PATHOLOGY OF MALIGNANT MELANOMA

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1 PATHOLOGY OF MALIGNANT MELANOMA

2 Springer Science+Business Media, LLC

3 PATHOLOGY of MALIGNANT MELANOMA Raymond L. Barnhill, MD Professor of Dermatology and Pathology, Departments of Dermatology and Pathology, University of Miami, Miami, FL, USA With a contribution by Martin J. Trotter, MD, PhD, FRCPC, DipRCPath Associate Professor, Department of Pathology and Laboratory Medicine University of Calgary and Calgary Laboratory Services Calgary, Alberta, Canada With 109 Illustrations Springer

4 Raymoud 1. Barnhill, MD Professor of Dermatology aud Pathology Departments of Dermatology aud Patholoh'Y University of Miami Miami, Florida USA Library of Congres. Cataloging-in-Publication Data Barnhill, Raymond 1.. Pathology of malignant melanoma I Raymond L. Barnhill, p. ;cm. Includes bibliographical references and index. ISBN O-O ISBN (ebook) DOI / Melanoma-Histopathology-Handbooks, manual., etc. 2. Melanoma-Diagnosis--Handbooks, manuals, etc. 3. Diagllosis, Differential-Haudbooks, manuals\ etc. [DNLM: 1. Melanoma-pathology. QZ 200 B262p 2003] RC280.M37B ' 477 -dc ISBN Printed an acid-frer paper Springer Scieuce+Busiuess Media New York Originally published by Springer-Verlag New York, Ine. in 2004 Al! rights reserved. This work may not be transiated or copied in whole or in part without the written permission of the pub Iisher Springer Science+Business Media., LLC. except for brief excerpts in connectiau with reviews ar scholarly analysis. Use in conuection with any form of information storage aud retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now knowti or hereafter developed is forbidden. 1he use in this publication of trade names, trademarks, serâce marks, and similar terms, even if they are not identified as such, is noi to be taken as au expression of opinion as to wbether Of not they are subject 10 proprietary rights. While the advice and information in this book are believed to be truc and accurate al the date of goiug ro press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors ar omissions lhat may be made. The publisher makes llo warranty, expres, or implied v.ith respect to the material contained herein. (MP/FRI) SPIN springeronline.com

5 .. Quand il s'agit d'ecrire, on est scrupuleux, on regarde de tres pres, on rejette tout ce qui n'est pas verite [for when it is a question of writing, one is scrupulous, one examines things meticulously, one rejects all that is not true]. -MARCEL PROUST a La Recherche du Temps Perdu (Le Temps Retrouve, La Pleiade, III p. 909). The author has been gratified by the enthusiastic response to the first edition of his book The Pathology of Melanocytic Nevi and Malignant Melanoma, and that it has proved so useful to many pathologists and other physicians who encounter melanocytic lesions on a regular basis. Since the publication of the first edition of the book, the challenge of diagnosis and management of melanoma to physicians has become even more compelling; hence there is a need for as much information as possible on this subject. As a result the author is pleased to offer a thoroughly revised stand-alone monograph dealing only with malignant melanoma. The goal of this monograph devoted to melanoma is "to provide a comprehensive [yet practical] description of melanomas occurring in the skin" in order to facilitate physicians in providing the best possible care for patients. A major emphasis of the monograph, in the spirit of Marcel Proust, has been to critically examine our current understanding of many entities and concepts in the pathology of melanoma. In this light the author has attempted to honestly scrutinize current information and to provide balanced perspectives on controversial subjects such as the development of melanoma, clinical and histopathological variants of melanoma, and borderline and biologically indeterminate lesions. This work discusses both new material and revised, in-depth discussions of many existing entities. Emphasis has been placed on clinical descriptions, detailed histopathological criteria for diagnosis, and a thorough discussion of differential diagnosis. A synoptic listing of the most pertinent information for all major entities is presented in tables throughout the book. Many color photomicrographs have been included. The author is grateful for the kind and generous help from many friends and colleagues at their respective medical institutions both past and present and from many referring physicians around the country and world. Without the referral of pathological material for consultation and the experience resulting from this, the v

6 vi Preface realization of this book would not have been possible. I would also like to thank Dr. Martin J. Trotter for his contribution to this book. The collective experience of rendering such consultations and writing this monograph is ultimately to assist other physicians and to manage patients most effectively, honestly, and compassionately. Raymond L. Barnhill, MD Washington, D.C. December 2003

7 Preface v Descriptive Epidemiology 1 Criteria for Diagnosis and Classification of Melanoma 2 Conventional Melanomas 12 Conventional Microinvasive Melanoma 32 Conventional Invasive Melanoma 33 Melanomas without Adjacent Intraepidermal Component 41 Solar Melanoma 46 Acral Melanoma (Palmar-Plantar Melanoma, Volar-Subungual Melanoma) 60 Subungual Melanoma (Melamoma of the Nail Apparatus) 65 Other Morphological and Cytological Variants of Melanoma 73 Unusual or Rare Variations of Melanoma and Particular Histomorphologic Alterations 128 Regression 139 Diagnosis and Management of the Borderline or Controversial Lesions Suggesting Melanoma 149 Histopathologic Reporting of Melanoma 155 vii

8 viii Contents References 156 Appendix I: Immunohistochemical Evaluation of Melanoma 173 Appendix II: Prognostic Factors for Malignant Melanoma 174 Appendix III: TNM Staging Classification for Malignant Melanoma 175 Appendix IV: Histopathological Reporting of Malignant Melanoma 176 Appendix V: Melanoma Staging, Prognostic Factors, and Pathology Reporting by Martin J. Trotter 177 Index 187

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