Elder - Superficial Melanocytic Pathology

Consultant Pathology Series

David E. Elder, MB, ChB

Series Editor

T UMORIGENIC M ELANOCYTIC P ROLIFERATIONS

David E. Elder

B RAIN T UMORS

Richard Prayson, Bette Kleinschmidt-DeMasters, and Mark L. Cohen

H EAD AND N ECK P ATHOLOGY

Leon Barnes, Raja Seethala, and Simion Chiosea

L IVER P ATHOLOGY

Linda Ferrell and Sanjay Kakar

I NTRAOPERATIVE F ROZEN S ECTIONS

Pedram Argani and Ashley Cimino-Mathews

B REAST P ATHOLOGY

Melinda E. Sanders and Jean F. Simpson

S UPERFICIAL M ELANOCYTIC P ATHOLOGY

David E. Elder and Sook Jung Yun

Forthcoming Volume in the Series

S OFT T ISSUE T UMORS

John S. J. Brooks

VOLUME 7

Superficial Atypical Melanocytic Proliferations

David E. Elder, MB, ChB, FRCPA

Professor of Pathology and Laboratory Medicine

Hospital of the University of Pennsylvania

Philadelphia, PA

Sook Jung Yun, MD, PhD

Associate Professor of Dermatology

Chonnam National University Medical School

Gwangju, South Korea

Visit our website at www.demosmedical.com

ISBN: 9781620700235

e-book ISBN: 9781617051869

Acquisitions Editor: Rich Winters

Compositor: diacriTech

2015 Demos Medical Publishing, LLC. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

Medicine is an ever-changing science. Research and clinical experience are continually expanding our knowledge, in particular our understanding of proper treatment and drug therapy. The authors, editors, and publisher have made every effort to ensure that all information in this book is in accordance with the state of knowledge at the time of production of the book. Nevertheless, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the contents of the publication. Every reader should examine carefully the package inserts accompanying each drug and should carefully check whether the dosage schedules mentioned therein or the contraindications stated by the manufacturer differ from the statements made in this book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market.

Library of Congress Cataloging-in-Publication Data

Elder, David E., author.

Superficial melanocytic pathology: superficial atypical melanocytic proliferations / David E. Elder, Sook Jung Yun.

p.; cm.(Consultant pathology; volume 7)

Includes bibliographical references and index.

ISBN 978-1-62070-023-5ISBN 978-1-61705-186-9 (e-book)

I. Yun, Sook Jung, author. II. Title. III. Series: Consultant pathology series; 7.

[DNLM: 1. Skin Neoplasmspathology. 2. Melanomapathology. 3. Nevus, Pigmentedpathology. WR 500]

RC280.S5

616.99477dc23

2014027367

Printed in the United States of America by Bradford & Bigelow.

14 15 16 17 / 5 4 3 2 1

D iagnostic surgical pathology remains the gold standard for diagnosis of most tumors and many inflammatory conditions in most, if not all, organ systems. The power of the morphologic method is such that, in many instances, a glance at a thin section of tissue stained with two vegetable dyes is sufficient to determine with absolute certainty whether a patient should undergo a major procedure or not, or whether a patient is likely to live a healthy life or die of an inoperable tumor. In such cases, the diagnostic process is one of gestalt, a form of almost instantaneous pattern recognition that is similar to the recognition of faces, different brands of automobiles, or breeds of dogs. In other difficult cases, the diagnosis is not so obvious. In many of these cases, a diagnosis may be possible, but may be outside of the experience of the routine practitioner. In such a circumstance, it may be possible for a practitioner with more experiencea consultantto make a diagnosis rather readily. In other cases, the problem may really not be suited to the histologic method. In these cases as well, a consultant may be invaluable in determining that it is simply not possible to make a reliable diagnosis with the materials available. In yet other cases, the diagnosis may be ambiguous, and again a consultants opinion can be important in establishing a differential diagnosis that may guide clinical investigation.

There are many fine consultants available to the practicing surgical pathology community. Many of them have authored textbooks, and many of them give presentations at national meetings. However, these materials can offer only a superficial insight into the vast amount of knowledge that is embedded in these individuals cerebral corticesand in their filing cabinets. This series represents an effort to enable the dissemination of this hitherto-inaccessible knowledge to the wider community. Our authors are individuals who have accumulated large collections of difficult cases and are willing to share their material and their knowledge. The cases are based on actual consultations, and the indications for the consultation, when available, are presented, because these are the records of the manner in which these cases presented themselves as being problematic. We have asked the consultants, when possible, to present their consultation letters in much the same form (albeit edited to some degree) as that in which they were first presented, because these represent the true records of the clinical encounter. In addition, we asked the authors to amplify upon these descriptions, with brief reference to the literature, and to richly illustrate the case reports with high-quality digital images. We hope that every reader finds these books to be valuable for reference and for education.

David E. Elder, MB, ChB, FRCPA
Professor of Pathology and Laboratory Medicine
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania

T he common (and most of the uncommon) cutaneous neoplasms derived from skin melanocytes can be divided into two major categories (1). In the first category, there is proliferation of neoplastic melanocytes in the epidermis and similar cells may enter the papillary dermis, without having the capacity to proliferate there. In either case, a mass lesion is not formed in the dermis, and these lesions are termed nontumorigenic. In the second category, a mass is formed in the dermis, and the lesions are termed tumorigenic. The former category is the subject of this monograph.