Junctional nevus: Difference between revisions

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[[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]].
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}}
{{Gross processing of skin excisions}}
==Microscopic evaluation==
==Microscopic evaluation==
''Mandatory findings'':<ref name=KVAST/>
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>
*Shoulder phenomenon, meaning that the extent of the dermal component is larger than the epidermal component.
*Rounded melanocyte nests on the epidermal side of dermoepidermal junction
*Lentiginous proliferation, meaning an increased amount of melanocytes in the basal area, along rete pegs and sometimes between them.
*Variable lentiginous melanocytic hyperplasia
*Irregularly distributed nests of melanocytes.
 
*Atypia
===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.


===Grading===
===Grading===
It is acceptable to grade a dysplastic nevus into either low or high grade by the following algorithm:<ref>{{cite journal|last1=Pozo|first1=Lucia|last2=Naase|first2=Mahmoud|last3=Cerio|first3=Rino|last4=Blanes|first4=Alfredo|last5=Diaz-Cano|first5=Salvador J.|title=Critical Analysis of Histologic Criteria for Grading Atypical (Dysplastic) Melanocytic Nevi|journal=American Journal of Clinical Pathology|volume=115|issue=2|year=2001|pages=194–204|issn=0002-9173|doi=10.1309/KXJW-1UJE-BPG6-AXBV}}</ref><ref group="notes" name="regression"/>
{{Epidermal and junctional nevus grading}}
[[File:Algorithm for low grade versus high grade dysplastic nevus.png|center|250px]]
[[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.]]
 
In uncertain cases, more specific grading, and/or differentiation from a non-atypical congenital nevus and suspected [[melanoma]], the following table can be used to determine the most fitting diagnosis:
 
{{Table comparing congenital nevus, dysplastic nevus and suspected melanoma}}


===Report===
===Report===
*Size
*Presence or absence of atypia.
*Preferably findings included in table.
:{{Moderate-begin}}If atypical, low-or high grade, or degree of atypia.{{Moderate-end}}
*Most likely grade if possible.
*{{Comprehensive-begin}}Size
*Findings included in table above if applicable.
*Most likely grade if possible.{{Comprehensive-end}}
{|class=wikitable
| Skin, upper back, excision:<br>- Junctional {{Moderate-begin}}melanocytic{{Moderate-end}} nevus with {{Moderate-begin}}moderate{{Moderate-end}} atypia.
|}
{{Reporting}}
{{Reporting}}
{{Bottom}}
{{Bottom}}
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