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Skin-Melanocytic Tumors
Last major update: November 2008 - next update November 2009
Revised: 11 July 2009
Author: Nat Pernick, M.D., PathologyOutlines.com, Inc.
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
Epidemiology
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● Uncommon; difficult to diagnosis clinically and pathologically
● Median age 59-66 years; common sites are great toe and thumb
Clinical
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● Often delay in diagnosis because lesion is attributed to trauma; most (73%) cases are AJCC stage II/III, acral lentiginous subtype (66%), Clark level IV/V (79%) (AJSP 2007;31:1902)
● Sentinel node metastases in 24%
Case reports
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● 86 year old man with post-traumatic amelanotic tumor (Dermatol Online J 2008;14(1):13)
● Regressed tumors with positive sentinel nodes (Dermatol Surg 2006;32:577)
● With osteocartilaginous differentiation (Skeletal Radiol 2003;32:724)
● Amelanotic tumor resembling pyogenic granuloma (J R Coll Surg Edinb 2002;47:638)
Treatment and prognosis
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● Wide local excision, may require amputation (Am J Surg 2008;195:244) although conservative approach for thumb lesions has been advocated (J Plast Reconstr Aesthet Surg 2007;60:635)
Clinical images
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Red, friable, broad-based Ulcer on left middle finger
nodule on tip of fourth finger
Micro description
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● Usually not circumscribed
● Have prominent lentiginous growth with more single cells than nests, moderate to severe atypia, haphazard and dense pagetoid intradermal spread
● Also ulceration (33%), tumor infiltrating lymphocytes
Micro images
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Tumor cells are single or in nests Tumor cells are MelanA+
Differential DiagnosIs
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● Lentigo
End of Skin-Melanocytic Tumors > Subungual melanoma
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