Dermatopathology Decoder Examples

"HISTOPATHOLOGY Solar keratosis left forearm. MACROSCOPY Container unlabelled as to site - An oval piece of skin 14 x 11 x 5mm bearing a cream macule 8 x 6mm. 4TS, all in. 1 block. MICROSCOPY: Sections show a variable crust of polymorphs, fibrin and keratotic material overlying focally ulcerated epidermis. There are variably sized nests of atypical melanocytes lining the basal epidermis and extending into the dermis widely to reach the dermis but not into the subcutaneous fat. There is focal pagetoid invasion by the epidermis by the atypical melanocytes. The atypical melanocytes show minimal pigmentation and are composed of large pleomorphic cells with round to oval nuclei, prominent nucleoli with granular to vacuolated cytoplasm. There is a variable degree of lymphocytic infiltrate through the lesion. Intravascular tumour is not identified in the sections. The lesion extends to a depth of 1.85mm and is a Clark's level IV malignant melanoma. The lesion extends within 0.5mm of a lateral cut margin. A wider excision is advised. The tumour was submitted for immunoperoxidase stains and the tumour cells are positive for Melan-A and S100. The tumour is negative for cytokeratins Cam 5.2, AE1/AE3. SYNOPTIC REPORT - MALIGNANT MELANOMA. DIAGNOSIS: ULCERATED MALIGNANT MELANOMA INVASIVE WITH ADJACENT SUPERFICIAL SPREADING COMPONENT. SITE: LEFT FOREARM. CLARK LEVEL: IV. BRESLOW THICKNESS: 1.85mm. ULCERATION: PRESENT. LYMPHOVASCULAR INVASION: ABSENT. NEUROTROPISM/DESMOPLASIA/SATELLITES: ABSENT. FEATURES OF REGRESSION: ABSENT. ASSOCIATED NAEVUS (TYPE): ABSENT. MARGINS: THE NEAREST MARGIN IS THE DEEP MARGIN WHICH IS 0.3mm CLEAR WHILE THE LATERAL MARGINS ARE 0.5mm CLEAR. RECOMMENDATION: WIDER EXCISION IS ADVISED."

"Skin (R) calf. MACROSCOPIC DESCRIPTION Labelled "(R) calf". Specimen consists of an ellipse of skin measuring 13x7mm to a depth of 2mm. On the surface is a pigmented papule measuring 5x4mm. Lesion all processed. 2T sections on 1 block. MICROSCOPIC DESCRIPTION: Sections of skin show mildly keratotic epidermis and dermis with a compound atypical melanocytic lesion. There is atypical junctional melanocytic cells with nest formation and focal lentiginous activity and superficial spreading melanocytic cells could be seen on H&E stain, some of them reaching the granular layer. Underlying dermal melanocytic cells appear epithelioid and show atypical nuclear features, including prominent nucleoli and the features of maturation are not clearly seen. Mitotic activity is noted, few in the lower one third of the lesion (up to 1/mm2). The dermal lesion is 0.73mm in thickness and 1.6mm clear of the closest peripheral margin. The junctional component extends beyond the dermal melanocytes and 0.3mm clear. No vascular invasion or neurotropism is noted. The overall appearances are those of an atypical compound melanocytic lesion. Case discussed with colleagues who agreed this is a challenging one. Many felt that features are in favour of a melanoma. Further report to follow. CONCLUSION: SKIN, RIGHT CALF, EXCISION - ATYPICAL COMPOUND MELANOCYTIC LESION (SEE TEXT)."

"1) Left proximal anterior tibia. 2) Left lateral anterior tibia. 3) Left proximal medial malleolus. MACROSCOPY: 1) A core of skin 2mm in diameter x 2mm in depth. All in. 2) A core of skin 2mm in diameter x 4mm in depth. All in. 3) A core of skin 2mm in diameter x 3mm in depth. All in. MICROSCOPY: 1) The punch biopsy shows hyperkeratotic squamous intraepidermal carcinoma. 2) The biopsy shows an atypical compound melanocytic lesion compatible with malignant melanoma, NOS. The in-situ component consists of single atypical lentiginous melanocytic proliferation. The invasive component extends to a depth of at least 1.25mm to reticular dermis. The lesion displays mixed epithelioid and spindled morphology. There is a mild lymphocytic infiltrate. The biopsy is right through the lesion. Appropriate wider excision recommended. 3) A well differentiated squamous cell carcinoma involves the full-thickness of the biopsy. SUMMARY DIAGNOSIS: 1) LEFT PROXIMAL ANTERIOR TIBIA, PUNCH BIOPSY - INTRAEPIDERMAL CARCINOMA. 2) LEFT LATERAL ANTERIOR TIBIA, PUNCH BIOPSY - MALIGNANT MELANOMA, NOS. BRESLOW THICKNESS 1.25mm, CLARK LEVEL IV. WIDER EXCISION RECOMMENDED. 3) LEFT PROXIMAL MEDIAL MALLEOLUS, PUNCH BIOPSY - SQUAMOUS CELL CARCINOMA."