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Pattern Analysis for Histopathologic Diagnosis of Melanocytic Lesions: A Guide to Practical Dermatopathology

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Pattern analysis is a powerful method that changed dermatopathology, nowadays an indispensable tool in the diagnostic workup of inflammatory and neoplastic lesions. The diagnosis of melanocytic lesions can also be mastered by pattern analysis, which is the link between pathology, dermatoscopy, and clinical dermatology and supports the integration of all views. The  histopathologic diagnosis of melanocytic lesions can be challenging for novices and experts alike. While classifications of melanocytic lesions come and go, pattern analysis is timeless; it can be assigned to any classification, current or future, and provides a framework that allows to address complex and uncertain cases in a repeatable manner. While uncertainty cannot be totally eliminated, pattern analysis helps to express this uncertainty in a meaningful way. Written by expert dermatopathologists with experience in dermatoscopy, this book is dedicated to young colleagues and to those who have not yet settled on one of the competing schools of thought; it is intended as a practical guide to help making correct observations, to describe them with a well-defined terminology, and to yield critical decisions in the face of incomplete or conflicting information. The illustrations contained in the volume are all original pictures in high-quality and full-color: reproductions of histopatological cuts in low and high magnification will assist pathologists, dermatologists, and dermatopathologists in interpreting histological slides of melanocytic skin lesions.

Author(s): Almut Böer-Auer, Harald Kittler, Philipp Tschandl
Publisher: Springer
Year: 2023

Language: English
Pages: 275
City: Cham

Foreword
Acknowledgments
Contents
About the Authors
1: Introduction
2: Historical Perspective
2.1 Melanoma
2.2 Melanocytic Nevi
2.3 The Relationship Between Melanocytic Nevi and Melanoma
3: Classifications
3.1 The WHO Classification of Melanocytic Tumors
3.2 Other Classifications
3.2.1 The MPATH-Dx Reporting Scheme
3.2.2 AJCC and TNM Melanoma Staging
3.2.3 ICD-11 and ICD-O Codes
3.3 The Relationship Between Pattern Analysis and Classifications
4: Pattern Analysis
4.1 Architecture and Silhouette
4.2 Main Patterns and Their Variations
4.2.1 Epidermal Patterns (Figs. 4.2, 4.3, 4.4, and 4.5)
4.2.1.1 Pigmented Keratinocytes, No Increase in Melanocytes (Fig. 4.2a, b)
4.2.1.2 Increased Single Melanocytes: Regular/Irregular (Fig. 4.2c, d)
4.2.1.3 Nests of Melanocytes: Arrangement, Size, Shape, and Number (Fig. 4.3a–h)
4.2.1.4 Suprabasal Melanocytes (Fig. 4.4a–d)
4.2.1.5 Epithelial Adnexal Involvement (Fig. 4.5a–d)
4.2.2 Dermal Patterns (Figs. 4.6, 4.7, and 4.8)
4.2.2.1 Single Melanocytes (Fig. 4.6a, b)
4.2.2.2 Nests (Fig. 4.6c–e)
4.2.2.3 Nodules and Sheets (Fig. 4.6e)
4.2.2.4 Interstitial Strands/Fascicles (Fig. 4.7a, b)
4.2.2.5 Periadnexal Strands/Nests (Fig. 4.7c–g)
4.2.2.6 Plexiform Fascicles (Fig. 4.7h)
4.2.2.7 Maturation (Fig. 4.8a–d)
4.2.3 Subcutaneous Pattern (Fig. 4.9a–d)
4.2.3.1 Periadnexal Strands/Fascicles
4.2.3.2 Septal Involvement
4.2.3.3 Lobular Involvement
4.2.4 Combination of Patterns
4.3 Cytology of Melanocytes
4.3.1 Shape (Fig. 4.10a–g)
4.3.1.1 Small Round
4.3.1.2 Epithelioid
4.3.1.3 Pagetoid
4.3.1.4 Spindled
4.3.1.5 Bipolar
4.3.1.6 Variants (Fig. 4.11a–f)
Ancient Change
Multinucleation
Balloon Cell
Neurotization
Others
4.3.2 Pleomorphism of Melanocytes (Fig. 4.12a–f)
4.3.3 Crowding (Fig. 4.13a)
4.3.4 Mitotic Figures (Fig. 4.13b, c)
4.3.5 Necrosis (Fig. 4.13d–f)
4.4 Other Changes
4.4.1 Epidermis (Fig. 4.14a–f)
4.4.1.1 Elongated Rete Ridges
4.4.1.2 Epidermal Hyperplasia
4.4.1.3 Intracorneal Pigmentation
4.4.1.4 Kamino Bodies
4.4.1.5 Atrophy
4.4.1.6 Ulceration
4.4.2 Collagen (Fig. 4.15a–f)
4.4.2.1 Fibroplasia
4.4.2.2 Sclerosis
4.4.2.3 Desmoplasia
4.4.2.4 Scar
4.4.2.5 Collagen Changes in Regression
4.4.2.6 Solar Elastosis
4.4.3 Vessels (Fig. 4.16a–d)
4.4.3.1 Vascularization
4.4.3.2 Vascular Invasion
4.4.4 Inflammatory Infiltrates (Fig. 4.17a–f)
4.4.4.1 Halo Phenomenon
4.4.4.2 Meyerson Phenomenon
4.4.4.3 Patchy Lymphocytes/Plasma Cells
4.4.4.4 Melanophages
4.4.4.5 Lymphocytic Infiltrates in Regression
5: Integration of Patterns
5.1 Combination of Patterns and Differential Diagnosis
5.2 The Full Histologic Examination Procedure on the Basis of Examples
5.2.1 Example 1
Overall Pattern: Epidermal and Dermal, Nested, Small, Symmetric
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
5.2.2 Example 2
Overall Pattern: Dermal, Periadnexal, and Interstitial
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
5.2.3 Example 3
Overall Pattern: Dermal, Interstitial
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
5.2.4 Example 4
Overall Pattern: Epidermal, Poorly Circumscribed, Single Melanocytes Predominate
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
5.2.5 Example 5
Overall Pattern: Asymmetric, Broad, Epidermal and Dermal
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
5.2.6 Example 6
Overall Pattern: Subcutaneous, Nodular
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
5.3 Limitations of Pattern Analysis
6: Integration of Context
6.1 Clinical Context
6.2 In Vivo Imaging
6.3 Ex Vivo Dermatoscopy
6.4 Immunohistochemistry
6.4.1 Use Cases
6.4.1.1 Diagnosing Melanoma Without Immunohistochemistry
6.4.1.2 Rule out a Melanocytic Process
6.4.1.3 Discovery of Histologically Invisible Melanoma
6.4.1.4 Desmoplastic and Spindle Cell Melanoma
6.4.1.5 Measuring Melanoma Thickness
6.4.1.6 Atypical Spitzoid Lesions
6.4.1.7 BAP1 Deficient Nevi
6.4.1.8 Malignancy Prediction Through Immunohistochemistry
6.5 Molecular Findings
6.5.1 General Concepts
6.5.1.1 Expected-Mutation Mismatch
6.5.1.2 Interobserver Agreement
6.5.1.3 Prognosis and Therapy
6.5.1.4 Bias
6.5.2 Selected Situations
6.5.2.1 TERT
6.5.2.2 Spitzoid/Epithelioid Lesions
6.5.2.3 Blue-Like Lesions
6.6 Adding It Up: But How?
7: Pattern Analysis in Practice
7.1 Patterns
7.1.1 Junctional
7.1.1.1 Example 1: Nests and Single Cells (Fig. 7.1)
Overall Pattern: Nested and Single Cells, Epidermal, Asymmetric
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.1.2 Example 2: Nests Mainly (Fig. 7.2)
Overall Pattern: Nested, Epidermal and Dermal, Symmetric
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.1.3 Example 3: Nests and Single Cells (Fig. 7.3)
Overall Pattern: Epidermal, Asymmetric, Poorly Circumscribed
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.1.4 Example 4: Nests and Single Cells, Chronic Sun Damage (Fig. 7.4)
Overall Pattern: Epidermal, Asymmetric, Poorly Circumscribed
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.1.5 Example 5: Small Lesion with Nests (Fig. 7.5)
Overall Pattern: Epidermal, Small, Nested, Symmetric
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.1.6 Example 6: Small Lesion with Nests, Heavily Pigmented (Fig. 7.6)
Overall Pattern: Epidermal, Small, Symmetric, Nested, Well Circumscribed
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.1.7 Example 7: Small Lesion with Large Nests and Single Cells (Fig. 7.7)
Overall Pattern: Epidermal, Asymmetric, Poorly Circumscribed
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.1.8 Example 8: Small Lesion with Small Nests and Single Cells on Sun-Damaged Skin (Fig. 7.8)
Overall Pattern: Epidermal, Asymmetric, Poorly Circumscribed
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.1.9 Example 9: Small Lesion with Nests, Heavily Pigmented, Spitzoid (Fig. 7.9)
Overall Pattern: Epidermal, Asymmetric, Large Nests
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
7.1.1.10 Example 10: Nests and Single Cells (Fig. 7.10)
Overall Pattern: Epidermal, Asymmetric, Poorly Circumscribed
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.1.11 Example 11: Single Cells and Small Nests, Facial (Fig. 7.11)
Overall Pattern: Epidermal, Asymmetric, Poorly Circumscribed
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.1.12 Example 12: Nests and Single Melanocytes, Broad Lesion (Fig. 7.12)
Overall Pattern: Epidermal and Dermal, Broad, Poorly Circumscribed
Detailed description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
7.1.2 Spindled and/or Epithelioid Pigmented, Dermal
7.1.2.1 Example 1: Pigmented Epithelioid, Dermal (Fig. 7.13)
Overall Pattern: Dermal, Well Circumscribed, Interstitial
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.2.2 Example 2: Pigmented Epithelioid, Dermal (Fig. 7.14)
Overall Pattern: Dermal, Plexiform, No Maturation
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.2.3 Example 3: Asymmetric Pigmented Epithelioid, Dermal and Subcutaneous (Fig. 7.15)
Overall Pattern: Asymmetric, Nested and Plexiform, Dermal and Subcutaneous, No Maturation
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.2.4 Example 4: Asymmetric Pigmented Epithelioid, Dermal and Subcutaneous (Fig. 7.16)
Overall Pattern: Asymmetric, Epidermal and Dermal, Well Circumscribed, No Maturation
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.2.5 Example 5: Nodular Reaching Subcutis, Heavily Pigmented (Fig. 7.17)
Overall Pattern: Nodular, Well Circumscribed, Dermal and Subcutaneous, Heavily Pigmented
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.2.6 Example 6: Heavily Pigmented Dermal Nodule with Junctional Component (Fig. 7.18)
Overall Pattern: Epidermal and Dermal, Asymmetric, Relatively Well Circumscribed
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.2.7 Example 7: Small Superficial Dermal Nodule, Pigmented Epithelioid (Fig. 7.19)
Overall Pattern: Dermal, Nested, Well Circumscribed
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
7.1.2.8 Example 8: Interstitial Dark Dermal Pigmentation (Fig. 7.20)
Overall Pattern: Interstitial Pigmentation, Dermal
Detailed Description
Silhouette
Patterns
Cytology
Immunohistochemistry
Integration
7.1.3 Epithelioid and/or Spindled Amphophilic
7.1.3.1 Example 1: Large Epidermal Nests and Epidermal Hyperplasia (Fig. 7.21)
Overall Pattern: Symmetric, Epidermal and Dermal, Nested
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.3.2 Example 2: Spindled and Epithelioid Cells in a Nodule in a Child (Fig. 7.22)
Overall Pattern: Epidermal and Dermal, Symmetric, Well Circumscribed
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.3.3 Example 3: Junctional, Epithelioid, with Kamino Bodies (Fig. 7.23)
Overall Pattern: Epidermal, Symmetric, Well Circumscribed
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.3.4 Example 4: Dermal Nevus with Epithelioid Melanocytes (Fig. 7.24)
Overall Pattern: Symmetric, Dermal, Single Cells
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.3.5 Example 5: Dermal Nodule of Pleomorphic Epithelioid Cells with Epidermal Hyperplasia (Fig. 7.25)
Overall Pattern: Largely Dermal, Well Circumscribed, Nested and Interstitial
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Molecular Diagnostics
Integration
7.1.3.6 Example 6: Ill-Defined Dermal Nodule of Epithelioid Pleomorphic Cells with Heavy Inflammatory Infiltrate (Fig. 7.26)
Overall Pattern: Dermal Only, Interstitial, Asymmetric, and Poorly Circumscribed
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
7.1.3.7 Example 7: Asymmetric, Partly Plexiform Dermal Nodule (Fig. 7.27)
Overall Pattern: Asymmetric, Dermal, Nested, and Plexiform
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
7.1.4 Nevoid Melanoma and Melanoma Associated with Nevi
7.1.4.1 Example 1: Dense Dermal Sheets of Melanocytes (Fig. 7.28)
Overall Pattern: Symmetric, Epidermal and Dermal
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.4.2 Example 2: Dermal Sheets and Nests, Asymmetric (Fig. 7.29)
Overall Pattern: Mainly Dermal, Asymmetric Nests and Sheets
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.4.3 Example 3: Very Large Nests, Epidermal (Fig. 7.30)
Overall Pattern: Nested, Epidermal
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.4.4 Example 4: Biphasic Lesion (Fig. 7.31)
Overall Pattern: Epidermal and Dermal, Asymmetric, Poorly Circumscribed on One Site Well Circumscribed on the Other
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.4.5 Example 5: Nodule in a Nevus Spilus (Fig. 7.32)
Overall Pattern: Interstitial Sheets Throughout the Dermis
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.1.5 Regression, Sclerosis, Recurrence, and Inflammation
7.1.5.1 Example 1: Irregular Epidermal Melanocytes with Underlying Scar (Fig. 7.33)
Overall Pattern: Broad, Single Melanocytes Predominate, Mostly Epidermal
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Elastica Stain
Immunohistochemistry
Integration
7.1.5.2 Example 2: Irregular Epidermal and Dermal Melanocytes with Underlying Scar (Fig. 7.34)
Overall Pattern: Asymmetric, Poorly Circumscribed, Epidermal and Dermal, Some Maturation
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
7.1.5.3 Example 3: Traumatized Nevus (Fig. 7.35)
Overall Pattern: Small, Asymmetric, Epidermal Only, Single Cells, and Nests
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
7.1.5.4 Example 4: Increased Epidermal Melanocytes in Melanoma Re-excision (Fig. 7.36)
Overall Pattern: Asymmetric, Not Well Defined, Single Cells with Irregular Nesting
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
7.1.5.5 Example 5: Epidermal Nests of Melanocytes with a Lichenoid Infiltrate (Fig. 7.37)
Overall Pattern: Symmetric, Poorly Circumscribed
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.2 Anatomic Sites
7.2.1 Acral
7.2.1.1 Example 1: Large Pigmented Nests (Fig. 7.39)
Overall Pattern: Epidermal, Regular, Mainly Large Nests
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.2.1.2 Example 2: Small Nests in Epidermis and Papillary Dermis (Fig. 7.40)
Overall Pattern: Epidermal and Superficially Dermal, Symmetric, Nested
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.2.1.3 Example 3: Asymmetric with Large Confluent Nests (Fig. 7.41)
Overall Pattern: Asymmetric, Epidermal and Dermal, Nested
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.2.2 Face
7.2.2.1 Example 1: Single Cells in Flat Epidermis (Fig. 7.44)
Overall Pattern: Epidermal, Single Cells, Asymmetric
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.2.2.2 Example 2: Asymmetric Horizontal Confluence and Sun Damage (Fig. 7.45)
Overall Pattern: Epidermis Confluent Nests, Asymmetric
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.2.2.3 Example 3: Parakeratosis, Clinical Suspicion of Melanoma (Fig. 7.46)
Overall Pattern: Atypical Keratinocytes, Intraepidermal
Detailed Description
Silhouette
Patterns
Other Changes
Integration
7.2.2.4 Example 4: Sun Damage, Morphologically Few Visible Melanocytes (Fig. 7.47)
Overall Pattern: Epidermal Only, Single Melanocytes, Poorly Circumscribed
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
7.2.2.5 Example 5: Nests and Inflammation (Fig. 7.48)
Overall Pattern: Single Melanocytes and Small Nests, Irregularly Distributed
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
7.2.3 Nail
7.2.3.1 Example 1: Asymmetric Longitudinal Nail Pigmentation (Fig. 7.49)
Overall Pattern: Broad, Not Well Circumscribed, Intraepithelial
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
7.2.3.2 Example 2: “Onychomycosis” with Periungual Pigmentation (Fig. 7.50)
Overall Pattern: Asymmetric, Nested, Epidermal and Dermal
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.2.3.3 Example 3: Slightly Changing Melanonychia Striata (Fig. 7.51)
Overall Pattern: Small, Increased Single Cells, Some Suprabasal
Detailed Description
Silhouette
Patterns
Cytology
Immunohistochemistry
Other Changes
Integration
7.2.3.4 Example 4: Melanonychia Striata in a Prepubescent Child (Fig. 7.52)
Overall Pattern: Small, Junctional, Nested
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.2.3.5 Example 5: Slightly Changing Melanonychia Striata (Fig. 7.53)
Overall Pattern: Subtle Pigmentation the Nail Matrix, Biopsy
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.2.4 “Special” Sites (Navel, Mamilla, Genital, Axilla)
7.2.4.1 Example 1: Flat Lesion on the Mamilla (Fig. 7.54)
Overall Pattern: Single Melanocytes, Poorly Circumscribed, Symmetric
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.2.4.2 Example 2: Lesion on the Mamilla (Fig. 7.55)
Overall Pattern: Nested, Epidermal and Dermal, Symmetric
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
7.2.4.3 Example 3: Umbilicus (Fig. 7.56)
Overall Pattern: Somewhat Asymmetric, Poorly Circumscribed, Epidermal and Dermal
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.2.4.4 Example 4: Vulvar Pigmentation with Sclerosis (Fig. 7.57)
Overall Pattern: Epidermal, Irregular, Single Melanocytes Predominate, Reaching the Margins
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.2.5 Conjunctiva
7.2.5.1 Example 1: Conjunctiva (Fig. 7.58)
Overall Pattern: Epithelial and Lamina Propria, Nested, Pericystic
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
7.2.5.2 Example 2: Conjunctiva (Fig. 7.59)
Overall Pattern: Nested, Epithelium and Lamina Propria
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
7.2.5.3 Example 3: Conjunctiva (Fig. 7.60)
Overall Pattern: Well Circumscribed, in Epithelium and Lamina Propria
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
7.2.5.4 Example 4: Conjunctiva (Fig. 7.61)
Overall Pattern: Broad Lesion, Confluence of Nests, Only Epithelial
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.2.5.5 Example 5: Caruncula (Fig. 7.62)
Overall Pattern: Only Epithelial, Single Melanocytes Predominate
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.2.5.6 Example 6: Conjunctiva, Nonpigmented Lesion (Fig. 7.63)
Overall Pattern: Epithelium and Lamina Propria, Single Melanocytes, Irregularly Distributed
Detailed Description
Silhouette
Patterns
Cytology
Integration
7.3 Clinical Setting
7.3.1 Partial Biopsies
7.3.1.1 Example 1: Curetting (Fig. 7.64)
Overall Pattern: Fragmented Shave Specimen, Single Melanocytes, Poorly Circumscribed
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.3.1.2 Example 2: Shave Biopsy (Fig. 7.65)
Overall Pattern: Nested, Epidermal and Dermal, Well Circumscribed, Incomplete Excision
Detailed Description
Silhouette
Patterns
Cytology
Immunohistochemistry
Other Changes
Integration
Excision: Nodular Lesion After Shave Biopsy (Fig. 7.66)
Overall Pattern: Nodular, Ulcerated, Epidermal and Dermal
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.3.1.3 Example 3: Punch Biopsies of a Large Lesion on the Face
Punch Biopsy 1 (Fig. 7.67)
Punch Biopsy 2 (Fig. 7.68)
Overall Pattern: Epidermal and Dermal, Irregular Single Melanocytes, Two Biopsies from One Lesion
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
Excision (Fig. 7.69)
Overall Pattern: Epidermal and Dermal, Irregular Single Melanocytes
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
7.3.1.4 Example 4: Small Nests and Single Melanocytes, Biopsy of a Large Lesion (Fig. 7.70)
Overall Pattern: Epidermal Only, Single Cells Predominate, Biopsy
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
7.3.2 Newborns, Babies, and Children
7.3.2.1 Example 1: Lesion of a 3-Week-Old Infant (Fig. 7.71)
Overall Pattern: Large Nests and Interstitial Strands in the Entire Dermis
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.3.2.2 Example 2: Lesion of a 9-Week-Old Infant (Fig. 7.72)
Overall Pattern: Asymmetric, Epidermal and Dermal, Nested and Interstitial
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
7.3.2.3 Example 3: Dermal Lesion with Thin Epidermis in a Child (Fig. 7.73)
Overall Pattern: Polypoid, Largely Dermal, Adnexocentric
Detailed description
Silhouette
Patterns
Cytology
Other Changes
Immunohistochemistry
Integration
7.3.2.4 Example 4: Nodule Arising in a Congenital Nevus in a Newborn (Fig. 7.74)
Overall Pattern: Dermal and Subcutis, Nodules and Sheets
Detailed Description
Silhouette
Patterns
Cytology
Other Changes
Integration
8: Bias, Noise, and Error
8.1 Last Words
References
Index