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[[Image:Blue nevus - intermed mag.jpg|thumb|right|A melanocytic lesion ([[blue nevus]]). [[H&E stain]]. (WC/Nephron)]] | |||
'''Melanocytic lesions''' are commonly encountered in [[dermatopathology]] and an area which causes some difficulty, i.e. it is hard to decide in some cases whether a lesion is benign (e.g. [[Spitz nevus]]) or malignant ([[malignant melanoma]]). | '''Melanocytic lesions''' are commonly encountered in [[dermatopathology]] and an area which causes some difficulty, i.e. it is hard to decide in some cases whether a lesion is benign (e.g. [[Spitz nevus]]) or malignant ([[malignant melanoma]]). | ||
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=Lentiginous melanocytic lesions= | =Lentiginous melanocytic lesions= | ||
==Lentigo simplex== | ==Lentigo simplex== | ||
{{Main|Lentigo simplex}} | |||
==Solar lentigo== | ==Solar lentigo== | ||
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**Classically at the tips of the rete ridges. | **Classically at the tips of the rete ridges. | ||
*No (melanocyte) nuclear atypia. | *No (melanocyte) nuclear atypia. | ||
*Solar damage ([[solar elastosis]]).<ref name=pmid19536147/> | *Solar damage ([[solar elastosis]]).<ref name=pmid19536147>{{Cite journal | last1 = Hafner | first1 = C. | last2 = Stoehr | first2 = R. | last3 = van Oers | first3 = JM. | last4 = Zwarthoff | first4 = EC. | last5 = Hofstaedter | first5 = F. | last6 = Klein | first6 = C. | last7 = Landthaler | first7 = M. | last8 = Hartmann | first8 = A. | last9 = Vogt | first9 = T. | title = The absence of BRAF, FGFR3, and PIK3CA mutations differentiates lentigo simplex from melanocytic nevus and solar lentigo. | journal = J Invest Dermatol | volume = 129 | issue = 11 | pages = 2730-5 | month = Nov | year = 2009 | doi = 10.1038/jid.2009.146 | PMID = 19536147 }}</ref> | ||
Notes: | Notes: | ||
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*[[Lichen planus-like keratosis]]. | *[[Lichen planus-like keratosis]]. | ||
*Pigmented [[seborrheic keratosis]]. | *Pigmented [[seborrheic keratosis]]. | ||
*[[Ephelis]] (freckle). | |||
Images | ====Images==== | ||
<gallery> | |||
Image:Skin_tumors_181.jpg | Solar lentigo. (WC) | |||
</gallery> | |||
*[http://www.dermaamin.com/site/images/histo-pic/a/actinic-lentigo/actinic-lentigo1.jpg Solar lentigo (dermammin.com)].<ref name=dermammin_sl>URL: [http://www.dermaamin.com/site/histopathology-of-the-skin/53-a/1555-actinic-lentigo-.html http://www.dermaamin.com/site/histopathology-of-the-skin/53-a/1555-actinic-lentigo-.html]. Accessed on: 6 May 2013.</ref> | *[http://www.dermaamin.com/site/images/histo-pic/a/actinic-lentigo/actinic-lentigo1.jpg Solar lentigo (dermammin.com)].<ref name=dermammin_sl>URL: [http://www.dermaamin.com/site/histopathology-of-the-skin/53-a/1555-actinic-lentigo-.html http://www.dermaamin.com/site/histopathology-of-the-skin/53-a/1555-actinic-lentigo-.html]. Accessed on: 6 May 2013.</ref> | ||
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*[[AKA]] ''intradermal melanocytic nevus''. | *[[AKA]] ''intradermal melanocytic nevus''. | ||
*[[AKA]] ''intradermal nevus'', abbreviated ''IDN''.<ref name=pmid11493376>{{Cite journal | last1 = Fullen | first1 = DR. | last2 = Reed | first2 = JA. | last3 = Finnerty | first3 = B. | last4 = McNutt | first4 = NS. | title = S100A6 preferentially labels type C nevus cells and nevic corpuscles: additional support for Schwannian differentiation of intradermal nevi. | journal = J Cutan Pathol | volume = 28 | issue = 8 | pages = 393-9 | month = Sep | year = 2001 | doi = | PMID = 11493376 }}</ref> | *[[AKA]] ''intradermal nevus'', abbreviated ''IDN''.<ref name=pmid11493376>{{Cite journal | last1 = Fullen | first1 = DR. | last2 = Reed | first2 = JA. | last3 = Finnerty | first3 = B. | last4 = McNutt | first4 = NS. | title = S100A6 preferentially labels type C nevus cells and nevic corpuscles: additional support for Schwannian differentiation of intradermal nevi. | journal = J Cutan Pathol | volume = 28 | issue = 8 | pages = 393-9 | month = Sep | year = 2001 | doi = | PMID = 11493376 }}</ref> | ||
{{Main|Intradermal nevus}} | |||
===Sign out=== | ===Sign out=== | ||
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====Compound melanocytic nevus==== | ====Compound melanocytic nevus==== | ||
{{Main|Compound nevus}} | |||
====Intradermal melanocytic nevus==== | ====Intradermal melanocytic nevus==== | ||
{{Main|Intradermal nevus}} | |||
==Congenital-pattern nevus== | ==Congenital-pattern nevus== | ||
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==Spitz nevus== | ==Spitz nevus== | ||
*[[AKA]] ''epithelioid and spindle | *[[AKA]] ''epithelioid and spindle cell nevus''. | ||
{{Main|Spitz nevus}} | {{Main|Spitz nevus}} | ||
==Acral nevus== | ==Acral nevus== | ||
*[[AKA]] ''melanocytic nevus with intraepidermal ascent of cells'' (MANIAC). | *[[AKA]] ''melanocytic nevus with intraepidermal ascent of cells'' ([[MANIAC]]). | ||
*[[AKA]] ''volar nevus''. | *[[AKA]] ''volar nevus''. | ||
{{Main|Acral nevus}} | |||
==Dysplastic melanocytic nevus== | ==Dysplastic melanocytic nevus== | ||
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**Should stain approximally the same number of cells as Melan A. | **Should stain approximally the same number of cells as Melan A. | ||
*Ki-67 -- only rare cells. | *Ki-67 -- only rare cells. | ||
==Nodal nevus== | |||
*AKA ''nevus in lymph node'' and ''benign nevus cells in lymph node''. | |||
{{Main|Nodal nevus}} | |||
=Miscellaneous= | =Miscellaneous= | ||
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DDx: | DDx: | ||
*[[Malignant melanoma]] - mitotic figures, necrosis, cytologic atypia, asymmetry ( | *[[Malignant melanoma]] - often lacks a Grenz zone (lesion in papillary dermis),<ref name=pmid16446716/> mitotic figures, [[necrosis]], cytologic atypia, asymmetry (architecture, pigment). | ||
*Atypical blue nevus - have some of the features of melanoma. | *Atypical blue nevus - have some of the features of melanoma. | ||
*[[Clear cell sarcoma]]. | *[[Clear cell sarcoma]]. | ||
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www: | www: | ||
*[http://www.dermatopathonline.com/blue%20nevus2.html Several types of blue nevi (dermatopathonline.com)]. | *[http://www.dermatopathonline.com/blue%20nevus2.html Several types of blue nevi (dermatopathonline.com)]. | ||
*[http://www.nature.com/modpathol/journal/v19/n2s/fig_tab/3800516f25.html#figure-title Melanoma that looks a bit like a blue nevus (nature.com)].<ref name=pmid16446716>{{Cite journal | last1 = Magro | first1 = CM. | last2 = Crowson | first2 = AN. | last3 = Mihm | first3 = MC. | title = Unusual variants of malignant melanoma. | journal = Mod Pathol | volume = 19 Suppl 2 | issue = | pages = S41-70 | month = Feb | year = 2006 | doi = 10.1038/modpathol.3800516 | PMID = 16446716 }}</ref> | |||
====Variants of blue nevus==== | ====Variants of blue nevus==== | ||
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The sections show pigmented spindle cells in the dermis between collagen bundles. The spindle cells show no nuclear atypia and no mitotic activity is appreciated. | The sections show pigmented spindle cells in the dermis between collagen bundles. The spindle cells show no nuclear atypia and no mitotic activity is appreciated. | ||
The lesion does not extend into the epidermis. There are no melanocyte nests. There is no significant inflammation. The lesion is completely excised. | The lesion does not extend into the epidermis and is separated from it by a Grenz zone. There are no melanocyte nests. There is no significant inflammation. The lesion is completely excised. | ||
The pigmented cells are negative on the Prussian blue stain. | The pigmented cells are negative on the Prussian blue stain. | ||
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*[[Cytopathology]]. | *[[Cytopathology]]. | ||
*[[Non-malignant skin disease]]. | *[[Non-malignant skin disease]]. | ||
*[[Pigmented lesions of the oral cavity]]. | |||
*[[Melanosis coli]]. | |||
*[[Small bowel pseudomelanosis]]. | |||
=References= | =References= |
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