Case Number : Case 2385 - 20 August 2019 Posted By: Uma Sundram

Sebaceous carcinoma?

last picture appear to show vascular invasion. Malignant melanoma

Nodular malignant melanoma

Nodular melanoma

Nodular melanoma, with angio-lymphatic growth ( fig 4,5,6 ).

Yes. In figure 4, do you all think this is a microsatellite lesion?

In Fig 5 as well.

I think there is an intralymphatic infiltration, but not sure for microsatellitosis...not far enough!

If it's separated by "normal demis" it's is a microsatelite. Most microsatelites are intra-lymphatic.

I'd say suspicious for a microsatelite in this case. It's of major importance as it is classified as pN2c. From the practical point of view the re-excision should be examined carefully by serial TS (normally we only embed one central block from re-exicisons) and the pathologist warned to look carefully for possible microsatelites.

We did call this a microsatellite; several dermatopathologists had this opinion. I have not seen one this subtle so wanted to share it with all of you. There are also intralymphatic foci, as pointed out by vincenzo. As pointed out by Richard, this is of major staging importance and I think, easily missed on a biopsy by a busy pathologist. The surgeons plan their surgery differently based on this information.