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Melanocytic Lesions
Published in Ashfaq A Marghoob, Ralph Braun, Natalia Jaimes, Atlas of Dermoscopy, 2023
Cristian Navarrete-Dechent, Konstantinos Liopyris, Natalia Jaimes, Ashfaq A. Marghoob
The key to avoid missing a nevoid melanoma is to remain suspicious of any “banal” mammillated intradermal nevus-like appearing lesion that is new or changing in an older individual, lacks a benign pattern under dermoscopy (i.e., intradermal and congenital nevi, Chapters 7a, 7c), and reveals atypical vessels, shiny white structures, atypical dots/globules, or any of the other melanoma-specific structures mentioned in Chapter 9a.
Nevoid melanoma
Published in Longo Caterina, Diagnosing the Less Common Skin Tumors, 2019
Nevoid melanoma (NeM) is an uncommon subtype of malignant melanoma included among the less frequent variants and it can be very difficult to differentiate clinically and histologically from nevi.1–6 Clinically, it presents as a variously pigmented papillomatous (Figure 11.1a) or dome-shaped papule or nodule (Figures 11.2a and 11.3a) that is often greater than 1 cm in diameter and is located on the trunk and on the limbs. The verrucous appearance of the nevoid melanoma can deceptively evoke a benign diagnosis of dermal or compound nevus, seborrheic keratosis or papilloma. There is a male predominance and mean age of patients is 51–57 years.5–8 Histologically, subtle clues that enable NeM to be differentiated from benign melanocytic lesions are the presence of multiple dermal mitoses, often deep and atypical, nucleolar prominence, subtle pleomorphism, slight asymmetry and impaired circumscription.5,8 Furthermore, when the tumor cells are small, NeM mimics ordinary compound nevus or dermal nevi; when cells are large, NeM mimics Spitz nevi.5
Multitarget fluorescence in situ hybridization diagnostic applications in solid and hematological tumors
Published in Expert Review of Molecular Diagnostics, 2021
Federica Zito Marino, Matteo Brunelli, Giulio Rossi, Giuseppe Calabrese, Anna Caliò, Pamela Nardiello, Guido Martignoni, Jeremy A. Squire, Liang Cheng, Daniela Massi, Renato Franco
Thus, in the presence of an atypical melanocytic proliferation, the absence of chromosomal copy number aberrations does not exclude the diagnosis of melanoma. In contrast, in the setting of worrisome histopathological features, the presence of unbalanced genomic aberrations provides evidence in support of a diagnosis of melanoma. The presence of segmental chromosomal copy number aberrations does not per se provide unequivocal proof of malignancy and results should always be interpreted in the context of the clinico-pathological features [19,21,22]. Common settings for which the enhanced performance of mFISH probe has been proposed include the diagnosis of spitzoid tumors, mitotically active nevi from nevoid melanoma, the distinction of intra-nodal nevi from metastatic melanoma and of epithelioid blue nevi from blue-nevus like melanoma, and the assessment of atypical melanocytic proliferation in the context of a congenital nevus [21].
BAPoma presenting as an incidental scalp papule: case report, literature review, and screening recommendations for BAP1 tumor predisposition syndrome
Published in Journal of Dermatological Treatment, 2022
Marcus Zaayman, Peter Nguyen, Annika Silfvast-Kaiser, Jillian Frieder, Cameron West, Katherine Tumminello, So Yeon Paek
Understanding of BIMTs has evolved significantly since their first identification in 2011 (10,16). Initially classified as atypical Spitz tumors (ASTs) by Wiesner et al. (10), they have since been known by several names, including: melanocytic BAP1-mutated atypical intradermal tumors (MBAITs), BAPomas, Wiesner nevi, nevoid melanoma-like melanocytic proliferations, and BIMTs (10,16). Since they harbor features that overlap with Spitz nevi, ASTs, and nevoid melanomas, they were originally considered a subgroup of Spitz tumors (12,16). However, they are now classified separately, partly because they require a significantly different treatment approach (12,16). BIMTs are typically described as skin-colored to reddish-brown, dome-shaped to pedunculated, well-circumscribed papules (7,12). They range from 2 to 10 mm in diameter and arise in the 2nd or 3rd decade of life (1,12). BIMTs can be described predominantly by two histologic patterns of growth: (1) large epithelioid cells with distinct cytoplasmic borders and sheet like growth and (2) mimicking a congenital nevus with biphasic appearance and proliferation of small nevoid cells as well as large epithelioid cells (12). Both patterns reveal intradermal lesions with large epithelioid and spindled melanocytes, with marked cytologic atypia and pleomorphic, hyperchromatic nuclei. The key to diagnosis lies in the loss of nuclear BAP1 on IHC (15,16). Ki67 immunostaining is typically negative (16). Nearby detectable remnants of a conventional intradermal or compound nevus are often present demonstrating a concurrent BRAF mutation (16). These findings are counter to Spitz nevi and ASTs which can occur at any level (epidermis, junctional, dermis), typically show mitotic activity with Ki67 staining, have Kamino bodies, feature an open nuclear chromatin with a small nucleolus, and no associated nevus or concurrent BRAF mutation (16,18).