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| 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 |
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| ==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. |
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| ===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
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| *Size >10mm
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| ;Mandatory findings:<ref name=KVAST/>
| | ===Report=== |
| *Shoulder phenomenon, meaning that the extent of the dermal component is larger than the epidermal component. | | *Presence or absence of atypia. |
| *Lentiginous proliferation, meaning an increased amount of melanocytes in the basal area, along rete pegs and sometimes between them.
| | :{{Moderate-begin}}If atypical, low-or high grade, or degree of atypia.{{Moderate-end}} |
| *Irregularly distributed nests of melanocytes.
| | *{{Comprehensive-begin}}Size |
| *Atypia
| | *Findings included in table above if applicable. |
| | | *Most likely grade if possible.{{Comprehensive-end}} |
| '''Microscopy'''<br>Classify into either of the following:
| | {|class=wikitable |
| | | | Skin, upper back, excision:<br>- Junctional {{Moderate-begin}}melanocytic{{Moderate-end}} nevus with {{Moderate-begin}}moderate{{Moderate-end}} atypia. |
| {|class="wikitable" | |
| !rowspan=2 colspan=2| Parameter !!colspan=2| Low-grade dysplasia !! High-grade dysplasia !!rowspan=2| Suspected melanoma in situ
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| |-
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| | Mild || Moderate || Severe
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| |-
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| |rowspan=7| Structural<br>''(Low<br>mag.)'' || Delimitation<ref name=KVAST/> || Rarely diffuse || Sometimes diffuse ||colspan=2| Often diffuse
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| |-
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| | Lentiginous proliferation<ref group="notes">Proliferation along the basal layer of the epidermis</ref><ref name=KVAST/> || 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]]
| |
| |-
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| | Bridging<ref name=KVAST/> || Rarely ||colspan=3| Often
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| |-
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| | Confluent nests<ref name=KVAST/> || Rarely || Sometimes || Often || Often widespread
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| |-
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| | Pigment distribution<ref name=KVAST/> || Regular ||colspan=3| Irregular
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| |-
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| | Suprabasal presence<ref name=KVAST/> (less than most superficial third of epidermis) || No ||colspan=2| Yes || Yes, multifocal
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| |-
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| | Pagetoid migration including superficial third of epidermis<ref name=KVAST/> || No || No || Yes, in a maximum of 2 HPF centrally, but not peripherally ||
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| Yes, multifocal and/or in periphery
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| |-
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| |rowspan=4| Cellular<br>''(high<br>mag.)'' || Nuclear pleomorphism<ref name="HusainMein2011">{{cite journal|last1=Husain|first1=Ehab A|last2=Mein|first2=Charles|last3=Pozo|first3=Lucia|last4=Blanes|first4=Alfredo|last5=Diaz-Cano|first5=Salvador J|title=Heterogeneous topographic profiles of kinetic and cell cycle regulator microsatellites in atypical (dysplastic) melanocytic nevi|journal=Modern Pathology|volume=24|issue=4|year=2011|pages=471–486|issn=0893-3952|doi=10.1038/modpathol.2010.143}}</ref> || Slight ||colspan=2| Prominent
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| |- | |
| | Chromatin pattern<ref name="HusainMein2011"/> ||colspan=2| Usually thin || Usually granular
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| |-
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| | Nucleolus<ref name="HusainMein2011"/> ||colspan=2| Usually inconspicuous || Usually prominent
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| |-
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| | Histological regression<ref name="HusainMein2011"/><ref group="notes">Histological regression is one or more areas within a tumor in which neoplastic cells have disappeared or decreased in number. In this case, this means complete or partial disappearance from areas of the [[dermis]] (and occasionally from the [[epidermis]]), which have been replaced by fibrosis, accompanied by [[melanophages]], new blood vessels, and a variable degree of inflammation.<br>- {{cite journal|last1=Ribero|first1=Simone|last2=Gualano|first2=Maria Rosaria|last3=Osella-Abate|first3=Simona|last4=Scaioli|first4=Giacomo|last5=Bert|first5=Fabrizio|last6=Sanlorenzo|first6=Martina|last7=Balagna|first7=Elena|last8=Fierro|first8=Maria Teresa|last9=Macripò|first9=Giuseppe|last10=Sapino|first10=Anna|last11=Siliquini|first11=Roberta|last12=Quaglino|first12=Pietro|title=Association of Histologic Regression in Primary Melanoma With Sentinel Lymph Node Status|journal=JAMA Dermatology|volume=151|issue=12|year=2015|pages=1301|issn=2168-6068|doi=10.1001/jamadermatol.2015.2235}}</ref> ||colspan=2| Usually || Usually not | |
| <!--
| |
| Most prevalent
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| Dominant
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| atypigrad
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| Easy
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| Easy-moderate
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| Moderate-severe | |
| Moderate-severe
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| cellular
| |
| atypia * | |
| Percentage of atypical
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| melanocytes
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| <10%
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| about 10 - 50%
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| about 50-90%
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| Usually> 90%
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| Extended retelists
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| Yes,
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| regular
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| Yes, varying
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| Yes, often
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| irregular
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| Varying,
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| planarized
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| Concentric fibrosis Yes Yes Yes Varies
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| Lamellar fibrosis Rarely Often Often Pronounced Varying
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| lymphocytic *
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| Sparingly,
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| perivascular
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| Easy-moderate
| |
| perivascular
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| Varying
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| Varying
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| reactive
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| changes
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| regressive
| |
| changes
| |
| No
| |
| No
| |
| Rarely
| |
| Varying
| |
| Melanocytic atypia
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| No
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| Rarely, in superficial
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| part
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| Can be detected in
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| superficial part
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| Can be detected in
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| superficial part.
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| intradermal
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| component
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| maturation
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| Yes
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| Yes, can be
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| partial
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| Yes, can be
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| partial
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| Yes, can be
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| partial; if
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| No
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| ripening
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| recital
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| invasive
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| melanoma!
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| ! Further workup !! !! !! Immunohistochemistry
| |
| |}
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| -->
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| |} | | |} |
| | {{Reporting}} |
| {{Bottom}} | | {{Bottom}} |