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Dr Richard A. Carr, Warwick Hospital

Case 205. F40. Lonstanding pigmented lesion. Enlarged last 6/12. Punch Bx by GP ?SSMM. Dr Richard A. Carr, Warwick Hospital. 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

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Dr Richard A. Carr, Warwick Hospital

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  1. Case 205. F40. Lonstanding pigmented lesion. Enlarged last 6/12. Punch Bx by GP ?SSMM Dr Richard A. Carr, Warwick Hospital

  2. 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!

  3. Parameters SUBTYPES • 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

  4. 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

  5. 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.

  6. 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

  7. 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

  8. 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

  9. 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

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