Melanocytic Lesions by Mai P. Hoang & Martin C. Mihm

Author:Mai P. Hoang & Martin C. Mihm
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

Fig. 8.38The in situ component is pigmented

Fig. 8.39The vertical growth phase is composed of fascicles of spindle-shaped cells

Fig. 8.40Fusiform nuclei with prominent nucleoli and prominent mitotic figure are seen

Diagnosis

Malignant melanoma, superficial spreading with spindle and amelanotic vertical growth phase, Clark level IV, and Breslow depth of 4.3 mm

Comment

This lesion is a very good example of amelanotic melanoma arising in association with a pigmented radial growth phase (Gualandri et al. 2009). 1.8 % of 2,881 melanomas in the series by Giuliano et al. (1982) have no associated pigmentation. It demonstrates that the clonality of the intraepidermal growth phase is different. The spindle cell melanoma is characterized by cells with prominent nucleus, marked irregular chromatin, and prominent nucleolus. The nucleus is surrounded by mass of fusiform cytoplasm in which there are no pigment granules. Furthermore, there is an amphophilic appearance to the cytoplasm. The cells are organized in fascicles with the nuclei abutting each other resembling a “school of fish.” In benign melanocytic lesion such as spindle cell or Spitz nevus, the nuclei are separated by ample cytoplasm. The orientation of the cells abutting the blood vessels is very characteristic of melanoma resembling the picture seen in glioblastoma multiforme. There is no maturation. There is individual cell necrosis. There are many mitoses and many of which are atypical.

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