Dr Richard A. Carr, Warwick Hospital

Case 205. F40. Lonstanding pigmented lesion. Enlarged last 6/12. Punch Bx by GP ?SSMM

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!

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

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

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.

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

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

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

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