A. Neil Crowson
Regional Medical Laboratory & The University of Oklahoma
Tulsa, Oklahoma
A 47 year old man presented to his dermatologist with a dark spot on his arm. Physical examination
showed a 0.9 x 0.7 cm brown flat lesion on his right arm. A shave biopsy was performed. Light
microscopy showed a nested and single cell population of melanocytes at the dermo-epidermal junction with
migration to the mid-spinous layers. These cells were epithelioid in character, had nuclei larger than
adjacent keratinocytes, manifested abundant quantities of irregularly-melanized pale cytoplasms, and
nuclei with prominent solitary nucleoli. There were no dermal stromal alterations one associates with
dysplastic nevi.
Case 1 - Figure A - Low magnification showing pagetoid and nested array of atypical epithelioid melanocytes. There is a peri-retal stromal fibrosing reaction with perivascular lymphocytes, melanophages and telangiectasia.
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Case 1 - Figure B - Intermediate magnification shows the loosely cohesive, pagetoid and nested array of atypical melanocytic cells.
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Case 1 - Figure C - High power shows atypical nuclei with slight indentation of contour, small, discrete nucleoli and open chromatin patterns. The degree of cytologic atypia is not one associated with criteria for fully transformed malignant degeneration.
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A 17 year old girl presented to her dermatologist's office with a "mole" in her genital area. Physical
examination showed a 0.8 x 0.6 cm tan-colored, slighted elevated lesion on her right mons pubis. A shave
biopsy was performed. Light microscopy showed nests of melanocytes at the dermo-epidermal junction that
manifested multinucleated giant cells with pale cytoplasms and variably-sized pigment granules. The
melanocyte nuclei were similar in size to those of adjacent keratinocytes and showed discrete nucleoli.
There was prominent homogeneous stromal collagen superficially. The junctional component extended past
the lateral confines of a banal dermal melanocytic populace in a symmetrical fashion. There were no
mitoses in the melanocytes.
Boris Bastian
UCSF Comprehensive Cancer Center
San Francisco, California
47 year old man with a pigmented lesion on his right sole. CGH shows multiple aberration including
amplifications of chromosomes 11q13 and 22q13.
Case 3 - Figure A - Acral skin biopsy, low power, showing a confluent nodular growth of atypical cells in the dermis with pagetoid spread through the overlying epidermis to the cornified layer. There is an asymmetric shoulder showing a lentiginous melanocytic proliferation.
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Case 3 - Figure B - There is a confluent growth of atypical melanocytes along the dermoepidermal junction with pronounced pagetoid single cell spread to the cornified layer.
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Case 3 - Figure C - At the lesional shoulder, a lentiginous array of fully transformed neoplastic melanocytes is present in the basal and immediate superbasilar spinous layers. The cells are hyperchromatic, polygonal and contracted and manifest fully transformed malignant cytologic features.
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Case 3 - Figure D - The vertical growth phase component is predominantly spindled in character. There are admixed squamous pearls which represent down growths of squamous epithelium as a pseudoepitheliomatous reaction to the neoplasm. Cells show mitotic activity and fully transformed malignant features.
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5 year old girl with a lesion on the left flank that was removed and recurred one year later. CGH did
not reveal any chromosomal aberrations.
Case 4 - Figure A - Low power examination shows a polypoid nodule with a symmetrical profile. There is an inverted apical growth of melanocytes along adnexal structures toward the base of the biopsy extending into the subcutaneous tissue.
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Case 4 - Figure B - Along the dermoepidermal junction are large nests of melanocytes showing vertically oriented spindled shaped cells in fasicles with a "raining down" architecture.
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Case 4 - Figure C - High power shows atypical spindled shaped melanocytes in dermal based nodules. Rare mitotic figures are apparent.
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33 year old man with a lesion of the left ear that was removed and recurred after several years. CGH
showed multiple chromosomal aberrations.
Case 5 - Figure A - A low power micrograph shows confluent nodules of cells irregularly dispersed in the dermis associated with a dense sclerosing reaction.
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Case 5 - Figure B - The melanocytic nests within the dense stromal collagen table show hyperchromatic and irregular nuclear contours.
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Case 5 - Figure C - A high power micrograph shows nuclear hyperchromasia, endonuclear cytoplasmic inclusions and fully transformed cytologic features of malignancy.
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45 year old man with a pigmented lesion on his back. CGH showed multiple chromosomal aberrations, but no
amplifications.
Dirk J. Ruiter
University Medical Center Nijmegen
Nijmegen, The Netherlands
A 44 year old man with a blue-grey skin tumor of the left shoulder, 1.1 cm.
Case 7 - Figure A - A low power micrograph shows a confluent deforming dermal nodule with attenuation of the overlying epidermis. The tumor extends deeply into the reticular dermis.
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Case 7 - Figure B - Intermediate power shows an intra-epidermal neoplastic component. The vertical growth phase nodules are larger than the overlying junctional nests or the nests seen in the adjacent epidermis in the microscopic field.
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Case 7 - Figure C - (high power): The vertical growth phase nodule shows fully transformed malignant features in melanocytes showing a confluent growth pattern with frequent and atypical mitotic figures.
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A 32 year old woman with an irregular black, partly grey-white slightly elevated mole of the right upper
arm, 1.8 cm.
Raymond Barnhill
George Washington University Medical School
Washington, DC
838-01: 51 year-old female with central back lesion biopsied to rule out squamous cell carcinoma.
Case 9 - Figure A - (intermediate power micrograph): In this vertical growth phase melanoma, tumor cells extend around a blood vessel in an abluminal disposition scaffolding along the outside of the basement membrane zone of the blood vessel.
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Case 9 - Figure B - Intermediate to high power micrograph of the vascular field from figure 1.
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C02-954: 61 year-old male with a lesion on the right chest biopsied by shave technique.
Martin C. Mihm, Jr
Harvard Medical School
Boston, Massachusetts
This 40 year old woman had a pigmented lesion present on the shoulder for 2 years that gradually
increased in size. A sentinel lymph node biopsy was negative.
Case 11 - Figure A - Intermediate power micrograph shows numerous cytotoxic lymphocytes admixed with neoplastic vertical growth phase melanoma cells.
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Case 11 - Figure B - This intermediate power micrograph shows sheets of loosely cohesive fully transformed malignant epithelioid melanocytes admixed with lymphocytes.
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Case 11 - Figure C - A high power micrograph shows cytotoxic lymphoid cells in apposition to a neoplastic melanocyte showing degenerating cytosol.
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Case 11 - Figure D - A CD8 preparation shows cytotoxic lymphoid cells infiltrating the vertical growth phase component.
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This 34 year old woman with stage 4 melanoma showed a vigorous 30 cm diameter response to autologous
melanoma cells transfected with GM-CSF.
