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Skin-melanocytic tumor
Superpage

Revised: 10 June 2013
Copyright: (c) 2001-2013, PathologyOutlines.com, Inc.

Dermoscopy

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 30 March 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
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Terminology
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Uses by pathologists / other physicians
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Clinical images
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Nevus associated with skin type I    Nevus associated with skin type IV    Reticular nevus in white patients
(always burn and never tan)      (tan easily and never burn)      who may burn or tan
Image collections / lectures
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Dermoscopes
=========================================================================



Nevi - general

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 30 March 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
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Terminology
=========================================================================
Epidemiology
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Patterns associated with benign behavior
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Clinical features
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Prognostic factors
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Case reports
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Treatment
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Gross description
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Micro description
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Micro images
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Clusters of nevus cells in neck node of
patient with oral squamous cell carcinoma
Positive stains
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Molecular description
=========================================================================



Nevi
Specific sites

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 20 April 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

Acral nevi
General
========================================================================= Epidemiology
=========================================================================
Clinical features
=========================================================================
Dermoscopic description
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Clinical images
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Various patterns

Transition pattern

Various images
Micro description
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Micro images
=========================================================================

Contributed by Angel Fernandez-Flores, MD, PhD, Hospital El Bierzo and Clinica Ponferrada, Spain

Retraction artifact, cytological atypia and pagetoid spread
Differential diagnosis
=========================================================================
Ankle nevi
Epidemiology
=========================================================================
Clinical features
=========================================================================
Micro description
=========================================================================
Differential diagnosis
=========================================================================
Auricular nevi
Clinical features
=========================================================================
Micro description
=========================================================================
Differential diagnosis
=========================================================================
Flexural skin nevi
Sites
=========================================================================
Micro description
=========================================================================
Differential diagnosis
=========================================================================
Genital nevi
Epidemiology
=========================================================================
Clinical features
=========================================================================
Atypical melanocytic nevi of genital type
=========================================================================
Micro description
=========================================================================
Micro images
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Large expansile oval
junctional nests

Papillomatosis and large
junctional nests with
retraction artifact

Atypia is present
Differential diagnosis
=========================================================================
Head and neck nevi
Clinical features
=========================================================================
Micro description
=========================================================================
Differential diagnosis
=========================================================================



Nevi
Active Nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 30 March 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

Terminology
=========================================================================
Epidemiology
=========================================================================
Clinical features
=========================================================================



Nevi
Balloon cell nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 30 March 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

Clinical features
=========================================================================
Micro images
=========================================================================

Balloon cell nevus of conjunctiva

Site unspecified

Contributed by Dr. Amy Lynn, Toledo, Ohio
Positives stains
=========================================================================
Differential diagnosis
=========================================================================



Nevi
Becker's nevus (Becker's melanosis)

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 30 March 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Clinical features
=========================================================================
Clinical images
=========================================================================

Various images

Bilateral Becker’s nevus
Case reports
=========================================================================
Treatment
=========================================================================
Micro description
=========================================================================
Differential diagnosis
=========================================================================



Nevi
Blue nevus - common type

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 30 March 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Clinical features
=========================================================================
Clinical images
=========================================================================

Various images

Homogeneous blue-gray pattern with central hypopigmented
area and no pigmented network, dots or globules
Case reports
=========================================================================
Dermoscopy
=========================================================================
Micro description
=========================================================================
Micro images
=========================================================================

Various images
Contributed by Angel Fernandez-Flores, MD, PhD, Hospital El Bierzo and Clinica Ponferrada, Spain:

Various images

10x

20x

40x
Positive stains
=========================================================================
Molecular description
=========================================================================
Differential diagnosis
=========================================================================



Nevi
Blue nevus - variants

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 29 March 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

Atypical cellular blue nevus
General
=========================================================================
Epidemiology
=========================================================================
Sites
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Clinical features
=========================================================================
Case reports
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Treatment
=========================================================================
Micro description
=========================================================================
Positive stains
=========================================================================
Differential diagnosis
=========================================================================
Cellular blue nevus
General
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Clinical features
=========================================================================
Case reports
=========================================================================
Treatment
=========================================================================
Clinical images
=========================================================================
Infiltrative giant cellular blue nevus
Micro description
=========================================================================
Micro images
=========================================================================
Infiltrative giant cellular blue nevus
Low / medium power
High power
Contributed by Angel Fernandez-Flores, MD, PhD, Hospital El Bierzo and Clinica Ponferrada, Spain
Positive stains
=========================================================================
Negative stains
=========================================================================
Molecular description
=========================================================================
Videos
=========================================================================
Differential diagnosis
=========================================================================

Epithelioid blue nevus
General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Case reports
=========================================================================
Micro description
=========================================================================
Positive stains
=========================================================================
Negative stains
=========================================================================
Molecular description
=========================================================================
Differential diagnosis
=========================================================================

Malignant blue nevus
General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Prognostic factors
=========================================================================
Case reports
=========================================================================
Treatment
=========================================================================
Micro description
=========================================================================
Micro images
=========================================================================
Various images

Various images

Positive stains
=========================================================================
Molecular description
=========================================================================
Differential diagnosis
=========================================================================



Nevi
Cockarde nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 30 March 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
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Drawings
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Cockade / cockarde ribbon
Terminology
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Epidemiology
=========================================================================
Sites
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Clinical features
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Case reports
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Treatment
=========================================================================
Dermoscopy description
=========================================================================
Clinical images
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Figure 4: dermoscopy of scalp lesion
Figure 4

Micro description
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Positive stains
=========================================================================
Differential diagnosis
=========================================================================



Nevi
Combined nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 30 March 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Clinical features
=========================================================================
Clinical images
=========================================================================

Globular pattern associated with a
central homogenous pattern (darker area)
Case reports
=========================================================================
Micro images
=========================================================================
Various images
Spitz nevus and common nevus
Positive stains
=========================================================================



Nevi
Compound nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 30 March 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Clinical features
=========================================================================
Dermoscopy images
=========================================================================

Cobblestone pattern
with “fitted” globules

Peripheral regular pigmented
network, central homogeneous
area and central black dots
Clinical images
=========================================================================

Eccentric hyperpigmented nevus
suspicious for melanoma
Case reports
=========================================================================
Micro description
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Micro images
=========================================================================

Ki-67 compared to melanoma

With underlying dermatofibroma

With features of milk line nevus

Confocal microscopy
Videos
=========================================================================
Differential diagnosis
=========================================================================



Nevi
Congenital nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 30 March 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Clinical features
=========================================================================
Case reports
=========================================================================
Treatment
=========================================================================
Dermoscopic description
=========================================================================
Dermoscopic / clinical images
=========================================================================

Reticular pattern and regular globules

Globular pattern and patchy network

Haloed globules

Target network and target globules

Various images
Micro description
=========================================================================
Micro images
=========================================================================

Symmetrical broad proliferation of melanocytes in papillary and reticular dermis with maturation, splaying between collagen bundles, permeation of muscles of hair erection, blood vessels, adnexa

Deep congenital nevus

Fig 1, 2: congenital nevus;
Figure 3: melanoma in axillary node (inset: S100)
Molecular description
=========================================================================
Videos
=========================================================================
Differential diagnosis
=========================================================================
Giant congenital nevus
General
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Terminology
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Epidemiology
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Sites
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Case reports
=========================================================================
Treatment
=========================================================================
Clinical images
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Newborn with giant hairy congenital nevus

Ulcerated nodule within scalp
Micro description
=========================================================================
Micro images
=========================================================================

Proliferation of melanocytes along hair follicle

Melanocytes are uniform in large ulcerated nodule
Molecular description
=========================================================================



Other tumors of skin

Connective tissue nevus


Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 19 September 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
=========================================================================

● Rare connective tissue hamartoma derived from cells of mesodermal origin
● May be syndromic (Proteus syndrome, tuberous sclerosis, others) or isolated (collagenoma)

Case reports
=========================================================================

● 8 year old girl with connective tissue nevus with zosteriform distribution (Pediatr Dermatol 2007;24:557)
● 8 year old boy with linear connective tissue nevus (Pediatr Dermatol 2007;24:439)
● 25 year old man with 40 nodules/papules distributed in zosteriform pattern (Am J Dermatopathol 2007;29:303)




Nevi
Deep penetrating nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 30 March 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Clinical features
=========================================================================
Clinical images
=========================================================================

Linear distribution of nevi behind ear
Case reports
=========================================================================
Treatment
=========================================================================
Micro description
=========================================================================
Micro images
=========================================================================
Various images
Various images
Differential diagnosis
=========================================================================



Nevi
Dermal nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 30 March 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Clinical features
=========================================================================
Dermoscopy description
=========================================================================
Clinical images
=========================================================================

Mole with osseous metaplasia
Case reports
=========================================================================
Micro description
=========================================================================
Micro images
=========================================================================

Low power

Medium power

With adjacent fibrohistiocytic proliferation

Intradermal nevus with osseous metaplasia
Contributed by Angel Fernandez-Flores, MD, PhD, Hospital El Bierzo and Clinica Ponferrada, Spain: Unna’s pattern



Nevi
Divided / kissing nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 7 April 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Case reports
=========================================================================
Treatment
=========================================================================
Clinical images
=========================================================================

Upper and lower lids & medial canthus

Circumorbital nevus during childhood

Black colored patches on glans and prepuce
Various images - involvement of eyelid


Micro images
=========================================================================

Brown-black pigmented patches on glans penis



Nevi
Dysplastic nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 7 April 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Clinical features
=========================================================================
Case reports
=========================================================================
Treatment
=========================================================================
Dermoscopic description
=========================================================================
Dermoscopic images
=========================================================================

Dysplastic pointillist nevi with
multiple brown dots on an
erythematous background

"Diffuse and patchy" network pattern
Clinical images
=========================================================================

Agminated atypical nevi

Multiple melanocytic nevi (anterior chest and abdomen),
large nevus (right side of chest near midline)

Agminated atypical nevi on right arm

Development of a clinically dysplastic nevus

Minimal change in a clinically dysplastic nevus

Evolving and regressing clinical dysplastic nevus

Various images
Micro description
=========================================================================
Micro images
=========================================================================

Mild atypia

Moderate atypia

Severe atypia

Lentiginous melanocytic proliferation
with papillary dermal fibrosis

Pointillist dysplastic nevus
with cytologic atypia

Dysplastic nevus

S100A6 staining (negative)

Strong BRMS1 (A); weak Cul1 (B)
Contributed by Angel Fernandez-Flores, MD, PhD, Hospital El Bierzo and Clinica Ponferrada, Spain:

Clark's nevus
Positive stains
=========================================================================
Molecular description
=========================================================================
Electron microscopy description
=========================================================================
Differential diagnosis
=========================================================================



Nevi
Epidermolysis bullosa nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 7 April 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Clinical features
=========================================================================
Case reports
=========================================================================
Dermoscopic description
=========================================================================
Dermoscopic images
=========================================================================

Irregular dots and globules, blue-gray
pigment and hypopigmented areas
Clinical images
=========================================================================

Large pigmented lesion
with irregular border

Regression after 18 months
Micro description
=========================================================================
Micro images
=========================================================================

Various images



Benign nonmelanotic epidermal tumors / tumor-like lesions

Hair follicle nevus


Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 20 June 2012, last major update June 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
=========================================================================

● Rare, congenital, hamartomatous
● Usually on face

Case reports
=========================================================================

● 2 year old boy with nose nodule (Pediatr Dermatol 2008;25:60)
● 26 year old man with small soft nodules on his nose since childhood (Eur J Dermatol 2008;18:185)
● In a distribution following Blaskho's lines (J Am Acad Dermatol 2002;46:S125)

Dermoscopy
=========================================================================

● Many uniform hair follicles and an interfollicular pseudo-pigment network in the nodules

Gross description
=========================================================================

● Papule or plaque with vellus hairs

Micro description
=========================================================================

● Well-differentiated hair follicles and sebaceous glands
● No cartilage (seen in accessory tragus), central cysts or a central canal (seen in trichofolliculoma)

Electron macroscopy description
=========================================================================

● Follicular germ cells present
● Active fibroblasts around the follicles merge with colloid substance (J Dermatol 2001;28:324)

Differential diagnosis
=========================================================================

● Accessory tragus, trichofolliculoma



Nevi
Halo nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 7 April 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Clinical features
=========================================================================
Treatment
=========================================================================
Clinical images
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16 year old boy with normal mole and halo nevus 1 year later

25 year old man with depigmentation around nevi on back
Micro description
=========================================================================
Micro images
=========================================================================

Various images

Early regression

CD8+ T cells

Contributed by Angel Fernandez-Flores, MD, PhD, Hospital El Bierzo and Clinica Ponferrada, Spain

Various images

CD3 (T cells)

CD20 (B cells)

Melan-A
Differential diagnosis
=========================================================================



Nevi
Ito’s nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 9 April 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Clinical features
=========================================================================
Case reports
=========================================================================
Treatment
=========================================================================
Clinical images
=========================================================================

Shoulder lesions

Nevus of Ota (face) and
nevus of Ito (shoulder)
Micro description
=========================================================================



Nevi
Junctional nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 9 April 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Clinical features
=========================================================================
Case reports
=========================================================================
Treatment
=========================================================================
Dermoscopic description
=========================================================================
Clinical images
=========================================================================

Lentigo simplex

Various images
Micro description
=========================================================================
Micro images
=========================================================================

Junctional nests
Differential diagnosis
=========================================================================



Nevi
Lentiginous nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 9 April 2013, last major update November 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Clinical features
=========================================================================
Case reports
=========================================================================
Treatment
=========================================================================
Clinical images
=========================================================================

Adjacent type with a raised hypertrichotic
portion with macular hyperpigmentation
and superimposed darker macules

A: speckled lentiginous nevus-likeappearance on abdomen;
B: darkening nevus;
C: congenital melanocytic appearance

Adjacent type with a thick hypertrichotic
inferolateral portion next to speckled
lentiginous nevus-like inguinal crease

Admixed type hypertrichotic hybrid nevus

A large unilateral speckled lentiginous nevus
that contains numerous small dark macules

Extensive speckled lentiginous nevus
Micro description
=========================================================================
Micro images
=========================================================================

A, B: melanocytes are disposed in small
nests and single cells;
C: epithelioid melanocytes with enlarged
nuclei and prominent nucleoli

A: preservation of the retiform epidermis with virtual confluent
proliferation of melanocytes at dermoepidermal junction
B: Clark level II invasion into the papillary dermis

A, B: melanocytic proliferation and pagetoid
spread of melanocytes with Mart-1 stain
C: Mitf

Nests of small and monomorphic melanocytes
at the dermoepidermal junction and within
the reticular dermis, with many melanocytes concentrated
around blood vessels and adnexal structures

Elongated rete ridges and lentiginous
proliferation of melanocytes at the
dermal-epidermal junction

Prominent basal layer pigmentation
similar to that seen in lentigo simplex
Differential diagnosis
=========================================================================



Nevi
Meyerson's nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 9 April 2013, last major update January 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Case reports
=========================================================================
Treatment
=========================================================================
Dermoscopic description
=========================================================================
Clinical images
=========================================================================

Multiple perinevic
dermatitis over trunk

Multiple lesions on back

Asymmetry, streaks and pigmentary
globules, irregularly distributed

Various images before steroids
Micro description
=========================================================================
Micro images
=========================================================================

Epidermic hyperplasia with melanocytic
proliferation and discreet spongiosis

Lateral border shows subacute eczema
(parakeratosis, spongiotic vesicles) in epidermis
Virtual images
=========================================================================

Meyerson’s nevus
Differential diagnosis
=========================================================================



Nevi
Mongolian spot

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 9 April 2013, last major update January 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Case reports
=========================================================================
Treatment
=========================================================================
Clinical images
=========================================================================

Mongolian spots
Micro description
=========================================================================
Differential diagnosis
=========================================================================



Adnexal tumors-sebaceous glands

Nevus sebaceus of Jadassohn


Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 14 July 2012, last major update June 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
=========================================================================

● Often incorrectly spelled “nevus sebaceous”
● Congenital, organoid epidermal nevus on scalp and face
● Malformed adnexal structures, increased risk of trichoblastomas, basal cell carcinoma, squamous cell carcinoma
● Sex hormone responsive => need prophylactic excision before puberty

Clinical images
=========================================================================


   
Various images

Gross description
=========================================================================

● Yellow, greasy-appearing, “cobblestone” texture, hairless

Micro description
=========================================================================

● Hamartoma composed of large sebaceous glands, heterotopic apocrine glands, defective hair follicles, acanthosis and epithelial papillomatosis

Micro images
=========================================================================


Nevus sebaceus of Jadassohn #1, #2



Nevi
Nevus of Ota

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 13 April 2013, last major update January 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Clinical features
=========================================================================
Case reports
=========================================================================
Treatment
=========================================================================
Clinical images
=========================================================================

Flat blue-gray pigmentation with an irregular border on the skin of lateral ocular areas;
bilaterally, the sclerae also involved

Acquired dark brown
spots below eyes

Episcleral involvement

With nevus of Ito

Bilateral acquired nevus of
Ota-like macules
Micro description
=========================================================================
Micro images
=========================================================================

Bipolar dendritic melanocytes in papillary and reticular dermis are arranged as single units between collagen bundles, also numerous pigment-laden macrophages
Contributed by Dr. Asmaa Gaber Abdou, Menofiya University, Egypt:

Elongated dendritic melanocytes scattered with collagen bundles extending around hair follicles

Wavy dendritic cells with evenly dispersed melanin granules distributed in the superficial reticular dermis

Differential diagnosis
=========================================================================



Nevi
Phacomatosis pigmentokeratotica

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 13 April 2013, last major update January 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Case reports
=========================================================================
Clinical images
=========================================================================

Verrucous epidermal nevus
and ipsilateral speckled lentiginous nevus

Papular type speckled lentiginous nevus,
telangiectatic nevoid area on upper right side

Sebaceous nevus on left preauricular area

Sebaceous nevus involving face,
speckled-lentiginous nevus on trunk

Systematized epidermal nevus pn right side of body,
speckled-lentiginous nevus with checkerboard
distribution on both sides

Organoid nevus involving
eye and mouth

Speckled lentiginous nevus showing a
checkerboard distribution and hemiatrophy
with postural deviation

Speckled-lentiginous nevus

Linear arrangement of organoid
nevus on neck and upper back

Systematized epidermal
nevus of left side of body

Epidermal nevus and pigmented
lesions right forearm and back

Speckled lentiginous
nevus in lumbar area

Epidermal nevus right side of trunk and leg plus
epidermal and melanocytic nevus on right hand

With epidermal nevus following Blaschko’s lines and
a large light-brown macule on each side of trunk



Nevi
Phacomatosis pigmentovascularis (PPV)

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 13 April 2013, last major update February 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Case reports
=========================================================================
Clinical images
=========================================================================

Extensive nevus flammeus
involving face, thorax , arms;
nevus anemicus on right pectoral area

Aberrant mongolian spots
affecting upper part of back

Extensive nevus flammeus
involving back and left arm

Blue-black macular pigmentation
on periorbital areas (bilateral scleral melanosis)

Extensive nevus flammeus
involving lower limbs

Extensive nevus flammeus and livedo
reticularis pattern on trunk and extremities, more pronounced on right chest with diffuse involvement of face

Left lower limb 3 cm longer, circumference larger than right side

Diffuse bluish discoloration on back, right lateral chest wall, lower extremities

Phacomatosis cesioflammea

Phacomatosis spilorosea

Phacomatosis cesiomarmorata



Nevi
Pigmented spindle cell nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 14 April 2013, last major update February 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Clinical features
=========================================================================
Case reports
=========================================================================
Treatment
=========================================================================
Dermoscopic description
=========================================================================
Clinical images
=========================================================================

Rim of brown globules around lesion

Pseudopods arranged regularly at periphery
and retiform depigmentation at center

Small multicolored lesion showing
irregular and ill-defined borders

Small slightly raised dark
lesion with defined borders

Small and symmetrical lesion differs from Spitz
nevus in its uniform dark blue-black pigmentation
that may suggest melanoma clinically (AFIP)
Micro description
=========================================================================
Micro images
=========================================================================

Various images

Symmetric pigmented tumors
AFIP images:

Fig A: bilaterally symmetrical lesion has proliferation of nested melanocytes that "rain down" from epidermis and expand papillary dermis without involving reticular dermis
Fig B: lesional cells mature from superficial to deep
Fig C: the most lateral cells are in the form of a nest rather than single cells (well circumscribed)

Some intraepidermal nests show clefts similar to Spitz nevi, but they more often blend imperceptibly with keratinocytes in a pigmented spindle cell nevus (fig B);
Mitotic figures in the epidermis are common, but they are not numerous in the dermis;
Maturation towards a small nevoid cell at the base in the papillary dermis, without involvement of the reticular dermis, is typical

Fig B: bilaterally symmetrical lesion whose cells mature from epidermis to base of papillary dermis, respecting the reticular dermis interface (fig B);
Fig C: nucleolated lesional cells with abundant, coarse and dusty pigment are characteristic
Symmetric pigmented tumor; #2; #3; #4

Pigmented spindle cell tumor


Positive stains
=========================================================================
Molecular description
=========================================================================
Videos
=========================================================================
Differential diagnosis
=========================================================================



Nevi
Spitz nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 20 April 2013, last major update February 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

See also atypical Spitz nevus, desmoplastic Spitz nevus

General
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Terminology
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Clinical features
=========================================================================
Case reports
=========================================================================
Treatment
=========================================================================
Clinical images
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Small, symmetrical, pink-tan lesion

Various images

On ear of child

11 year old boy with dark pigmented arm lesion
Micro description
=========================================================================
Micro images
=========================================================================

Various images

Limited Ki-67 staining

Strong S100A6 staining

Various images

Spitz nevus-figures a-c

Compound Spitz tumor

Compound Spitz nevus

Lip lesion - superficial nests with
spread of cells in deeper areas

Cells demonstrate pleomorphism,
hyperchromatism and multinucleation
AFIP images:

Bilaterally symmetric lesion has uniform hyperkeratosis with hypergranulosis, fairly uniformly elongated rete ridges
and a proliferation of melanocytes in the epidermis that "rain down" through the papillary dermis into the reticular dermis
as attenuated spindle cells


Fig A: bilaterally symmetrical lesion
Fig B: has lateral cells arranged in nests
Fig C: indicating that the lesion is well circumscribed; "transepidermal elimination" does not indicate pagetoid spread
Fig D: dermal lesional cells show imperfect, but definite maturation with attenuated single cells at the base of the lesion

Melanocytes extend focally into epidermis, mostly as nests;
the maturation into the dermis, globoid bodies in epidermis
and characteristic cell type are attributes of Spitz nevus, not melanoma

Pink eosinophilic globoid Kamino
bodies are probably apoptotic cells

Fig A: giant cells are commonly seen in Spitz nevi
Fig B: as are the large intranuclear cytoplasmic invaginations
that may also be seen in melanomas

Fig A: mitotic figures, if not numerous and especially when entirely superficial, are not indicative of melanoma
Fig B: maturation from large epithelioid cells to small nevus cells, from superficial to deep, within a Spitz
nevus is an extremely important diagnostic feature, as is the permeation of reticular dermis by attenuated
single cells at the base
Comparison with melanoma:

Fig A-H: Spitz nevus
Fig I: compared to spitzoid melanoma
Contributed by Angel Fernandez-Flores, MD, PhD, Hospital El Bierzo and Clinica Ponferrada, Spain:

Various images
Symmetric circumscribed lesion; nests of tumor cells with Kamino bodies; #2;

Nests of spindle cells; nests of epithelioid cells; #2; multinucleated cells;

Junctional; intradermal; #2; compound; #2; trunk; #2


Positive stains
=========================================================================
Negative stains
=========================================================================
Molecular description
=========================================================================
Differential diagnosis
=========================================================================



Nevi
Atypical Spitz nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 3 May 2013, last major update March 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
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Terminology
=========================================================================
Epidemiology
=========================================================================
Clinical features
=========================================================================
Case reports
=========================================================================
Treatment
=========================================================================
Micro description
=========================================================================
Micro images
=========================================================================

Various images

Thigh

Various images

Asymmetry but highly cohesive nests
AFIP images:

Large epithelioid cells with amphophilic cytoplasm
are characteristic of Spitz nevi, and the nuclear atypia
observed here should not suggest melanoma in the
absence of other features
Buttock tumor:

Multinucleated tumor cells

Sheets of atypical tumor cells with frequent mitotic figures

Somewhat symmetric

Large nests of atypical tumor cells
Positive stains
=========================================================================
Molecular description
=========================================================================
Differential diagnosis
=========================================================================



Nevi
Desmoplastic Spitz nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 17 April 2013, last major update March 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Epidemiology
=========================================================================
Dermoscopic features
=========================================================================
Clinical features
=========================================================================
Micro description
=========================================================================
Micro images
=========================================================================

Melanocytes with spitzoid appearance,
stromal hypereosinophilic bundles of
collagen and melanophages in the
junctional region and superficial dermis

Near-dermal lesion with
laterally sharp border
AFIP images:

Symmetrical lesion shows maturation of lesional cells in the dermis with attenuated single cells
among reticular dermis collagen bundles at the base, but unlike desmoplastic melanoma, the
intraepidermal component does not extend substantially beyond the dermal component, and
there are no clusters of mitotically active epithelioid melanocytes in the superficial dermis
#1; #2; #3; #4; #5; #6; desmoplastic angiomatoid Spitz nevus


Positive stains
=========================================================================
Differential diagnosis
=========================================================================



Nevi
White sponge nevus

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 20 April 2013, last major update March 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Epidemiology
=========================================================================
Sites
=========================================================================
Clinical features
=========================================================================
Case reports
=========================================================================
Treatment
=========================================================================
Clinical images
=========================================================================

White plaques on buccal mucosa

White plaques on tongue
Micro description
=========================================================================
Micro images
=========================================================================

Parakeratosis, acanthosis and spongiosis of mucosal epithelium
with blunting of rete ridges; vacuolated and dyskeratotic epithelial
keratinocytes demonstrate perinuclear eosinophilic condensations
Differential diagnosis
=========================================================================



Other melanocytic lesions - general

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 20 April 2013, last major update March 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Patterns of benign behavior
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Other benign features
=========================================================================
Maturation
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Case reports
=========================================================================



Other melanocytic lesions
Atypical melanocytic hyperplasia

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 20 April 2013, last major update March 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Terminology
=========================================================================
Case reports
=========================================================================
Micro description
=========================================================================
Micro images
=========================================================================

Benign atypical junctional melanocytic hyperplasia
Differential diagnosis
=========================================================================



Other melanocytic lesions
Café-au-lait spot

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 20 April 2013, last major update April 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
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Terminology
=========================================================================
Epidemiology
=========================================================================
Case reports
=========================================================================
Clinical images
=========================================================================

Various images

Various images

Axillary freckling

Lesion of face

Neurofibromatosis type I patient
Micro description
=========================================================================
Micro images
=========================================================================

Macromelanosomes have pigment restricted to basal epidermis
Electron microscopy description
=========================================================================
Differential diagnosis
=========================================================================



Other melanocytic lesions
Ephelis (freckle)

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 20 April 2013, last major update April 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
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Terminology
=========================================================================
Clinical images
=========================================================================

Face

Face and upper body
Micro description
=========================================================================
Differential diagnosis
=========================================================================



Other melanocytic lesions
Hyperpigmentation

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 20 April 2013, last major update April 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
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Clinical features
=========================================================================
Case reports
=========================================================================
Treatment
=========================================================================
Clinical images
=========================================================================


Drug related:

Amiodarone

Bleomycin

Diltiazem

Imatinib

Imipramine
Other:

42 year old African American woman with lesions
on left side of face as a result of acne excoriée

Familial Progressive Hyperpigmentation

Pre- and post-treatment for Vitamin B12 deficiency
Micro description
=========================================================================
Micro images
=========================================================================

Amiodarone



Diltiazem

Imatinib

Imipramine: gold brown pigment
in upper and mid dermis

Familial Progressive Hyperpigmentation
Electron microscopy images
=========================================================================

Photoexposed pigmented skin



Other melanocytic lesions
Linear and whorled nevoid hypermelanosis

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 25 April 2013, last major update April 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Diagrams
=========================================================================

Lines of Blaschko
Clinical features
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Case reports
=========================================================================
Treatment
=========================================================================
Clinical images
=========================================================================

Hyperpigmented streaks show whorled
pattern over trunk; no improvement
after chemical peel

Diffuse swirls and streaks of
macular hyperpigmentation
Micro description
=========================================================================
Micro images
=========================================================================

Epidermal hypermelanosis without
pigment incontinence in the dermis

Diffuse melanosis of
basal layer of epidermis



Other melanocytic lesions
Melasma

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 25 April 2013, last major update April 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
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Terminology
=========================================================================
Clinical features
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Treatment
=========================================================================
Clinical images
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Confluent hyperpigmented macules in a malar distribution
Micro description
=========================================================================
Electron microscopy description
=========================================================================
Differential diagnosis
=========================================================================



Other melanocytic lesions
Paraganglioma-like dermal melanocytic tumor

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 25 April 2013, last major update April 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Epidemiology
=========================================================================
Clinical features
=========================================================================
Case reports
=========================================================================
Micro description
=========================================================================
Micro images
=========================================================================

Well demarcated cellular nodule
in dermis with normal epidermis

Tumor restricted to deep dermis
without any contact with normal
overlying epidermis

S100+

Various images

Neoplasm composed of organoid and nested
groups of large epithelioid cells, separated by
delicate fibrous strands and prominent blood
vessels; epithelioid cells have somewhat clear
cytoplasm, large nuclei with prominent red nucleoli
Positive stains
=========================================================================
Negative stains
=========================================================================
Molecular description
=========================================================================
Differential diagnosis
=========================================================================



Other melanocytic lesions
Solar lentigo

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 25 April 2013, last major update April 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
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Terminology
=========================================================================
Epidemiology
=========================================================================
Clinical features
=========================================================================
Treatment
=========================================================================
Dermoscopic description
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Clinical images
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Back lesions

Various images


Pre- and post-laser treatment
Micro description
=========================================================================
Differential diagnosis
=========================================================================



Other melanocytic lesions
Vitiligo

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 25 April 2013, last major update April 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
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Epidemiology
=========================================================================
Clinical features
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Treatment
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Clinical images
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Various images

Mucosal

Poliosis

Marginal inflammatory

Segmental

Trichrome

Nonsegmental

Hand

Autologous epidermal graft
using suction blister
Micro description
=========================================================================
Electron microscopy description
=========================================================================
Differential diagnosis
=========================================================================



Melanoma
Melanoma in situ

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 25 April 2013, last major update April 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================
Epidemiology
=========================================================================
Clinical features
=========================================================================
Case reports
=========================================================================
Treatment
=========================================================================
Dermoscopic description
=========================================================================
Clinical images
=========================================================================

Various images

Acral lesion with parallel ridge pattern (B)

Before and after Imiquimod cream (A, B)

Various images
Micro description
=========================================================================
Micro images
=========================================================================

Hyperkeratotic keratosis with coexisting melanoma in situ and MITF staining

Melanoma in situ

With fibrohistiocytic proliferation extending to epidermis

Frozen section from Moh’s procedure -
positive (A) and negative (B) margins

Asymmetry, atypia and limited pagetoid spread in nail
Videos
=========================================================================
Differential diagnosis
=========================================================================



Melanoma
Invasive - general

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 29 May 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
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Epidemiology
=========================================================================
Populations at higher risk:
Sites
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Clinical warning signs
=========================================================================
Clinical features
=========================================================================
Physiology
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Regression
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Metastases
=========================================================================
Survival
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Poor prognostic factors
=========================================================================
Possible poor prognostic factors:
Case reports
=========================================================================
Diagnosis and Treatment
=========================================================================
Clinical images
=========================================================================
Scaly erythematous crusty pigmentation and thickened
plaques on the nipple, spreading to surrounding areola
Dermoscopy
=========================================================================
Micro description
=========================================================================
4 major subtypes: (described separately)
Regressed melanoma:
Other microscopic features
=========================================================================
Micro images
=========================================================================
Primary melanoma and epidermotropic metastases
Thin and thick melanoma
Vascular invasion
Ulceration
Satellite metastasis
Tumor infiltrating lymphocytes
Confocal microscopy versus H&E
Nipple melanoma, nodular type
HMB45+
PMEL17

Punch biopsy - depth of invasion was incorrect since it was measured along hair follicle that was not initially evident:
No hair follicle seen
Hair follicle seen on recut
Excision

Contributed by Angel Fernandez-Flores, MD, PhD, Hospital El Bierzo and Clinica Ponferrada, Spain:
Pagetoid extension
Follicular growth
Cytology description
=========================================================================
Positive stains
=========================================================================

Distinguish melanocytes from non-melanocytes, but not malignant cells from benign cells: Electron microscopy description
=========================================================================
Molecular description
=========================================================================
Differential diagnosis
=========================================================================
Helpful features of melanoma that differentiate from benign lesions (from Rosai):



Melanoma
Acral lentiginous melanoma (ALM)
Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 5 June 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
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Epidemiology
=========================================================================

Sites
=========================================================================

Clinical features
=========================================================================

Poor prognostic factors
=========================================================================

Case reports
=========================================================================

Clinical images
=========================================================================

Plantar surface

Various images

Erosive and macerated lesion


In situ 5 years ago

Invasive ALM

Dermoscopy
=========================================================================

Micro description
=========================================================================

Micro images
=========================================================================

In situ: minimal atypical melanocytic hyperplasia without invasion

Invasion: nest formation by melanoma cells


Various images

Positive stains
=========================================================================

Molecular description
=========================================================================

Differential diagnosis
=========================================================================




Melanoma
Desmoplastic melanoma
Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 5 June 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================

Terminology
=========================================================================

Epidemiology
=========================================================================

Sites
=========================================================================

Clinical features
=========================================================================

Case reports
=========================================================================

Treatment
=========================================================================

Clinical images
=========================================================================

2.5 cm scalp lesion

Dermoscopy
=========================================================================

Micro description
=========================================================================

Micro images
=========================================================================

Desmoplastic vs. non-desmoplastic melanoma

Hypocellular spindle cells

Mixed with classic melanoma

Atypical spindled cells


81 year old man with scalp lesion


Various images


Strong S100 staining

T311 (tyrosinase)


HMB-45 and Mart-1 negative

MITF positive

Cytology description
=========================================================================

Cytology images
=========================================================================

Various images

Positive stains
=========================================================================

Negative stains
=========================================================================

Molecular description
=========================================================================

Differential diagnosis
=========================================================================




Melanoma
Follicular melanoma

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 7 June 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================

Epidemiology
=========================================================================

Clinical features
=========================================================================

Case reports
=========================================================================

Treatment
=========================================================================

Differential diagnosis
=========================================================================




Melanoma
Lentigo maligna melanoma

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 8 June 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================

Terminology
=========================================================================

Clinical features
=========================================================================

Case reports
=========================================================================

Treatment
=========================================================================

Dermoscopy
=========================================================================

Dermoscopy images
=========================================================================

Annular-granular pattern

With slate-gray dots


Typical dermoscopy features

Clinical images
=========================================================================

Various images


Micro description
=========================================================================

Micro images
=========================================================================

Atypical melanocytes


Contributed by Angel Fernandez-Flores, MD, PhD, Hospital El Bierzo and Clinica Ponferrada, Spain:

Various images

Molecular description
=========================================================================

Differential diagnosis
=========================================================================




Melanoma
Lentiginous melanoma

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 7 June 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================

Epidemiology
=========================================================================

Sites
=========================================================================

Micro description
=========================================================================

Micro images
=========================================================================

Various images (same image)

Extensive melanocytic proliferation and pagetoid spread (MART1 and MITF)


Virtual confluent proliferation of melanocytes

Corresponding to Clark level II invasive melanoma

Differential diagnosis
=========================================================================




Melanoma
Minimal deviation melanoma
Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 8 June 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================

Terminology
=========================================================================

Epidemiology
=========================================================================

Clinical features
=========================================================================

Treatment
=========================================================================

Micro description
=========================================================================

Micro images
=========================================================================

Various images

Figure b


Nodular tumor filling papillary dermis

Ki-67 (Fig C)

Halo variant

Positive stains
=========================================================================

Differential diagnosis
=========================================================================




Melanoma
Nevoid melanoma

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 8 June 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================

Terminology
=========================================================================

Epidemiology
=========================================================================

Clinical features
=========================================================================

Case reports
=========================================================================

Micro description
=========================================================================

Micro images
=========================================================================

Various images

Figures 3-6


Verrucous variant

Monotonous melanocytes

Mitotic figures

Smooth contoured variant


Expansile nodules

Pseudomaturation

Fully transformed malignant melanocytes


Lesion #1:

Various images


Lesion #2:

Various images


Lesion #3:

Various images

Atypical single cells

Mitotic figures

Virtual slides
=========================================================================

Nevoid melanoma

Positive stains
=========================================================================

Differential diagnosis
=========================================================================




Melanoma
Nodular melanoma

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 8 June 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================

Epidemiology
=========================================================================

Sites
=========================================================================

Clinical features
=========================================================================

Case reports
=========================================================================

Dermoscopy
=========================================================================

Dermoscopic images
=========================================================================

Atypical globular pattern (A)

Non-specific pattern (A)

Clinical images
=========================================================================

25 cm tumor

Various images


Micro description
=========================================================================

Micro images
=========================================================================

Hyperkeratosis without pagetoid spreading (C)

Noncoalescence atypical melanocytes (B)

Fig B and C


Poor differentiation

Ki-67 staining


Contributed by John Irlam, D.O., Department of Pathology, University of Toledo Medical Center:

Low power (4x)

Medium power (10x)


Medium power (20x)

High power (40x)


Molecular description
=========================================================================

Differential diagnosis
=========================================================================




Melanoma
Pigmented epithelioid melanocytoma

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 8 June 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================

Terminology
=========================================================================

Epidemiology
=========================================================================

Sites
=========================================================================

Clinical features
=========================================================================

Case reports
=========================================================================

Treatment
=========================================================================

Clinical images
=========================================================================

27 year old man

23 year old woman

Micro description
=========================================================================

Micro images
=========================================================================

Melanocytoma - various images


Case of the week #113:

Low power

Medium power


High power

Positive stains
=========================================================================

Negative stains
=========================================================================

Molecular description
=========================================================================

Electron microscopy description
=========================================================================

Differential diagnosis
=========================================================================




Melanoma
Primary dermal melanoma

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 8 June 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================

Epidemiology
=========================================================================

Sites
=========================================================================

Clinical features
=========================================================================

Case reports
=========================================================================

Treatment
=========================================================================

Dermoscopy
=========================================================================

Clinical images
=========================================================================

Blue nodule on arm

Slightly bluish scalp nodule

Micro description
=========================================================================

Micro images
=========================================================================

Various images


Metastatic melanoma vs. primary dermal melanoma

Positive stains
=========================================================================

Molecular description
=========================================================================

Differential diagnosis
=========================================================================




Melanoma
Subungual melanoma

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 8 June 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================

Epidemiology
=========================================================================

Sites
=========================================================================

Clinical features
=========================================================================

Case reports
=========================================================================

Treatment
=========================================================================

Dermoscopy
=========================================================================

Clinical images
=========================================================================

Red, friable, broad-based nodule

Ulcer on left middle finger

Micro description
=========================================================================

Micro images
=========================================================================

Tumor cells are single or in nests

Tumor cells are MelanA+

Differential diagnosis
=========================================================================




Melanoma
Superficial spreading melanoma

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 8 June 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================

Epidemiology
=========================================================================

Sites
=========================================================================

Clinical features
=========================================================================

Case reports
=========================================================================

Dermoscopy
=========================================================================

Clinical images
=========================================================================

Irregular black tumor with
elevation in periumbilical area

Various images


Reticular pattern

Homogeneous area

Micro description
=========================================================================

Micro images
=========================================================================

Superficial spreading melanoma
and satellite nodule

S100A6 staining (negative)

Beta catenin expression in primary

Positive stains
=========================================================================

Molecular description
=========================================================================

Differential diagnosis
=========================================================================




Miscellaneous
Breslow’s system for tumor thickness

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 7 June 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================

Diagrams
=========================================================================

Breslow depth




Miscellaneous
Clark’s levels of invasion

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 7 June 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================

Diagrams
=========================================================================

Clark’s levels

Uses by pathologists
=========================================================================




Miscellaneous
Melanoma - features to report

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 7 June 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

Features to report
=========================================================================

Mandatory features used for pathologic staging: Features used in some protocols for treatment choice: Lymph nodes Additional features:

Templates
=========================================================================

Diagrams
=========================================================================

Brisk tumor-infiltrating lymphocytes




Miscellaneous
Sentinel node biopsy for melanoma

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 8 June 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
=========================================================================

Recommendations
=========================================================================

Prognostic factors
=========================================================================

Clinical images
=========================================================================

Schematic of intraoperative lymphatic mapping and sentinel node

Intraoperative left axillary node
seen after uptake with blue dye

Micro images
=========================================================================

D2-40+ lymphatic in tumor


Metastatic tumor by RT-PCR, H&E, S100, HMB45

Nevus cells and melanoma cells (S100)

HMB45

Tattoo pigment (not tumor)


Increased 11q13 (cyclin D1) by FISH

Positive stains
=========================================================================

Molecular description
=========================================================================

Videos
=========================================================================

Differential diagnosis
=========================================================================




Miscellaneous
Staging of melanomas

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 8 June 2013, last major update May 2013
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

Staging
=========================================================================

Prior staging systems
=========================================================================

Primary tumor (T)
=========================================================================

Regional lymph nodes (N)
=========================================================================

Distant Metastases (M)
=========================================================================

Clinical stage grouping
=========================================================================

0:TisN0M0
IA:T1aN0M0
IB:T1b / T2aN0M0
IIA:T2b / T3aN0M0
IIB:T3b / T4aN0M0
IIC:T4bN0M0
III:any TN1-3M0
IV:any Tany NM1

Pathologic stage grouping
=========================================================================

0:TisN0M0
IA:T1aN0M0
IB:T1b / T2aN0M0
IIA:T2b / T3aN0M0
IIB:T3b / T4aN0M0
IIC:T4bN0M0
IIIA:T1-4aN1a / N2aM0
IIIB:T1-4bN1a / N2aM0or T1-4a N1b / N2b / N2c M0
IIIC:T1-4bN1b / N2b / N2cM0or any T N3 M0
IV:any Tany NM1
End of Skin-melanocytic tumor > Superpage


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