Last major update: November 2008 - next update November 2009
Revised: 22 September 2009
Author: Nat Pernick, M.D., PathologyOutlines.com, Inc.
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
● 15-30% of melanoma patients
● Affects all body surfaces, but usually legs and trunk
● Rapid growth; comprises 34% of thick (2 mm+) melanomas (Arch Dermatol 2005;141:745)
● Higher risk for metastases due to vertical growth phase, but differs from “vertical growth melanoma” (J Dermatol 2008;35:643)
● May recur even in sentinel lymph node negative patients (Surgeon 2006;4:153)
● Median age 63 years; screening methods have had little impact on this subtype (Cancer 2008 Nov 5 [Epub ahead of print] )
● 25 cm tumor (Dermatol Online J 2007;13(2):7)
● Metastatic amelanotic tumor during pregnancy (Medicina (Kaunas) 2008;44:467)
● With Spitz nevus like features (J Dermatol 2007;34:821)
● Smooth nodule covered by normal epidermis, elevated blue-black plaque or ulcerated polypoid mass
● Usually no lateral flat component
25 cm tumor Various images
● Nonspecific global dermoscopic patterns of globules, blue-white veil, atypical vessels and structureless areas (Arch Dermatol 2008;144:1311)
● No radial growth phase
● Epidermis is thin and may be ulcerated
● No in situ melanoma
● Dermal component consists of a cohesive nodule of tumor cells with pushing border
● Cells are most commonly epithelioid, may be spindled or small with occasional monster cells (Am J Dermatopathol 2005;27:208)
Contributed by John Irlam, D.O., Department of Pathology, University of Toledo Medical Center:
Low power (4x)
Medium power (10x)
Medium power (20x)
High power (40x)
Molecular / cytogenetics
● B-RAF and N-RAS mutations in 25-30% (J Invest Dermatol 2005;125:312)
● Primary dermal melanoma - no in situ component, ulceration, regression, associated nevus (Arch Dermatol 2008;144:49)
End of Skin-Melanocytic Tumors > Nodular melanoma
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