PHILIP E. LEBOIT. Histological Diagnosis of Nevi and Melanoma

Transcription

1 GUIDO MASSI PHILIP E. LEBOIT Histological Diagnosis of Nevi and Melanoma

2 GUIDO MASSI PHILIP E. LEBOIT Histological Diagnosis of Nevi and Melanoma With Contributions by PAOLA PASQUINI and FRANCESCO FEDERICO, FEDERICA CASTRI, LEO CELLENO WITH 396 FIGURES IN 760 SEPARATE ILLUSTRATIONS STEINKOPFF fi), Springer

3 Prof. Gumo MASSI, M. D. Professor of Pathology and Dermatopathology Department of Pathology Catholic University Medical School Largo F. Vito, Rome, Italy PHILIP E. LEBOIT, M. D. Professor of Dermatopathology University of California 1701 Divisadero St., Room 350 CA 94115, San Francisco, USA PAOLA PASQUINI, M. D. FRANCESCO FEDERICO, M. D. FEDERICA CASTRI, M. D. Department of pathology Catholic University Medical School Largo F. Vito, Rome, Italy LEONARDO CELLENO, M. D. Department of Dermatology Catholic University Medical School Largo F. Vito, Rome, Italy ISBN DOI / ISBN (ebook) Bibliographic information published by Die Deutsche Bibliothek Die Deutsche Bibliothek lists this publication in the Deutsche Nationalbibliografie; detailed bibliographic data is available in the Internet at < This work is subject to copyright. AU rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Steinkopff Verlag. Violations are liable for prosecution under the German Copyright Law. Springer-Verlag Berlin Heidelberg 2004 Origina1ly published by Steinkopff Verlag Darmstadt 2004 Softcover reprint of the hardcover 1 st edition The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Production Manager: K. Schwind Cover Designer: E. Kirchner Printing and binding: Stiirtz AG, Wiirzburg SPIN / O - Printed on acid-free paper

4 This book is dedicated to my mother FERNANDA CELLINI MASSI (G.M.) and to KAREN,JONAH, TOR~ PHOEBE AND MOLLIE (P.1.)

5 Foreword The interpretation of melanocytic tumors represents one of the most important topics and probably the most difficult challenge in the field of dermatopathology. For example, the evaluation of the so called nevoid (spitzoid) melanoma, Spitz's nevi with conflicting criteria, or some benign simulators of malignant melanoma can pose seemingly insurmountable diagnostic problems. A correct diagnosis is expected, because the implications are serious. The misreading of a section of a malignant melanoma as a nevus, which will then be left untreated, may result in regrowth at the biopsy site, may metastasize and lead to death. Whereas, overdiagnosis of Spitz's nevus may be followed by unnecessarily extensive surgery including lymph node dissection and, sometimes, immunotherapy and chemotherapy also. Melanocytic tumors are identified by clinical and histological criteria, with the later based on both architectural and cytomorphological features. A clear, comprehensive book on this subject can be of help to dermatopathologists, general pathologists, and dermatologists. Philip LeBoit and Guido Massi are particularly suited to deal with this task, because of their great experience. They have produced an impressive work that will be respected as a major teaching guide and diagnostic aid for melanoma and benign melanocytic lesions. I would like to underline the following prominent features found in this text which reveal how modern dermatopathology should be presented: - Complete coverage of the field. Remarkably all special variants of melanocytic proliferations are described - Emphasis on a concise differential diagnostic approach - Clinicopathologic correlation, also crucial for the diagnosis of melanocytic tumors - Presentation of new concepts and observations - Beautiful design with illustrations of exceptional quality. All these accomplishments will mark this book as an important and most valuable contribution to the literature concerning melanocytic neoplasms. HELMUT KERL, Graz Austria

6 Preface The aim of this book is to provide an ample illustration of the melanocytic lesions as we know them today, emphasizing those which are important in the distinction between nevi and melanomas. In fact, although outstanding books on the subject have already been published, and many new texts are in color, we think that even in the age of internet the present collection of large format half-tone pictures of a significant number of different cases can still be useful to any physician dealing with this subject in their daily work. This book has some aspects and limits that the reader should know of: The diagnoses put forward in the captions of illustrations represent only the opinions of the authors. Although the follow-up of the patient is known in many cases, no such information has been collected for the vast majority of patients; moreover, in many cases the follow-up is too short to really reveal the nature of melanocytic lesions (which in their malignant entities are notoriously known as being able to metastas ize even after decades). Hence, our diagnoses are largely supported by our collective experience in similar cases. Our goal is to illustrate in detail melanocytic neoplasms of diagnostic interest encountered in daily practice, and to present as many variations that can be fitted between these two covers. We have ignored or treated only in passing pigmented and melanocytic lesions which have no important diagnostic difficulty; moreover, the reader should consult other more complete publications for the general aspects of the biology pathology of nevi and melanomas. A logical but also practical classification of melanocytic lesions does not currently exist. We have used an empirical approach and the neoplasms have been simply listed according to the most frequently used names in dermatopathology laboratories. Also, the language used in the book reflects the one commonly used in our practice, in which the shorter Spitz nevus has replaced the cumbersome "spindle or epithelioid cell nevus". Even the title of this book reflects such an attitude: Nevi is the colloquial, if incomplete shorthand for melanocytic nevi. Few colleagues mistake the declaration "it's a nevus" as a statement that the lesion at hand is an eccrine nevus. If the reader can learn something new, true and useful from this book we will count it a success. Rome, Italy and San Francisco, USA May 2004 GUIDO MASSI PHILIP E. LEBOIT

7 Acknowledgments Many of this book's illustrations have been taken from cases collected by many colleagues in their files, other slides have been sent to us or to others for consultation. We thank these colleagues for their help and take upon ourselves the entire responsibility for the diagnoses provided here. A few pictures have been reported from publications, we thank the Journals for their kind grant of permission for reproduction. Special thanks are of course to be addressed to the authors whose interpretation of the cases has been wholly accepted. Histological slides have been mostly prepared in the laboratories of dermatopathology of the University of California, San Francisco, of the Catholic University of Rome and of the Roman dermatopathology private laboratory; the skill of all the technicians has been crucial to the final quality of the pictures. Cinzia Cecoli provided a decisive contribution by helping in the preparation of the photographic films and in the manuscript's typing. The lay-out of this book were devised by Giorgio Spadanuda. Sandro Verzilli did the gauging of the figures' grey tones and contrast. The proofs have been thoroughly revised by Brian Steven Paul. Finally, we would like to mention the teachers, colleagues and co-workers who, with their encouragement, advise and assistance, helped us finish this book.

8 Contents Criteria for the Diagnosis of Benign Melanocytic Nevus 1 2 Melanocytic Hyperplasia Melanotic Macules "Common" Nevus 35 5 Congenital Nevus Junctional Anomalies in Congenital and Acquired Nevi in the First Years of Life 85 7 Proliferative Nodules in Congenital Nevi Nevus Spilus Dermal Melanocytoses "Common" Blue Nevus "Cellular" Blue Nevus Spitz Nevus 13 Reed Nevus Deep Penetrating Nevus Dysplastic & Clark's Nevus Combined Nevus Nevi on Acral Skin Nevi on Genital Skin Nevi in the Oral Cavity Polypoid Nevus of Pregnancy and Milk Line Nevi Nevi of the Conjunctiva Melanocytic Nevi affected by Inflammatory Skin Diseases Halo Nevus Recurrent and Persistent Nevi Criteria for the Diagnosis of Malignant Melanoma Melanoma in Situ Lentigo Maligna Superficial Spreading Pattern of Melanoma Nodular Pattern of Melanoma 425

9 30 Melanoma with Spindle Cell Nevoid Melanoma Spitzoid Melanoma Desmoplastic Melanoma Neurotropic Melanoma Melanoma with Neural Differentiation Myxoid Melanoma Melanoma resembling Blue Nevus Animal Type Melanoma Melanoma arising in Blue Nevus Unusual and Bizarre Forms of Melanoma Melanoma arising in a pre-existent Nevus Melanoma on Palms, Soles and Subungual Melanoma - Acral Melanoma Melanoma on Genital Skin Melanoma on Oral Cavity Melanoma on Conjunctiva Recurrent and Persistent Melanoma Regressing and Regressed Melanoma Cutaneous Metastatic Melanoma Histological Prognostic Factors 645 Index 651 II