Junctional nevus: Difference between revisions
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Yes, multifocal and/or in periphery | Yes, multifocal and/or in periphery | ||
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| | | Extended rete pegs || Yes, regular || Yes, varying || Yes, often irregular || Varying, flattened | ||
|- | |||
| Concentric fibrosis || Yes || Yes || Yes || Varies | |||
|- | |- | ||
| | | Lamellar fibrosis || Rarely || Often || Often pronounced || Varying | ||
|- | |- | ||
| | | Lymphocytic infiltrate || Mild, perivascular || Mild or moderate, perivascular || Varying || Varying | ||
|- | |- | ||
| | | | ||
reactive | reactive | ||
changes | changes | ||
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Rarely | Rarely | ||
Varying | Varying | ||
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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 | |||
|- | |||
| Chromatin pattern<ref name="HusainMein2011"/> ||colspan=2| Usually thin || Usually granular | |||
|- | |||
| Nucleolus<ref name="HusainMein2011"/> ||colspan=2| Usually inconspicuous || Usually prominent | |||
|- | |||
| 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this means complete or partial disappearance from areas of the dermis (and occasionally from the epidermis), which have been replaced by fibrosis, accompanied by melanophages, new blood vessels, and a variable degree of inflammation.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 | |||
|- | |||
| Percentage of atypical melanocytes<ref name=KVAST/> || <10% || About 10 - 50% || about 50-90% || Usually> 90% | |||
|- | |||
| Intradermal melanocytic atypia<ref name=KVAST/> || No || Rarely, in superficial part || Can be detected in superficial part || Can be detected in | |||
|- | |||
| Intradermal melanocyte maturation<ref name=KVAST/> || Yes || Yes, can be partial || Yes, can be partial || Yes, can be || Variable | |||
|- | |||
! Further workup !! !! !! Immunohistochemistry<ref name=KVAST/> | |||
|} | |} | ||
{{Bottom}} | {{Bottom}} | ||
Revision as of 03:50, 24 September 2019
Author:
Mikael Häggström [note 1]
Suspected dysplastic nevus (also called dysplastic melanocytic nevus).
Evaluation
Review of clinical information, mainly:[1]
- Growth
- Abnormal visual appearance
- Size >10mm
Microscopy:
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
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 | |
| 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 | |
| Extended rete pegs | Yes, regular | Yes, varying | Yes, often irregular | Varying, flattened | |
| Concentric fibrosis | Yes | Yes | Yes | Varies | |
| Lamellar fibrosis | Rarely | Often | Often pronounced | Varying | |
| Lymphocytic infiltrate | Mild, perivascular | Mild or moderate, perivascular | Varying | Varying | |
|
reactive changes regressive changes No No Rarely Varying
| |||||
| 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 | |||
| Percentage of atypical melanocytes[1] | <10% | About 10 - 50% | about 50-90% | Usually> 90% | |
| Intradermal melanocytic atypia[1] | No | Rarely, in superficial part | Can be detected in superficial part | Can be detected in | |
| Intradermal melanocyte maturation[1] | Yes | Yes, can be partial | Yes, can be partial | Yes, can be | Variable |
| Further workup | Immunohistochemistry[1] | ||||
Notes
- ↑ Lentiginous proliferation is proliferation along the basal layer of the epidermis
- ↑ 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:. ISSN 2168-6068.
- ↑ 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
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 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.
- ↑ 2.0 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:. ISSN 0893-3952.
Image sources