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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

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Summary: N=53 Benign: 24 –Spitz n: SPARK –DN: 4 –CN: 1 Uncertain Favour Benign: 6* –1 Spitz n. 1 SPARK –4 unclassified Uncertain Favour Malignant:1 –1 Spitz n.! Malignant23 –SSMM: 19; LMM: 2: Spitzoid: 2 * Includes some cases marked benign!

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Parameters SUBTYPES SSMM: 19; LMM 2: Spitzoid: 2 Clark level IIIIIIIVV Breslow: 0.3 to 0.6 (Mean: 0.39; Median 0.4) VGP: 15RGP: 8 Regression: Yes: 12No: 12 Mitoses: Absent: 20: Low: 2: High: 0

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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

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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.

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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

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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

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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

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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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