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Dysplastic nevus with severe cytologic and architectural atypia DD superficial spreading melanoma
Skin, Lower Extremity
Haematoxylin & Eosin (H&E)
46 years
History of melanoma. Skin lesion of the upper leg.
Asymmetrical melanocytic compound lesion with shoulder formation (lateral spread of junctional component over dermal component). Strong pleomorphism and almost continuous atypia of the melanocytes especially of the junctional component. Focal predominance of single cells over nests in the epidermis. Retained maturation of dermal melanocytes. Focal fibrosis and regression of the dermal component with preserved rete ridges above the area of dermal fibrosis. Prominent fusion of rete ridges. Subepidermal lamellar (stacked) fibroplasia parallel to epidermis. Chronic inflammation and vascular proliferates of the dermis.
This lesion shows all the histological features of a dysplastic (Clerk's) nevus but cytological and architectural atypia are very marked. A clear distinction from a malignant melanoma is therefore almost impossible considering the fact, that the patient has a history of melanoma. The following features are in favor of a benign nevus: cytologically bland dermal component showing signs of maturation and lacking mitotic figures. Preservation of rete ridges above an area with tumor regression.
Manuel, Schlageter, University of Basel
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