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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=== |
| 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>
| | <gallery mode=packed heights=200> |
| *Growth | | File:Histopathology of lentigo maligna.jpg|'''[[Melanoma in situ]]''', by higher atypia and dysplasia (see table in [[#Grading|the grading section]]). |
| *Abnormal visual appearance
| | File:Histopathology of dermal nevus, high magnification.jpg|'''[[Dermal nevus]]''', with nevus cells enclosed within the dermis. |
| *Size >10mm
| | 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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| '''Microscopy''':<br>''Mandatory findings'':<ref name=KVAST/>
| | ===Grading=== |
| *Shoulder phenomenon, meaning that the extent of the dermal component is larger than the epidermal component.
| | {{Epidermal and junctional nevus grading}} |
| *Lentiginous proliferation, meaning an increased amount of melanocytes in the basal area, along rete pegs and sometimes between them.
| | [[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.]] |
| *Irregularly distributed nests of melanocytes.
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| *Atypia
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| 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 colspan=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 |
| |rowspan=2| Macroscopic || Lateral circumscription<ref name="Arumi-UriaMcNutt2003">{{cite journal|last1=Arumi-Uria|first1=Montserrat|last2=McNutt|first2=N Scott|last3=Finnerty|first3=Bridget|title=Grading of Atypia in Nevi: Correlation with Melanoma Risk|journal=Modern Pathology|volume=16|issue=8|year=2003|pages=764–771|issn=0893-3952|doi=10.1097/01.MP.0000082394.91761.E5}}</ref> || Sharp || Slightly diminished ||colspan=2| Moderate || Poor
| | | Skin, upper back, excision:<br>- Junctional {{Moderate-begin}}melanocytic{{Moderate-end}} nevus with {{Moderate-begin}}moderate{{Moderate-end}} atypia. |
| |-
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| | Symmetry<ref name="Arumi-UriaMcNutt2003"/> ||colspan=3| Good || Often broken || Rare
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| |-
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| |rowspan=11| 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">Lentiginous proliferation is 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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| |-
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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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| | Extended rete pegs || Yes, regular || Yes, varying || Yes, often irregular || Varying, flattened
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| |-
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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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| |-
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| | Lymphocytic infiltrate || Mild, perivascular || Mild or moderate, perivascular || Varying || Varying
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| |-
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| |rowspan=7| 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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| |- | |
| | 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
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| | Percentage of atypical melanocytes<ref name=KVAST/> || <10% || About 10 - 50% || about 50-90% || Usually> 90%
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| |-
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| | Intradermal melanocytic atypia<ref name=KVAST/> || No || Rarely, in superficial part || Can be detected in superficial part || Can be detected in
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| |-
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| | Intradermal melanocyte maturation<ref name=KVAST/> || Yes || Yes, can be partial || Yes, can be partial || Variable
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| !colspan=2| Further workup !! !! !! !! Immunohistochemistry<ref name=KVAST/>
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| |} | | |} |
| | {{Reporting}} |
| {{Bottom}} | | {{Bottom}} |