This program is concerned with the quality of diagnoses made by the dermatopathologist.
The slide set images will be available to registrants online.
To view the quality of electronic images that will be part of the program, please refer to the sample case we have provided for your review. Good luck!
Example Case #1:
73-year-old man with a plaque-like non-pigmented lesion on the back of his neck. Click on images to enlarge.
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- Scar
- Malignant peripheral nerve sheath tumor
- Lentigo maligna
- Lentigo maligna melanoma
- Desmoplastic melanoma
E. DESMOPLASTIC MELANOMA (DM), typically occurring in sun-damaged skin of the head and neck areas, is the vertical growth phase component of melanoma characterized by spindle cells. It may or may not have an antecedent lentiginous radial growth phase component, which is either lentigo maligna (LM), acral-lentiginous or mucosal-lentiginous melanoma. The antecedent radial growth phase in the case shown is LM. The desmoplastic growth phase is almost always amelanotic so that clinical signs may be comparatively subtle. Scanning magnification reveals the two main components i.e. the junctional lentiginous and the other tumorigenic proliferation of spindle cells separated by delicate collagen bundles within which is the highly characteristic host response consisting of clusters of mature small lymphocytes. Although the tumor cells are commonly amelanotic they are usually positive for S100 protein. Distinguishing DM from scars especially in re-excision specimens can be tricky and a report showing the presence of S100 positive spindle cells in scar tissue, representing a potential diagnostic pitfall, further confounds the issue! Lentigo maligna, with a distribution similar to that of DM, is pigmented and characterized by an atrophic epidermis with increased numbers of atypical melanocytes arranged as single cells and in nests with minimal pagetoid spread. Lentigo maligna melanoma or invasive LM is characterized, in addition to the above, by a dermal component of atypical spindle or epithelioid melanocytes. Malignant peripheral nerve sheath tumor is characterized by interlacing bundles of spindle cells embedded in a fibromyxoid matrix with alternating densely cellular and more loosely textured areas.
REFERENCES- Chorny JA, Barr RJ. S-100 positive spindle cells in scars: a potential diagnostic pitfall. Am J Dermatopathol 2001; 24:309-12.
- Whittaker DC, Argenyi Z, Smith AC. Desmoplastic malignant melanoma: rare and difficult to diagnose. J Am Acad Dermatol 1992;26:704-9.
- Jain S, Allen PW. Desmoplastic malignant melanoma and its variants. Am J Dermatopathol 1989; 13: 358-73.
