Junctional nevus: Difference between revisions

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===Swedish approach===
===Swedish approach===
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>
;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>
*Growth
*Growth
*Abnormal visual appearance
*Abnormal visual appearance
*Size >10mm
*Size >10mm
;Mandatory findings:<ref name=KVAST/>
*Shoulder phenomenon, meaning that the extent of the dermal component is larger than the epidermal component.
*Lentiginous proliferation, meaning an increased amount of melanocytes in the basal area, along rete pegs and sometimes between them.
*Irregularly distributed nests of melanocytes.
*Atypia


'''Microscopy'''<br>Classify into either of the following:
'''Microscopy'''<br>Classify into either of the following:
Line 20: Line 26:
| Mild || Moderate || Severe
| Mild || Moderate || Severe
|-
|-
| Delimitation || Rarely diffuse || Sometimes diffuse || Often diffuse || Often diffuse
|rowspan=6| Structural<br>''(Low<br>mag.)'' || Delimitation<ref name=KVAST/> || Rarely diffuse || Sometimes diffuse ||colspan=2| Often diffuse
|-
| 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]]
|-
| Bridging<ref name=KVAST/> || Rarely ||colspan=3| Often
|-
| Confluent nests<ref name=KVAST/> || Rarely || Sometimes || Often || Often widespread
|-
| Pigment distribution<ref name=KVAST/> || Regular ||colspan=3| Irregular
|-
| Suprabasal presence<ref name=KVAST/> (less than most superficial third of epidermis) || No ||colspan=2| Yes || Yes, multifocal
|-
| Pagetoid migration including superficial third of epidermis<ref name=KVAST/> || No || No || Yes, in a maximum of 2 HPF centrally, but not peripherally ||
Yes, multifocal and/or in periphery
|-
|-
| 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]]
|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
|-
|-
|
| Chromatin pattern<ref name="HusainMein2011"/> ||colspan=2| Usually thin || Usually granular
<!--Irregular
|-
second distribution *
| Nucleolus<ref name="HusainMein2011"/> ||colspan=2| Usually inconspicuous || Usually prominent
Yes
|-
Yes
| 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
Yes
<!--
Yes
Most prevalent
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
Dominant
atypigrad
atypigrad
Line 109: Line 116:




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?
-->
-->
|}
|}
{{Bottom}}
{{Bottom}}

Revision as of 10:52, 20 September 2019

Author: Mikael Häggström [note 1]
Suspected dysplastic nevus (also called dysplastic melanocytic nevus).

Evaluation

Swedish approach

Review of clinical information, mainly
[1]
  • Growth
  • Abnormal visual appearance
  • Size >10mm
Mandatory findings
[1]
  • Shoulder phenomenon, meaning that the extent of the dermal component is larger than the epidermal component.
  • Lentiginous proliferation, meaning an increased amount of melanocytes in the basal area, along rete pegs and sometimes between them.
  • Irregularly distributed nests of melanocytes.
  • Atypia

Microscopy
Classify into either of the following:

Parameter Low-grade dysplasia High-grade dysplasia Suspected melanoma in situ
Mild Moderate Severe
Structural
(Low
mag.)		 Delimitation[1] Rarely diffuse Sometimes diffuse Often diffuse
Lentiginous proliferation[notes 1][1] 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
Bridging[1] Rarely Often
Confluent nests[1] Rarely Sometimes Often Often widespread
Pigment distribution[1] Regular Irregular
Suprabasal presence[1] (less than most superficial third of epidermis) No Yes Yes, multifocal
Pagetoid migration including superficial third of epidermis[1] No No Yes, in a maximum of 2 HPF centrally, but not peripherally

Yes, multifocal and/or in periphery

Cellular
(high
mag.)		 Nuclear pleomorphism[2] Slight Prominent
Chromatin pattern[2] Usually thin Usually granular
Nucleolus[2] Usually inconspicuous Usually prominent
Histological regression[2][notes 2] Usually Usually not

Notes

  1. ↑ Proliferation along the basal layer of the epidermis
  2. ↑ 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.
    - Ribero, Simone; Gualano, Maria Rosaria; Osella-Abate, Simona; Scaioli, Giacomo; Bert, Fabrizio; Sanlorenzo, Martina; Balagna, Elena; Fierro, Maria Teresa; et al. (2015). "Association of Histologic Regression in Primary Melanoma With Sentinel Lymph Node Status ". JAMA Dermatology 151 (12): 1301. doi:10.1001/jamadermatol.2015.2235. ISSN 2168-6068. 
  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Katarzyna Lundmark, Britta Krynitz, Ismini Vassilaki, Lena Mölne, Annika Ternesten Bratel. 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). KVAST (Swedish Society of Pathology). Retrieved on 2019-09-18.
  2. ↑ 2.0 2.1 2.2 2.3 Husain, Ehab A; Mein, Charles; Pozo, Lucia; Blanes, Alfredo; Diaz-Cano, Salvador J (2011). "Heterogeneous topographic profiles of kinetic and cell cycle regulator microsatellites in atypical (dysplastic) melanocytic nevi ". Modern Pathology 24 (4): 471–486. doi:10.1038/modpathol.2010.143. ISSN 0893-3952. 

Image sources


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