Case Number : Case 440 Posted By: Guest

[b]Phillip McKee - Overseas Consultations (Cave Creek, Arizona, USA) Wrote:[/b]

The diagnosis of nested in situ melanoma is based upon the poor circumscription, asymmetry, large size of the junctional nests which are composed of cells the majority of which show severe cytological atypia with prominent large nucleoli. The fact that most of the cells are affected is the main clue to the diagnosis. In contrast for example, in a dysplastic nevus the cytological atypia is random. Some cells are affected but many are not. Nevi at special sites certainly have large nests but they are often vertically orientated and typically heavily pigmented. Cytological atypia may be severe but as with dysplastic nevus it is random affecting cells here and there rather than the vast majority of cells. Nested in situ melanoma is very rare but I have seen examples very similar to this one associated with an invasive vertical growth phase melanoma. It is important to recognise this variant.

[size=2]Submitted on 19/02/2012 00:51[/size]
[b]Izzat Abdul-kadir - ST2 - York Hospital (UK) Wrote:[/b]

I must ask, why is this a melanoma? Granted, it's asymmetrical; however, Ackerman has been criticised for emphasising the symmetry criterion. It's small. There is polychromasia, but I wouldn't say polymorphism. Even those who thought there was atypia didn't go beyond a dysplastic naevus. Professor McKee's comments would be greatly appreciated. Thanks.

[size=2]Submitted on 16/02/2012 20:32[/size]
[b]Iskander H Chaudhry - Central Manchester NHS Trust (United Kingdom) Wrote:[/b]

Dear All - the diagnosis is going to surprise you and will require qualification by Prof McKee (I have sent him an email but he is away this week) ... it is ... In situ (nested) melanoma. Now I appreciate that there is cytological atypia (and some architectural atypia) but this requires an expert opinion ... I welcome your thoughts!

[size=2]Submitted on 16/02/2012 16:19[/size]
[b]Hazem Hamed - Department of Histopathology, Imperial College (London) Wrote:[/b]

Junctional melanocytic nevus with mild architectural atypia.

[size=2]Submitted on 15/02/2012 20:53[/size]
[b]Francisco Vílchez - Department of Dermatology. Clinical Universitary Hospital (Málaga (Spain)) Wrote:[/b]

Junctional nevus

[size=2]Submitted on 15/02/2012 16:35[/size]
[b]Sasi Attili - (United Kingdom) Wrote:[/b]

Not sure if thigh really qualifies as a special site. But the cells are epitheliod and there is a retraction artefact and therefore I would favour Junctional Spitz rather than dysplasia

[size=2]Submitted on 15/02/2012 15:29[/size]
[b]Eman El-Nabarawy - Cairo University (Egypt) Wrote:[/b]

Junctional nevus of special anatomic site.

[size=2]Submitted on 15/02/2012 14:12[/size]
[b]Marcela Saeb Lima - INCMNSZ (Mexico City) Wrote:[/b]

junctional flexural type nevus

[size=2]Submitted on 15/02/2012 12:16[/size]
[b]Marwa Fawzy - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:[/b]

Junctional dysplastic nevus

[size=2]Submitted on 15/02/2012 12:10[/size]
[b]Mona Abdel Halim - Dermatology Dept. Cairo Univ. (Egypt) Wrote:[/b]

I thought of a dysplastic nevus but could not find a lentiginous component? Is it an essential feature for it's diagnosis or not?

[size=2]Submitted on 15/02/2012 11:04[/size]
[b]ANDREW DANCKWERTS - WITS UNIVERSITY, JOHANNESBURG (JOHANNESBURG, RSA) Wrote:[/b]

SORRY, TYPOGRAPHICAL ERROR: JUNCTIONAL DYSPLASTIC NEVUS.

[size=2]Submitted on 15/02/2012 10:55[/size]
[b]ANDREW DANCKWERTS - WITS UNIVERSITY, JOHANNESBURG (JOHANNESBURG, RSA) Wrote:[/b]

JUNCTIONAL NEVOCELLULAR PROLIFERATION WITH FEATURES OF ASSYMMETRY, RANDOM CYTOLOGICAL ATYPIA, ARCHITECTURAL DISTORTION AND ADJACENT FIBROLAMELLAR HYPERPLASIA. IN VIEW OF THIS, I FAVOUR A JUNCTIONAL DYSPLASTC NEVUS.

[size=2]Submitted on 15/02/2012 10:53[/size]
[b]Mona Abdel Halim - Dermatology Dept. Cairo Univ. (Egypyt) Wrote:[/b]

The lesion is circumscribed yet assymetrical, the nests are large, still they show cleavage (retraction artifacts), bridging, there is some cytological atypia, no pagetoid spread. Some spitzoid features. In view of the site, I was thinking of a junctional nevus of special anatomic site with spitzoid features.

[size=2]Submitted on 15/02/2012 10:44[/size]
[b]Izzat Abdul-kadir - ST2 - York Hospital (UK) Wrote:[/b]

Junctional epithelioid Spitz naevus.

[size=2]Submitted on 15/02/2012 10:18[/size]
[b]Yüksel Okumuş - Bursa State Hospital (Turkey) Wrote:[/b]

Spitz Nevus

[size=2]Submitted on 15/02/2012 10:13[/size]