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Difference between revisions of "Melanocytic lesions"
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→Overview: re-arr table
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{| class="wikitable" | {| class="wikitable" | ||
| '''Name''' | | '''Name''' | ||
| '''Key feature''' | |||
| '''Microscopic''' | |||
| '''Clinical''' | | '''Clinical''' | ||
| '''Gross''' | | '''Gross''' | ||
| '''Image''' | | '''Image''' | ||
| '''Ref.''' | |||
|- | |- | ||
| Lentigo simplex | | Lentigo simplex | ||
| no nests, epidermis only | |||
| slender rete with melanocytes; no nests of melanocytes; no dermal melanocytes | |||
| < 40 years | | < 40 years | ||
| small flat pigmented lesion | | small flat pigmented lesion | ||
| | | | ||
| <ref name=Ref_WMSP498>{{Ref WMSP|498}}</ref> | | <ref name=Ref_WMSP498>{{Ref WMSP|498}}</ref> | ||
|- | |- | ||
| Junctional melanocytic nevus | | Junctional melanocytic nevus | ||
| nests in epidermis | |||
| nests of melanocytes at tips of rete, no dermal melanocytes | |||
| usu. sun exposed skin, unusual in >50 years | | usu. sun exposed skin, unusual in >50 years | ||
| small flat (uniformly) pigmented lesion | | small flat (uniformly) pigmented lesion | ||
| | | | ||
| <ref name=Ref_WMSP498>{{Ref WMSP|498}}</ref> | | <ref name=Ref_WMSP498>{{Ref WMSP|498}}</ref> | ||
|- | |- | ||
| Compound melanocytic nevus | | Compound melanocytic nevus | ||
| benign nests in dermis & epidermis | |||
| nests of melanocytes at tips of rete and in dermis; dermal melanocytes lack nucleoli, lack mitoses and "mature with depth" -- see ''Note 1''. | |||
| | | | ||
| small slightly raised (uniformily) pigmented lesion | | small slightly raised (uniformily) pigmented lesion | ||
| | | | ||
| <ref name=Ref_WMSP499>{{Ref WMSP|499}}</ref> | | <ref name=Ref_WMSP499>{{Ref WMSP|499}}</ref> | ||
|- | |- | ||
| Intradermal melanocytic nevus | | Intradermal melanocytic nevus | ||
| nested & individual melanocytes - only in dermis | |||
| nested & individual melanocytes - only in dermis, +/- multinucleation, +/-pseudovascular spaces | |||
| Clinical DDx: [[fibroepithelial polyp]] (skin tag), [[basal cell carcinoma]] | | Clinical DDx: [[fibroepithelial polyp]] (skin tag), [[basal cell carcinoma]] | ||
| raised, non-pigmented lesion | | raised, non-pigmented lesion | ||
| | | | ||
| <ref name=Ref_WMSP499>{{Ref WMSP|499}}</ref> | | <ref name=Ref_WMSP499>{{Ref WMSP|499}}</ref> | ||
|- | |- | ||
| Spitz nevus (epithelioid and spindle-cell nevus) | | Spitz nevus (epithelioid and spindle-cell nevus) | ||
| long axis of nests perpendicular to surface | |||
| spindled, epithelioid or mixed melanocytes, long axis of nests perpendicular to surface, superficial mitoses common | |||
| Children & adolescents | | Children & adolescents | ||
| usu. non-pigmented | | usu. non-pigmented | ||
| [http://www.drmihm.com/cases/casefigure.cfm?figID=931&CaseID=51 Spitz nevus (drmihm.com)] | | [http://www.drmihm.com/cases/casefigure.cfm?figID=931&CaseID=51 Spitz nevus (drmihm.com)] | ||
| <ref name=Ref_WMSP499>{{Ref WMSP|499}}</ref> | | <ref name=Ref_WMSP499>{{Ref WMSP|499}}</ref> | ||
|- | |- | ||
| Pigmented spindle cell nevus of Reed (AKA Pigmented spindle cell nevus) | | Pigmented spindle cell nevus of Reed (AKA Pigmented spindle cell nevus) | ||
| nests of heavily pigmented spindle cells | |||
| heavily pigmented spindle cells in epidermis & dermis, form "basketweave" pattern, nests (???) | |||
| women in teens & 20s; location: shoulder, pelvic girdle region | | women in teens & 20s; location: shoulder, pelvic girdle region | ||
| Pigmented +++, small size | | Pigmented +++, small size | ||
| [http://commons.wikimedia.org/wiki/File:Pigmented_spindle_cell_nevus_-_low_mag.jpg Reed nevus - low mag. (WC)], [http://commons.wikimedia.org/wiki/File:Pigmented_spindle_cell_nevus_-_2_-_intermed_mag.jpg Reed nevus - intermed. mag. (WC)], [http://www.histopathology-india.net/Reed.htm Reed nevus - collection (histopathology-india.net)] | | [http://commons.wikimedia.org/wiki/File:Pigmented_spindle_cell_nevus_-_low_mag.jpg Reed nevus - low mag. (WC)], [http://commons.wikimedia.org/wiki/File:Pigmented_spindle_cell_nevus_-_2_-_intermed_mag.jpg Reed nevus - intermed. mag. (WC)], [http://www.histopathology-india.net/Reed.htm Reed nevus - collection (histopathology-india.net)] | ||
| <ref name=Ref_WMSP500>{{Ref WMSP|500}}</ref> | | <ref name=Ref_WMSP500>{{Ref WMSP|500}}</ref> | ||
|- | |- | ||
| Blue nevus | | Blue nevus | ||
| lentil-shaped (ovoid) nests btw collagen bundles | |||
| dermal lentil-shaped nests, mix of spindle or dendritic or epithelioid cell morphology, nests btw collagen | |||
| usu. head & neck or extremities; clinically confused with melanoma<ref name=Ref_PCPBoD8_592>{{Ref PCPBoD8|592}}</ref> | | usu. head & neck or extremities; clinically confused with melanoma<ref name=Ref_PCPBoD8_592>{{Ref PCPBoD8|592}}</ref> | ||
| blue flat or slightly raised lesion | | blue flat or slightly raised lesion | ||
| [http://commons.wikimedia.org/wiki/File:Blue_nevus_%281_of_4%29.jpg Blue nevus (WC)], [http://commons.wikimedia.org/wiki/File:Blue_nevus_-_very_low_mag.jpg Blue nevus - very low mag. (WC)], [http://commons.wikimedia.org/wiki/File:Blue_nevus_-_intermed_mag.jpg Blue nevus - intermed. mag. (WC)] | | [http://commons.wikimedia.org/wiki/File:Blue_nevus_%281_of_4%29.jpg Blue nevus (WC)], [http://commons.wikimedia.org/wiki/File:Blue_nevus_-_very_low_mag.jpg Blue nevus - very low mag. (WC)], [http://commons.wikimedia.org/wiki/File:Blue_nevus_-_intermed_mag.jpg Blue nevus - intermed. mag. (WC)] | ||
| <ref name=Ref_WMSP501>{{Ref WMSP|501}}</ref> | | <ref name=Ref_WMSP501>{{Ref WMSP|501}}</ref> | ||
|- | |- | ||
| Cellular blue nevus | | Cellular blue nevus | ||
| dermal lesion with pigmented spindle cells & epithelioid cells | |||
| deep dermis; cells lack nucleoli; biphasic: (1) epithelioid cells with pale cytoplasm, (2) pigmented spindle cells +/- melanophages | |||
| congenital or acquired; usu. scalp or butt | | congenital or acquired; usu. scalp or butt | ||
| blue flat or raised lesion | | blue flat or raised lesion | ||
| | | | ||
| <ref name=Ref_WMSP501>{{Ref WMSP|501}}</ref> | | <ref name=Ref_WMSP501>{{Ref WMSP|501}}</ref> | ||
|- | |- | ||
| Congenital-pattern nevi | | Congenital-pattern nevi | ||
| growth along dermal structures | |||
| extend along dermal structures (e.g. nerves, hair shafts, ducts); lacks atypia; +/-mitoses | |||
| congenital or acquired; large ones increased melanoma risk<ref name=Ref_PBoD8_1170>{{Ref PBoD8|1170}}</ref> | | congenital or acquired; large ones increased melanoma risk<ref name=Ref_PBoD8_1170>{{Ref PBoD8|1170}}</ref> | ||
| small, intermediate (2-20 cm) or large | | small, intermediate (2-20 cm) or large | ||
| | | | ||
| <ref name=Ref_WMSP501>{{Ref WMSP|501}}</ref> | | <ref name=Ref_WMSP501>{{Ref WMSP|501}}</ref> | ||
|- | |- | ||
| Dysplastic nevus (Clark's nevus) | | Dysplastic nevus (Clark's nevus) | ||
| melanocyte bridges, lamellar fibrosis | |||
| melanocytes "bridges" btw sides of rete, "lamellar fibrosis" (collagen deep to epidermis), mod. atypia | |||
| may be familial - precursor to melanoma | | may be familial - precursor to melanoma | ||
| may have asymmetry in shape or pigmentation | | may have asymmetry in shape or pigmentation | ||
| | | | ||
| <ref name=Ref_WMSP502>{{Ref WMSP|502}}</ref> | | <ref name=Ref_WMSP502>{{Ref WMSP|502}}</ref> | ||
|- | |- | ||
| Halo nevus | | Halo nevus | ||
| lymphocytes +++ | |||
| lymphocytes at perimeter of melanocytic; epidermal melanocytes not nested; may be dermal, epidermal or both | |||
| central zone of pigment | | central zone of pigment | ||
| | | | ||
| | | | ||
| <ref name=Ref_WMSP502>{{Ref WMSP|502}}</ref> | | <ref name=Ref_WMSP502>{{Ref WMSP|502}}</ref> | ||