dr richard a. carr, warwick hospital
DESCRIPTION
Case 205. F40. Lonstanding pigmented lesion. Enlarged last 6/12. Punch Bx by GP ?SSMM. Dr Richard A. Carr, Warwick Hospital. Summary: N=53. Benign: 24 Spitz n: 18 + 1 SPARK DN: 4 CN: 1 Uncertain Favour Benign: 6* 1 Spitz n. 1 SPARK 4 unclassified - PowerPoint PPT PresentationTRANSCRIPT
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Dr Richard A. Carr, Warwick Hospital
Case 205. F40. Lonstanding pigmented lesion. Enlarged last 6/12. Punch Bx by GP ?SSMM
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Summary: N=53• Benign: 24
– Spitz n: 18 + 1 SPARK
– DN: 4
– CN: 1
• Uncertain Favour Benign: 6*– 1 Spitz n. 1 SPARK
– 4 unclassified
• Uncertain Favour Malignant: 1– 1 Spitz n.!
• Malignant 23– SSMM: 19; LMM: 2: Spitzoid: 2
* Includes some cases marked benign!
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ParametersSUBTYPES• SSMM: 19; LMM 2: Spitzoid: 2• Clark level
I II III IV V
2 16 5 2 0• Breslow: 0.3 to 0.6 (Mean: 0.39; Median 0.4)• VGP: 15 RGP: 8• Regression: Yes: 12 No: 12• Mitoses: Absent: 20: Low: 2: High: 0
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EQA Participants - 1• I favour an (almost entirely) junctional Spitz
nevus• I think dysplastic compound naevus but
with some superficial dermal nests with atypical melanocytes. ?enough cytological atypia for SSMM. Need levels + sections of whole lesion
• severely dysplastic naevus with probable regression less than 1mm in depth
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EQA Participants• melanoma in situ with regression
• Severely dysplastic naevus
• it looks like a regressing Spitz naevus - Kamino bodies, ly infiltrate vascularity and focal fibrosis
• asymmetrical - irregular architecture. Atypical spitz I think
• Although only one nest in the dermis it is larger than the epidermal nest and hence favour vertical growth phase melanoma.
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EQA Participants• Lots of Kamino bodies. Epithelioid
melanocytes. Compound. Some atypia but has history of punch biopsy. I think this is a Spitz naevus that has been previously traumatised by the punch biopsy.
• Difficult case- assymetrical lesion , cytological atypia more than expected for site specific naevi
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EQA Participants• Some Kamino bodies and spitzoid nests
but variation in nuclear atypia and features of dermal regression which is diffuse rather than focal.
• I think this is a compound DYSPLASTIC NAEVUS but would like to see more levels in view of history and previous biopsy
• I can't see the punch bx site
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EQA Participants• Fairly symmetrical lesion with numerous
Kamino bodies. Limited dermal component with no mitotic figures.
• Has rather spizoid look. Unsure whether there is true dysplasia
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Slide Club “Experts”
• Spitz & Clark’s dysplastic naevus (SPARK) x1
• Spitz naevus x1
• Spitzoid lesion, mostly junctional but with a small intradermal element. Given the age of the patient we tend to call these atypical: Atypical Spitz x1