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Lymph node with melanoma metastasis. Massive invasion of tumoral pigmented cells throughout the pulp of the lymph node. HE26x.
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Blue nevus is an uncommon pigmented lesion of dermal melanocytes. By convention,two well defined histologic variants, designated as “common” and “cellular”, have been recognised. In the last few years, these lesions have attracted much attention due to the recognition of news entities and to its confusion with malignant melanoma. In the prestient r...
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Context 1
... and location of the cells inside the lymph node are the most significant differential aspects. Whereas "malig- Blue Nevus: Classical Types and New Related Entities . 633 nant" cases usually have pleomorphic cells with fre- quent mitoses forming large foci that affect lymph node sinuses, capsule, and parenchyma, as well as geo- graphic necrosis (Fig. 9), benign cases contain homoge- neous, nonmitotic cells forming small clumps usually lining the peripheral sinuses 41 ...
Citations
... The common nevus presents as a solitary dome-shaped papule. Unlike melanoma, common nevi are often <1 cm in diameter and arise in adolescence (González-Cámpora et al., 1994). They also preferentially affect the dorsal surface of the hands and feet. ...
... 2,3 Several clinical and histologic variants have been described (Table 1), the most common of which are common blue nevus, cellular blue nevus, and combined blue nevus. 6,7 The variant described herein, blue nevus with satellite lesions clinically mimicking malignant melanoma with cutaneous metastases, is rare. 2,7---9 The etiology and pathogenesis of the satellite lesions are unknown, although the intense concentration of periadnexal and perivascular nevus cells indicates that they could be caused by the infiltration and dissemination of nevus cells through the perivascular route. ...
... 2,3 Dermoscopic examination typically shows a diffuse homogeneous blue or steel blue structureless pattern, although polychromasia and structures typically associated with melanoma may be seen. 6 Malignant transformation of blue nevus is a controversial topic, 8---10 but there have been reports of the rare malignant blue nevus variant arising from a pre-existing blue nevus, at the site of an excised blue nevus, or in association with de novo melanoma. This clinical variant mainly affects patients like ours, i.e., men with lesions on the scalp. ...
... Depending on the location of the nevus cells, the malformation is classified histologically as intradermal, junctional, compound and blue nevi [1]. The blue nevus is a neoplasm that is composed of pigmented dendritic dermal melanocytic cells in the reticular dermis with the potential for malignant transformation [2]. A blue nevus can develop anywhere on the body, however, approximately 50% of the common blue nevi are usually located on the dorsal surface of the hands and feet, scalp, and buttocks [1,2]. ...
... The blue nevus is a neoplasm that is composed of pigmented dendritic dermal melanocytic cells in the reticular dermis with the potential for malignant transformation [2]. A blue nevus can develop anywhere on the body, however, approximately 50% of the common blue nevi are usually located on the dorsal surface of the hands and feet, scalp, and buttocks [1,2]. A blue nevus in the oral cavity is considered a rare lesion with important differential diagnoses [3]. ...
... Histologically, nevus cells are observed in the basal epithelial layers, the connective tissue or both. Therefore, they are classified as junctional, intradermal, intramucosal and compound nevi [1,2]. Of the different types of pigmented nevi, blue nevi are characterized by a proliferation of dermal melanocytes deep within the lamina propria, which accounts for the surface blue color [2,3,[7][8][9][10][11][12][13][14]. ...
Background and Overview: Nevi are either congenital or developmental pigmented malformations rarely found in the oral cavity. Approximately 30% of reported cases in this anatomical region are of the blue type, a histological variant with the potential for malignant transformation. There is no consensus in the literature regarding biopsy of pigmented lesions with malignant potential. In children, the intraoral blue nevus is rare. This case report describes the clinical features of a blue nevus in a 12-year old Asian male on the right hard palate of the maxilla. A differential diagnosis, rationale for excisional biopsy of this oral lesion and review of the literature are presented. The goal of this case report is to create awareness that such a rare pigmented lesion in the oral cavity can also occur in children.
... Depending on the location of the nevus cells, the malformation is classified histologically as intradermal, junctional, compound and blue nevi [1]. The blue nevus is a neoplasm that is composed of pigmented dendritic dermal melanocytic cells in the reticular dermis with the potential for malignant transformation [2]. A blue nevus can develop anywhere on the body, however, approximately 50% of the common blue nevi are usually located on the dorsal surface of the hands and feet, scalp, and buttocks [1,2]. ...
... The blue nevus is a neoplasm that is composed of pigmented dendritic dermal melanocytic cells in the reticular dermis with the potential for malignant transformation [2]. A blue nevus can develop anywhere on the body, however, approximately 50% of the common blue nevi are usually located on the dorsal surface of the hands and feet, scalp, and buttocks [1,2]. A blue nevus in the oral cavity is considered a rare lesion with important differential diagnoses [3]. ...
... Histologically, nevus cells are observed in the basal epithelial layers, the connective tissue or both. Therefore, they are classified as junctional, intradermal, intramucosal and compound nevi [1,2]. Of the different types of pigmented nevi, blue nevi are characterized by a proliferation of dermal melanocytes deep within the lamina propria, which accounts for the surface blue color [2,3,[7][8][9][10][11][12][13][14]. ...
Background and Overview: Nevi are either congenital or developmental pigmented malformations rarely found in the oral cavity. Approximately 30% of reported cases in this anatomical region are of the blue type, a histological variant with the potential for malignant transformation. There is no consensus in the literature regarding biopsy of pigmented lesions with malignant potential. In children, the intraoral blue nevus is rare. This case report describes the clinical features of a blue nevus in a 12-year old Asian male on the right hard palate of the maxilla. A differential diagnosis, rationale for excisional biopsy of this oral lesion and review of the literature are presented. The goal of this case report is to create awareness that such a rare pigmented lesion in the oral cavity can also occur in children.
... Blue nevi are an uncommon dermal melanocyte tumor that have attracted attention due to occasionally having a similar clinical presentation to malignant melanoma (8). Malignant melanoma often appear as brown-black nodules, with the "ABCDE" mnemonic commonly used as diagnostic criteria for biopsy: asymmetry, irregular borders, variegated color, diameter > 6 mm, and enlargement of the lesion (9). ...
... To further demonstrate that this behavior is consistent in melanins from other types of melanocytic lesions, we analyze cutaneous blue nevi lesions, acquired with pump wavelengths of 705 nm and 725 nm (see methods section). These lesions tend to be highly pigmented and exhibit remarkable pigment heterogeneity 25 . Figure 5 shows the gnomonic projections of the concatenated 705 nm and 725 nm data. ...
Pump-probe microscopy is an emerging technique that provides detailed chemical information of absorbers with sub-micrometer spatial resolution. Recent work has shown that the pump-probe signals from melanin in human skin cancers correlate well with clinical concern, but it has been difficult to infer the molecular origins of these differences. Here we develop a mathematical framework to describe the pump-probe dynamics of melanin in human pigmented tissue samples, which treats the ensemble of individual chromophores that make up melanin as Gaussian absorbers with bandwidth related via Frenkel excitons. Thus, observed signals result from an interplay between the spectral bandwidths of the individual underlying chromophores and spectral proximity of the pump and probe wavelengths. The model is tested using a dual-wavelength pump-probe approach and a novel signal processing method based on gnomonic projections. Results show signals can be described by a single linear transition path with different rates of progress for different individual pump-probe wavelength pairs. Moreover, the combined dual-wavelength data shows a nonlinear transition that supports our mathematical framework and the excitonic model to describe the optical properties of melanin. The novel gnomonic projection analysis can also be an attractive generic tool for analyzing mixing paths in biomolecular and analytical chemistry.
... The main diagnostic dilemma of the dermal component is the presence of proliferative nodules mostly in congenital nevi; useful findings in this context include a superficial location (the few melanomas that arise in congenital nevi during infancy are generally deeply located, sarcoma-like, massively cellular tumors), multiplicity (melanoma arising multiply is vanishingly rare), gradual transition/merging of the atypical cells in the proliferative nodule with those of the surrounding nevus (rather than 2 distinct cell types in melanoma arising in congenital nevi), absence of an epidermal component with pagetoid spread, absence of high-grade nuclear atypia and, mostly, necrosis. [182,183] The size of the lesion, deep dermal or subcutaneous extension and mitogenic or dermal nodular pattern are features of diagnostically borderline lesions that biologically can represent intermediate states during the neoplastic transformation or low-grade malignancies (melanocytic tumors of uncertain malignant potential). Other characteristics including age of the patient, ulceration, cytologic atypia, and ancillary studies such as assessment of mitotic index, other biologic markers, and analysis of chromosomal aberrations may aid in this evaluation. ...
The tumor progression in melanocytic lesions is assumed to follow a multistep process where the genetic alterations and the morphological steps are closely related. In general terms, this process is usually identified pathologically as dysplasia, intraepithelial malignancy, and early neoplasm. However, melanocytic lesions with dysplasia are, on one hand, controversial in its diagnostic criteria and, on the other hand, difficult to grade and subcategorize due to its heterogeneity. The key condition is the atypical (dysplastic) melanocytic nevus (AMN), which requires both architectural and cytological features to be defined and always needs grading to provide a more accurate risk assessment for the development of malignant melanoma. At this point, it is essential to identify reliably and predict high-grade dysplasia/melanoma-in-situ (HGD-MIS) at clinical, dermatoscopic, biological, and pathological levels within these highly heterogeneous lesions.
AMN-HGD and MIS share the same clinical and dermatoscopic features, which makes extremely hard to differentiate between them at this level. They are clearly different from atypical nevi with low-grade dysplasia, which usually present with soft clinical and dermatoscopic findings. Key dermatoscopic features for the low-grade vs. high-grade distinction are atypical pigment network, eccentric hyperpigmented blotches, and peripheral globules. Histologically, HGD-MIS is mainly defined by junctional asymmetry with both lentiginous and nested patterns, suprabasal melanocytes and at least three nuclear abnormalities (mainly nuclear enlargement, anisokaryosis and hyperchromatism as more predictive features). Biologically, these lesions reveal both cell kinetics and topographic genetic heterogeneity, which are mostly driven by abnormal TP53, dissociated from cyclin-dependent kinase inhibitors (p21WAF1-CDKN1A and p27KIP1-CDKN1B), especially for MIS. The differential diagnosis requires distinguishing them from atypical but not dysplastic melanocytic lesions (particularly in specific locations), and invasive malignant melanomas (mostly thin and non-tumorigenic status). The implications are also different for lentiginous and epithelioid dysplastic lesions, whose criteria are weighted in a slightly different way. Finally, the progression pathway in dysplastic melanocytic lesions is unlikely linear at morphological and genetic levels, and they show a distinct correlation with the molecular subtypes of malignant melanomas.
... The main diagnostic dilemma of the dermal component is the presence of proliferative nodules mostly in congenital nevi; useful findings in this context include a superficial location (the few melanomas that arise in congenital nevi during infancy are generally deeply located, sarcoma-like, massively cellular tumors), multiplicity (melanoma arising multiply is vanishingly rare), gradual transition/merging of the atypical cells in the proliferative nodule with those of the surrounding nevus (rather than 2 distinct cell types in melanoma arising in congenital nevi), absence of an epidermal component with pagetoid spread, absence of high-grade nuclear atypia and, mostly, necrosis. [182,183] The size of the lesion, deep dermal or subcutaneous extension and mitogenic or dermal nodular pattern are features of diagnostically borderline lesions that biologically can represent intermediate states during the neoplastic transformation or low-grade malignancies (melanocytic tumors of uncertain malignant potential). Other characteristics including age of the patient, ulceration, cytologic atypia, and ancillary studies such as assessment of mitotic index, other biologic markers, and analysis of chromosomal aberrations may aid in this evaluation. ...
The tumor progression in melanocytic lesions is assumed to follow a multistep process where the genetic alterations and the morphological steps are closely related. In general terms, this process is usually identified pathologically as dysplasia, intraepithelial malignancy, and early neoplasm. However, melanocytic lesions with dysplasia are, on one hand, controversial in its diagnostic criteria and, on the other hand, difficult to grade and subcategorize due to its heterogeneity. The key condition is the atypical (dysplastic) melanocytic nevus (AMN), which requires both architectural and cytological features to be defined and always needs grading to provide a more accurate risk assessment for the development of malignant melanoma. At this point, it is essential to identify reliably and predict high-grade dysplasia/melanoma-in-situ (HGD-MIS) at clinical, dermatoscopic, biological, and pathological levels within these highly heterogeneous lesions.AMN-HGD and MIS share the same clinical and dermatoscopic features, which makes extremely hard to differentiate between them at this level. They are clearly different from atypical nevi with low-grade dysplasia, which usually present with soft clinical and dermatoscopic findings. Key dermatoscopic features for the low-grade vs. high-grade distinction are atypical pigment network, eccentric hyperpigmented blotches, and peripheral globules. Histologically, HGD-MIS is mainly defined by junctional asymmetry with both lentiginous and nested patterns, suprabasal melanocytes and at least three nuclear abnormalities (mainly nuclear enlargement, anisokaryosis and hyperchromatism as more predictive features). Biologically, these lesions reveal both cell kinetics and topographic genetic heterogeneity, which are mostly driven by abnormal TP53, dissociated from cyclin-dependent kinase inhibitors (p21WAF1-CDKN1A and p27KIP1-CDKN1B), especially for MIS. The differential diagnosis requires distinguishing them from atypical but not dysplastic melanocytic lesions (particularly in specific locations), and invasive malignant melanomas (mostly thin and non-tumorigenic status). The implications are also different for lentiginous and epithelioid dysplastic lesions, whose criteria are weighted in a slightly different way. Finally, the progression pathway in dysplastic melanocytic lesions is unlikely linear at morphological and genetic levels, and they show a distinct correlation with the molecular subtypes of malignant melanomas.
... The main diagnostic dilemma of the dermal component is the presence of proliferative nodules mostly in congenital nevi; useful findings in this context include a superficial location (the few melanomas that arise in congenital nevi during infancy are generally deeply located, sarcoma-like, massively cellular tumors), multiplicity (melanoma arising multiply is vanishingly rare), gradual transition/merging of the atypical cells in the proliferative nodule with those of the surrounding nevus (rather than 2 distinct cell types in melanoma arising in congenital nevi), absence of an epidermal component with pagetoid spread, absence of high-grade nuclear atypia and, mostly, necrosis. [182,183] The size of the lesion, deep dermal or subcutaneous extension and mitogenic or dermal nodular pattern are features of diagnostically borderline lesions that biologically can represent intermediate states during the neoplastic transformation or low-grade malignancies (melanocytic tumors of uncertain malignant potential). Other characteristics including age of the patient, ulceration, cytologic atypia, and ancillary studies such as assessment of mitotic index, other biologic markers, and analysis of chromosomal aberrations may aid in this evaluation. ...
The tumor progression in melanocytic lesions is assumed to follow a multistep process where the genetic alterations and the morphological steps are closely related. In general terms, this process is usually identified pathologically as dysplasia, intraepithelial malignancy, and early neoplasm. However, melanocytic lesions with dysplasia are, on one hand, controversial in its diagnostic criteria and, on the other hand, difficult to grade and subcategorize due to its heterogeneity. The key condition is the atypical (dysplastic) melanocytic nevus (AMN), which requires both architectural and cytological features to be defined and always needs grading to provide a more accurate risk assessment for the development of malignant melanoma. At this point, it is essential to identify reliably and predict high-grade dysplasia/melanoma-in-situ (HGD-MIS) at clinical, dermatoscopic, biological, and pathological levels within these highly heterogeneous lesions.
AMN-HGD and MIS share the same clinical and dermatoscopic features, which makes extremely hard to differentiate between them at this level. They are clearly different from atypical nevi with low-grade dysplasia, which usually present with soft clinical and dermatoscopic findings. Key dermatoscopic features for the low-grade vs. high-grade distinction are atypical pigment network, eccentric hyperpigmented blotches, and peripheral globules. Histologically, HGD-MIS is mainly defined by junctional asymmetry with both lentiginous and nested patterns, suprabasal melanocytes and at least three nuclear abnormalities (mainly nuclear enlargement, anisokaryosis and hyperchromatism as more predictive features). Biologically, these lesions reveal both cell kinetics and topographic genetic heterogeneity, which are mostly driven by abnormal TP53, dissociated from cyclin-dependent kinase inhibitors (p21WAF1-CDKN1A and p27KIP1-CDKN1B), especially for MIS. The differential diagnosis requires distinguishing them from atypical but not dysplastic melanocytic lesions (particularly in specific locations), and invasive malignant melanomas (mostly thin and non-tumorigenic status). The implications are also different for lentiginous and epithelioid dysplastic lesions, whose criteria are weighted in a slightly different way. Finally, the progression pathway in dysplastic melanocytic lesions is unlikely linear at morphological and genetic levels, and they show a distinct correlation with the molecular subtypes of malignant melanomas.
Also selected for publication in Advances in Medicine and Biology, Vol 100, pages 109-153
... They are also found rarely in oral and genital mucosa [2,6-8]. They usually measure less than 2 cm in diameter and are generally single, small size and dark blue [2,8]. ...
