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M.D. Smoller - Epidermal Cell Tumors: The Basics

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M.D. Smoller Epidermal Cell Tumors: The Basics

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Epidermal Cell Tumors: The Basics will serve as an effective and efficient handbook for the student of dermatopathology, and as a practical bench reference for the practicing diagnostician who desires rapid access to criteria that are useful in differentiating histologically similar entities. The reader will be able to focus upon a single histologic observation, i.e., inflammatory conditions without epidermal changes, and use this as a starting point from which to build a differential diagnosis based upon pattern recognition. As each entity is addressed, there will be a concise discussion of the basic clinical findings and epidemiologic associations. This will be followed by a histologic description, highlighting areas that serve to discriminate between the entity under discussion and similar ones. Any immunologic studies that might augment the diagnostic sensitivity or specificity will be discussed.The chapters are thematically based and consist of essential bullet points arranged in organized outlines allowing for easy access and direct comparison between entities. The salient histologic features are depicted with abundant high quality, full-color photomicrographs placed immediately adjacent to the appropriate histologic bullet points. This volume will serve as an effective and efficient handbook for the student of dermatopathology, and as a practical bench reference for the practicing diagnostician who desires rapid access to criteria that are useful in differentiating histologically similar entities. The elaborate pictorial documentation will also enable the book to serve as an atlas of the commonest dermatologic disorders.

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Bruce R. Smoller and Kim M. Hiatt Epidermal Cell Tumors: The Basics 10.1007/978-1-4419-7704-5_1 Springer Science+Business Media, LLC 2011
1. Benign Melanocytic Proliferations
Bruce R. Smoller 1 and Kim M. Hiatt 1
(1)
Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
Abstract
Benign melanocytic proliferations
Also known as melanocytic nevi, moles
Nevus means hamartoma and is likely a misnomer and nevi have been shown to be true clonal proliferations
Present at birth, but most arise during adolescence or early adulthood
Only rarely arise later in life (after age 40)
Present in vast majority of Caucasians, also present in other racial groups
  • Benign melanocytic proliferations
    • Also known as melanocytic nevi, moles
      • Nevus means hamartoma and is likely a misnomer and nevi have been shown to be true clonal proliferations
    • Present at birth, but most arise during adolescence or early adulthood
    • Only rarely arise later in life (after age 40)
    • Present in vast majority of Caucasians, also present in other racial groups
    • Potential for malignant transformation is less than 1/100,000 in acquired melanocytic nevi
  • Benign melanocytic proliferations (see Table )
    Table 1.1
    Benign melanocytic proliferations
    Common acquired melanocytic nevus
    Congenital melanocytic nevus
    Halo nevus
    Nevus of special sites (acral, genital)
    Combined nevus
    Balloon cell nevus
    Volume III,
    Spindle and epithelioid cell (Spitz) nevus
    Volume III,
    Blue nevus
    Volume II, Chapter 12
  • Common melanocytic nevus
  • Proposed life cycle for melanocytic proliferations (including common acquired, congenital, dysplastic or atypical, Spitz, acral)
    • Clinical
      • Junctional nevus flat, deeply pigmented lesions with sharp edges, usually oval or circular
      • Compound nevus raised above surface of skin, retain pigmentation
      • Intradermal nevus nodular to polypoid, lose pigment (skin-colored)
    • Histologic
      • Junctional nevus proliferation of melanocytes confined to the epidermis, largely nested along basement membrane (Figs. )
      • Compound nevus some melanocytes drop into dermis and some remain in the epidermis (Fig. )
      • Intradermal nevus intraepidermal component of melanocytic proliferation is absent; all residual melanocytes are within dermis (Fig. )
      Fig 11 Junctional melanocytic nevus with nests of melanocytes confined to the - photo 1
      Fig. 1.1
      Junctional melanocytic nevus with nests of melanocytes confined to the base of rete ridges. Original magnification 40
      Fig 12 Junctional melanocytic nevus demonstrates small nests of melanocytes - photo 2
      Fig. 1.2
      Junctional melanocytic nevus demonstrates small nests of melanocytes that can be differentiated from keratinocytes based upon morphologic features. Original magnification 200
      Fig 13 Compound melanocytic nevus has nests of nevus cells within the - photo 3
      Fig. 1.3
      Compound melanocytic nevus has nests of nevus cells within the epidermis as well as within the dermis. Original magnification 100
      Fig 14 Intradermal nevus demonstrates nests of melanocytes restricted to the - photo 4
      Fig. 1.4
      Intradermal nevus demonstrates nests of melanocytes restricted to the dermis with no epidermal involvement. Original magnification 100
  • Acquired melanocytic nevus
    • Histologic
      • Junctional component should be almost entirely nested and sharply circumscribed
      • Proliferation of single melanocytes is uncommon
      • Pagetoid cells may occur secondary to trauma, in childhood, and in acral sites, but should not be abundant
      • Pagetoid single or nested melanocytes located above the basal layer of the epidermis
        • Presence implies loss of connection to basement membrane (through either trauma or deranged cellular substructure)
      • Maturation in dermis (Fig. )
        • Nevus cells become smaller and darker
          • Abundant cytoplasm and vesicular nuclei in papillary dermis
          • Minimal cytoplasm, small, dark nuclei at base
        • Nests become smaller and eventuate in single melanocytes traversing between dermal collagen bundles
        • Orderly maturation sequence is the rule absence raises possibility of melanoma
      • Dermal mitoses rare should never be at base of lesion
    Fig 15 Maturation is a feature of benign melanocytic proliferations The - photo 5
    Fig. 1.5
    Maturation is a feature of benign melanocytic proliferations. The melanocytes become smaller and darker and the nests become smaller and more widely dispersed with progressive descent into the dermis. Pigmentation also tends to diminish with progressive descent. Original magnification 100
  • Congenital melanocytic nevus
    • Clinical
      • Present in about 1% of newborns
      • Often larger than acquired nevi
      • May be hair-bearing
      • So-called giant congenital nevi (>20 cm) often have a bathing suit distribution
      • Incidence of developing melanoma
        • Minimally increased in small congenital nevi
        • May be as much as 10% in giant nevi
    • Histologic (Figs. )
      • Can be junctional, compound, or intradermal
      • Abundant single melanocytes within epidermis in some congenital nevi in children
      • Nevus nests extend into lower third of reticular dermis or into subcutis
      • Nevus nests track down appendages
      • Nevus nests often have a superficial perivascular dermatitis appearance at low magnification
      • Scattered Pagetoid cells may be present in the central portion of congenital nevi, especially during the first year of life
      • Pseudovascular spaces are often present and are due to dyscohesion of melanocytes within dermal nests (Fig. )
      • Neurotization is commonly seen and is believed to be part of the maturation process (Fig. )
    Fig 16 Congenital nevi are characterized by dense clusters of melanocytes - photo 6
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