidermal component?
| |
| • Melanocytic atypia?
| |
| • Which atypical degree dominates? Easy? Moderate? Grave?
| |
| • What proportion of melanocytes are atypical?
| |
| • Suprabasal growth (in the basal 2/3 parts of the epidermis) of atypical melanocytes?
| |
| • Pagetoid migration (in the upper 1/3 part of the epidermis) of atypical melanocytes?
| |
| Is there melanocytic atypia in the intradermal component?
| |
| • Only in the superficial part?
| |
| • “Matured”?
| |
| • Mitoses?
| |
| Assess radicalism
| |
| When does the change in preparation edge / resection edge?
| |
| --> | |
| |} | | |} |
| | {{Reporting}} |
| {{Bottom}} | | {{Bottom}} |