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Dr Richard A. Carr, Warwick Hospital

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








9 Summary: N=53 Benign: 24 Uncertain Favour Benign: 6*
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.! Malignant SSMM: 19; LMM: 2: Spitzoid: 2 * Includes some cases marked benign!

10 Parameters SUBTYPES SSMM: 19; LMM 2: Spitzoid: 2 Clark level
I II III IV V 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

11 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

12 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.

13 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

14 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

15 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

16 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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