Wednesday, October 3, 2012

Superficial Spreading Melanoma with Signs of Regression

Try to imagine what this lesion would look like clinically.  What you see is scattered nests and individual melanocytes which have a "dusty (finely granular) cytoplasm, enlarged blood vessels and some evidence of regression in that you can see clumps of melanin in the superficial dermis.  There is superficial perivascular inflammation as well.  How does this translate to the naked eye?

The scattered melanocytes mean that the edge of the lesion will be more diffuse and hazy rather than clear cut, because the usual well-defined melanocytic lesion has nests of cells, rather than individual cells of pigment production at the edge.  

The pigment incontinence gives it a very, very dark appearance, often jet black, because of the depth of the pigment.  This pigmentary incontinence comes from the lesion being attacked by the immune system, which in turn causes the pigment in the melanocytes to leak out into the dermis.  

The enlarged blood vessels give it a slightly pinkish look at the periphery, and that, along with the inflammatory cells, makes it look slightly edematous.

I gave credit for any answer which involved melanoma, because it was a very subtle call between SSMM and MIS with regression.  

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