Junctional nevus
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
Microscopy
Classify into either of the following:
| Parameter | Low-grade dysplasia | High-grade dysplasia | Suspected melanoma in situ | ||
|---|---|---|---|---|---|
| Mild | Moderate | Severe | |||
| Delimitation | Rarely diffuse | Sometimes diffuse | Often diffuse | Often diffuse | |
| Lentiginous proliferation
Yes, along with retelister Yes, along with and focal between retelister Yes, along with and focal between retelister Yes partially continuous, multilayer Irregular second distribution * Yes Yes Yes Yes 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 atypigrad Easy Easy-moderate Moderate-severe Moderate-severe cellular atypia * Percentage of atypical melanocytes <10% about 10 - 50% about 50-90% Usually> 90% Extended retelists Yes, regular Yes, varying Yes, often irregular Varying, planarized Concentric fibrosis Yes Yes Yes Varies Lamellar fibrosis Rarely Often Often Pronounced Varying lymphocytic * Sparingly, perivascular Easy-moderate perivascular Varying Varying reactive changes regressive changes No No Rarely Varying Melanocytic atypia No Rarely, in superficial part Can be detected in superficial part Can be detected in superficial part. intradermal component maturation Yes Yes, can be partial Yes, can be partial Yes, can be partial; if No ripening recital invasive melanoma! |
Further workup | Immunohistochemistry | |||
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?
Notes
- ↑ 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
- ↑ 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.
Image sources