Consultant Consultant Pathology Series Editor ■ David E. Elder, MB, ChB Series Editor ■ David E. Elder, MB, ChB ■ Pathology7 Consultant Pathology 7 MelanocyticSuperficial Pathology 7 Superficial Superficial Melanocytic Pathology Melanocytic Superficial Atypical Melanocytic Proliferations Pathology Superficial Atypical David E. Elder, MB, ChB • Sook Jung Yun, MD, PhD Melanocytic Proliferations Add Expert Analysis of Difficult Cases to Your Practice With Consultant Pathology Superficial Melanocytic Pathology provides expert guidance for resolving the real world problems pathologists face when diagnosing melanomas and other atypical pigmented lesions. It reviews each major category of atypical melanocytic lesions, including the pathology of the superficial categories of melanoma followed by a discussion of the major simulants David E. Elder of melanoma. The book provides an overview of the morphologic description and diagnostic issues for each lesion, followed by 60 detailed, Sook Jung Yun abundantly illustrated case presentations, offering an expert approach to diagnosis for a range of challenging cases. Five hundred high-quality color images support the case presentations. Of special interest is a chapter on “ambiguous” lesions of uncertain significance. The book’s thorough analysis of challenging lesions will aid pathologists in differentiating between benign superficial proliferations and malignant melanocytic tumors. All Consultant Pathology Titles Provide: Elder • Yun ■ ACTUAL consultation cases and expert analysis ■ EXPERT analysis provides a detailed discussion of the reasoning behind the diagnosis of each case ■ COMPREHENSIVE coverage of challenging diagnoses ■ CASES that are richly illustrated with high-quality photomicrographs About the Authors: Recommended Shelving Category David E. Elder, MB, ChB, is Professor of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania Pathology Sook Jung Yun, MD, PhD is Associate Professor, Department of Dermatology, Chonnam National University Medical School, Gwangju, South Korea 11 W. 42nd Street New York, NY 10036 www.demosmedical.com 9 781620 700235 This is a sample from Superficial Melanocytic Pathology: Superficial Atypical Melanocytic Proliferations Visit This Book’s Web Page / Buy Now / Request an Exam/Review Copy Consultant Pathology superficial melanocytic pathology © Demos Medical Publishing This is a sample from Superficial Melanocytic Pathology: Superficial Atypical Melanocytic Proliferations Visit This Book’s Web Page / Buy Now / Request an Exam/Review Copy Consultant Pathology Series David E. Elder, MB, ChB Series Editor Tumorigenic Melanocytic Proliferations David E. Elder Brain Tumors Richard Prayson, Bette Kleinschmidt-DeMasters, and Mark L. Cohen Head and Neck Pathology Leon Barnes, Raja Seethala, and Simion Chiosea Liver Pathology Linda Ferrell and Sanjay Kakar Intraoperative Frozen Sections Pedram Argani and Ashley Cimino-Mathews Breast Pathology Melinda E. Sanders and Jean F. Simpson Superficial Melanocytic Pathology David E. Elder and Sook Jung Yun Forthcoming Volume in the Series Soft Tissue Tumors John S. J. Brooks © Demos Medical Publishing This is a sample from Superficial Melanocytic Pathology: Superficial Atypical Melanocytic Proliferations Visit This Book’s Web Page / Buy Now / Request an Exam/Review Copy Consultant Pathology Volume 7 superficial melanocytic pathology 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 New York © Demos Medical Publishing This is a sample from Superficial Melanocytic Pathology: Superficial Atypical Melanocytic Proliferations Visit This Book’s Web Page / Buy Now / Request an Exam/Review Copy 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 care- fully 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 978-1-62070-023-5—ISBN 978-1-61705-186-9 (e-book) I. Yun, Sook Jung, author. II. Title. III. Series: Consultant pathology series; 7. [DNLM: 1. Skin Neoplasms—pathology. 2. Melanoma—pathology. 3. Nevus, Pigmented—pathology. WR 500] RC280.S5 616.99’477—dc23 2014027367 Special discounts on bulk quantities of Demos Medical Publishing books are available to corporations, professional associations, pharmaceutical companies, health care organizations, and other qualifying groups. For details, please contact: Special Sales Department Demos Medical Publishing, LLC 11 West 42nd Street, 15th Floor New York, NY 10036 Phone: 800-532-8663 or 212-683-0072 Fax: 212-941-7842 E-mail: [email protected] Printed in the United States of America by Bradford & Bigelow. 14 15 16 17 / 5 4 3 2 1 © Demos Medical Publishing This is a sample from Superficial Melanocytic Pathology: Superficial Atypical Melanocytic Proliferations Visit This Book’s Web Page / Buy Now / Request an Exam/Review Copy Contents Series Foreword ix Preface xi Acknowledgments xv Introduction xvii 1.0 “Low CSD” Superficial Atypical Melanocytic Proliferations (SAMP) 1 1.1 Superficial Spreading Melanoma 3 References 6 1.1.1 SSM Thin Mitogenic Versus Atypical Nevus With Mitoses 7 1.1.2 Thin Mitogenic Melanoma Versus Nevus With Mitoses 10 1.1.3 SSM With Extensive Regression Versus Regressing Nevus (Halo Nevus) 13 1.1.4 Thin SSM Versus Pagetoid Spitz Tumor in a Child 16 1.1.5 SSM Versus LMM Versus Atypical Nevus 19 1.1.6 Severely Dysplastic Nevus Versus Melanoma 22 1.1.7 SSM In Situ Versus SAMPUS—Severe Dysplasia 25 1.1.8 SSM Versus Pagetoid Spitz Tumor 28 1.2 Nevi Including Dysplastic Nevi 31 References 36 1.2.1 Epithelioid Cell Melanocytic Dysplasia Versus Superficial Spreading Melanoma 38 1.2.2 Moderate Versus Severe Dysplasia 41 1.2.3 Mild Dysplasia Versus Junctional Nevus 43 1.2.4 Severe Dysplasia Versus Nevoid Melanoma 45 1.2.5 Severe Dysplasia Versus Melanoma 48 1.2.6 Severe Dysplasia Versus Melanoma In Situ 52 1.2.7 Fibrosing Dysplastic Nevus Versus Melanoma With Regression 54 1.2.8 Dysplastic Nevus or Not? 57 1.2.9 Severe Dysplasia Versus Melanoma 59 1.2.10 Fibrosing Dysplastic Nevus Versus Regressing Melanoma 62 1.3 Recurrent and Traumatized Nevi 65 References 66 1.3.1 Recurrent Nevus Versus Melanoma 67 1.3.2 Recurrent and Traumatized Nevi 70 1.3.3 Recurrent Nevus Versus Melanoma 73 1.3.4 Recurrent Nevus Versus Melanoma 76 v © Demos Medical Publishing This is a sample from Superficial Melanocytic Pathology: Superficial Atypical Melanocytic Proliferations Visit This Book’s Web Page / Buy Now / Request an Exam/Review Copy vi CONTENTS 1.3.5 Recurrent and Traumatized Nevi 79 1.3.6 Nevus Versus Melanoma 82 2.0 High Chronic Solar Damage Superficial Atypical Melanocytic Proliferations 85 2.1 Lentigo Maligna Melanoma (High CSD Melanoma) 87 References 89 2.1.1 Lentigo Maligna Melanoma and Possible Precursor Lesions 90 2.1.2 Lentigo Maligna Melanoma With Desmoplastic Vertical Growth Phase Versus Atypical Neurotized Compound Nevus 95 2.1.3 Intraepidermal Atypical Melanocytic Proliferation of Uncertain Significance, Regressing Melanoma Versus Benign Lichenoid Keratosis With Junctional Melanocytic Hyperplasia Versus Atypical Nevus 99 2.1.4 Lentigo Maligna Melanoma, Invasive, Versus Incidental Dermal Nevus in Lentigo Maligna 102 2.1.5 Nevoid Lentigo Maligna Versus Severely Dysplastic Nevus 105 2.1.6 Nevoid Lentigo Maligna Versus Atypical Lentiginous Junctional Nevus 108 2.1.7 Melanoma In Situ Versus Lentiginous Nevus With Atypia or Severe Dysplasia 111 2.1.8 Melanoma In Situ Versus Severe Dysplasia 115 2.2 Actinic (Solar) Lentigo and Lentiginous Nevi in Sun-Damaged Skin 119 References 121 2.2.1 Actinic Lentigo Versus Lentigo Maligna 122 2.2.2 Actinic Lentigo Versus Lentigo Maligna 125 2.2.3 Actinic Lentigo With Spindle Cells 128 2.2.4 Atypical Lentigo Versus