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Post by Mike Inskip on Dec 30, 2015 0:53:59 GMT -5
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Post by Mike Inskip on Dec 30, 2015 0:57:03 GMT -5
I excised the central pink nodular area of this lesion last week and have just got back the following provisional histology report.
8mm punch excision nodule arising in centre of lentiginous lesion
posterior crown ?SCC ?melanoma.
SPECIMEN:
Posterior crown: An 8mm punch of skin 5mm deep with an eccentric pale
papule 5x3mm. Trisected transversely and all processed. One block.
MICROSCOPY:
The specimen is significant for a proliferation of rare markedly
atypical appearing epithelioid cells along the dermal-epidermal junction
with an underlying proliferation of atypical spindle cells in the
dermis. The dermal cells are pleomorphic and mitotically active.
CONCLUSION: Posterior crown, punch excision: Malignant spindle cell
neoplasm. Deeper levels and stains are pending to better characterize
this lesion; a supplementary report will follow.
I'm pretty sure I know what this lesion is.
Would anyone else like to comment ?
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Post by Roman Bronfenbrener on Dec 30, 2015 7:27:30 GMT -5
no problem Mike, I moved it. When you upload photos, it can take a few seconds for the photo to upload and paste into your thread... let me know if it becomes a repetitive issue!
As for this patient, I think its a desmoplastic MM with overlying lentigo maligna!
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Post by Mike Inskip on Dec 30, 2015 19:56:26 GMT -5
.......and that's what it was reported yesterday.
MICROSCOPY:
The specimen is significant for a proliferation of atypical appearing
epithelioid melanocytes along the dermal-epidermal junction with dermal
invasion. The dermal melanocytes are spindled appearing, pleomorphic and
mitotically active. The surrounding dermal stroma is fibrotic appearing.
The melanocytes stain strongly with S100 and focally with Melan-A. The
findings warrant a diagnosis of malignant melanoma.
MELANOMA SYNOPTIC CONCLUSION:
Site: Posterior crown
Specimen type: punch excision
Malignant melanoma of desmoplastic type.
Predominant cell type: Spindled
Breslow Thickness 2.7mm
Clark Level: V
Growth Phase: Vertical
Ulceration: Non Brisk.
Mitotic index: 6 per mm sq.
Lymphovascular invasion: Not identified.
Perineural invasion: Present.
Satellitosis: Not identified.
Regression: Not identified.
Inflammatory host response: Not identified.
Pre-existing naevus: Not identified.
Clearance: The lesion extends to both lateral margin and abuts the base
of the specimen.
Not sure if this is a desmoplastic melanoma arising from a lentigo maligna or whether the whole thing is desmoplastic melanoma.
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Post by Mike Inskip on Dec 31, 2015 19:40:43 GMT -5
This paper describes the dermoscopy of desmoplastic melanoma.
Jaimes N, Chen L, Dusza SW, Carrera C, Puig S, Thomas L, Kelly JW, Dang L, Zalaudek I, Braun RP, Menzies SW, Busam K, Marghoob AA.
Clinical and dermoscopic characteristics of desmoplastic melanomas.
JAMA Dermatol. 2013 Apr;149(4):413-21. doi: 10.1001/jamadermatol.2013.2248.
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Post by Mike Inskip on Dec 31, 2015 19:44:38 GMT -5
The conclusion was that the ' most common dermoscopic clues observed in desmoplastic melanomas were atypical vascular structures & peppering.
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