A cellular and malignant blue nevus: A light and electron microscopic study

Merkow, Leonard P.; Burt, Robert C.; Hayeslip, David W.; Newton, Frank J.; Slifkin, Malcolm; Pardo, Matias

doi:10.1002/1097-0142(196911)24:5<888::aid-cncr2820240505>3.0.co;2-8

Cited by 83 publications

(17 citation statements)

References 16 publications

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“…Overall, there is a slight male preponderance described in the literature (56 lesions in males compared with 51 women)-in contrast to our findings (9 men to 15 women). The most common anatomic site for these lesions is the head and neck region in 52 cases, 4,5,7,11,13,[15][16][17][18][19][20][21]23,24,27,28,31,33,36,39,42,[46][47][48]51,53 followed by the trunk in 28 cases, 4,5,7,[11][12][13]16,18,25,32,34,35,38,43,45,50,52 the lower extremity in 11 cases, 4,7,13,14,26,30,33...…”

Section: Discussionmentioning

confidence: 99%

“…Regarding pathologic findings, the reported cases (in order of frequency) included malignant melanocytic proliferations mimicking a cellular blue nevus but lacking an identifiable benign component (in 38% of cases) 5,11,[13][14][15]18,20,25,28,30,33,36,47,49 or melanomas arising in association with a distinctive blue nevus component, including (a) cellular blue nevus (26%), 4,5,11,16,18,29,40,46,50,51,53 (b) common blue nevus (21%), 5,13,22,24,27,31,32,34,37,39,41,43,52 (c) both cellular and common blue nevus (13%), 12,16,21,23,35,38,44,45,48 (d) neurocristic hamartoma (1%) 42 and (e) nevus of Ota (1%). 17 In contrast, all of the cases in our series consisted of distinctly biphenotypic melanocytic proliferations (melanoma together with a benign blue nevus component).…”

Section: Discussionmentioning

confidence: 99%

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Melanoma arising in association with blue nevus: a clinical and pathologic study of 24 cases and comprehensive review of the literature

et al. 2014

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Melanomas arising in association with blue nevi or mimicking cellular blue nevi comprise a relatively rare and heterogeneous group of melanomas. It remains controversial which prognostic indicators predictive of outcome in conventional cutaneous melanomas are applicable to this type of melanoma. Here, we describe the clinical and histopathologic features of 24 melanomas arising in association with blue nevi and correlate these with clinical outcome. The mean patient age was 49 years (range: 23-85) with a slight female predominance (15 females:9 males). The most common anatomic locations included the head and neck region (50%), the trunk (21%), and the buttock/sacrococcygeum (17%). Histologically, the tumors were typically situated in the mid to deep dermis with variable involvement of the subcutis, but uniformly lacked a prominent intraepithelial component. The mean tumor thickness (defined as either the standard Breslow thickness or, if not available due to the lack of orientation or lack of epidermis, the largest tumor dimension) was 20.9 mm (range: 0.6-130 mm). The mean mitotic figure count was 6.5/mm 2 (range: 1-30/mm 2 ). Perineural invasion was common (38%). Followup was available for 21 cases (median 2.1 years). The median overall survival, recurrence-free survival, time to local recurrence, and time to distant recurrence were 5.2, 0.7, 2.6, and 1.6 years, respectively. Logistic regression analyses demonstrated a significant association between tumor thickness and recurrence-free survival (hazard ratio ¼ 1.02 per mm; P ¼ 0.04) and reduced time to distant metastasis (hazard ratio ¼ 1.03 per mm; P ¼ 0.02) with a similar trend toward reduced time to local recurrence (hazard ratio ¼ 1.02 per mm; P ¼ 0.07). No other parameters (age, anatomic location, mitotic figures, lymphovascular or perineural invasion, or type of associated blue nevus) emerged as significant. In addition, we provide a comprehensive review of 109 cases of melanoma blue nevus type described in the English literature and summarize our findings in this context.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Melanoma arising in association with blue nevus: a clinical and pathologic study of 24 cases and comprehensive review of the literature

et al. 2014

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“…[87][88][89][90][91][92][93][94][95][96][97] These lesions are most common on the scalp, although they have been reported at other sites such as the arm (Figures 26 and 27). 98 In only rare cases will a malignant blue nevus arise de novo with no apparent benign precursor, and in such circumstances, an alternate label or diagnosis should be considered.…”

Section: Introduction and Clinical Featuresmentioning

confidence: 99%

Unusual variants of malignant melanoma

2006

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A potential diagnostic pitfall in the histologic assessment of melanoma is the inability to recognize unusual melanoma variants. Of these, the more treacherous examples include the desmoplastic melanoma, the nevoid melanoma, the so-called 'minimal-deviation melanoma,' melanoma with prominent pigment synthesis or 'animal-type melanoma,' and the malignant blue nevus. Also problematic are the unusual phenotypic profiles seen in vertical growth phase melanomas; these include those tumors whose morphological peculiarities mimic cancers of nonmelanocytic lineage and those melanomas that express aberrant antigenic profiles not commonly associated with a melanocytic histogenesis. Metaplastic change in melanoma, balloon cell melanoma, signet-ring cell melanoma, myxoid melanoma, small cell melanoma and rhabdoid melanoma all have the potential to mimic metastatic and primary neoplasms of different lineage derivations. Abnormal immunohistochemical expression of CD 34, cytokeratins, epithelial membrane antigen, and smooth muscle markers as well as the deficient expression of S100 protein and melanocyte lineage-specific markers such as GP100 protein (ie HMB-45 antibody) and A103 (ie Melan-A) also present confusing diagnostic challenges. In this review, we will discuss in some detail certain of these novel clinicopathologic types of melanoma, as well as the abnormal phenotypic expressions seen in vertical growth phase melanoma. Modern Pathology (2006) 19, S41-S70. doi:10.1038/modpathol.3800516Keywords: melanoma; variants; phenotype; immunohistochemistry; morphology Desmoplastic melanoma Introduction and Clinical FeaturesDemoplastic melanoma is a rare variant of malignant melanoma first recognized in 1971.1 Desmoplastic and neurotropic melanoma may be mistaken clinically for a scar, a fibroma, a basal cell carcinoma, or a fibromatosis. Sometimes there is pronounced mucin deposition that imparts a boggy quality to the lesion. 2,3 The clinical clue to the diagnosis, when present, is cutaneous or mucosal pigmentation overlying a palpable dermal or submucosal nodule. That said, only half of desmoplastic melanomas are clinically pigmented. 3 Desmoplastic melanomas tend to occur in the head and neck area and the upper back [4][5][6][7] but are also seen in mucosal sites such as the vulva or gingiva 8 and in acral locations. Typically, they occur in older patients, with mean ages in the larger series falling into the sixth to eighth decades of life. 4,6,[9][10][11][12][13][14][15] Larger series show a male preponderance of 1.75 to 1. 15 Although any given desmoplastic melanoma can be deeply invasive, when matched for depth of invasion, they are associated with a lesser risk of metastatic disease than conventional melanomas of similar depth. The classical clinical finding is that of a pale or fleshy firm nodule reminiscent of a scar, which tends to delay clinical diagnosis and biopsy. Carlson et al,6 who reported an equal distribution in men and women, found most tumors to be located in the head and neck area (75%) and to be nonpigment...

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“…These are represented by numerous hypertrophic nerves and nerve-like structures, which run, variously oriented, in the substance of the nevus and are, in turn, colonized by its cells. These findings, which were repeatedly highlighted in the past for their possible histogenetic significance, [1][2][3][4][5][6][7][8] are currently given little consideration and regarded as merely coincidental. However, the conventional, 4-to 5-mm-thick histologic sections can only catch short tracts of cordlike structures such as nerves, which run across them in all directions, disappearing above and below their plane.…”

Section: Introductionmentioning

confidence: 99%

Perineural Pattern of Aggregation of Cellular Blue Nevus: Probable Histoarchitectural Reminiscence of Histogenesis

Castelli

Morello²,

Rm³

2008

The American Journal of Dermatopathology

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A striking feature of cellular blue nevus consists in the presence, in its histologic picture, of numerous hypertrophic nerves and nerve-like figures, positive for histochemical and immunohistochemical methods for nerve fibers and myelin sheaths. These findings, first described in Masson's original article and repeatedly highlighted in the past for their possible histogenetic significance, are currently considered as merely coincidental. However, the thin conventional histologic sections, catching only short tracts of the nerves, preclude a correct observation of their route and do not allow us to verify if there is an architectural relationship between them and the nevus as a whole. With this aim, we observed a few specimens of cellular blue nevus on digitally overlapped images of contiguous 25-microm-thick sections, processed with Winkelmann's technique of silver impregnation for nerve fibers, which supplied an overall, 3-dimensional view of the lesions and the nerves running through them. In these images, the lobular form of the nevus could be seen gathering around a branching hypertrophic nerve, whose stem stretched vertically from the depth to the most superficial tract of the lesion. The nevus cell aggregates invested the stem and the limbs individually, and these followed the curvilinear contour of the nevus lobules. Our images represent evidence of a preferential perineural aggregation of cellular blue nevus, at least in its lobular form. This indicates that the numerous nerves and the neuroid figures, observed in detail-but within a limited perspective- in the conventional sections, are not merely coincidental and they could indeed be a sign of neural differentiation and/or a clue to the possible neural origin of the nevus.

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A cellular and malignant blue nevus: A light and electron microscopic study

Cited by 83 publications

References 16 publications

Melanoma arising in association with blue nevus: a clinical and pathologic study of 24 cases and comprehensive review of the literature

Melanoma arising in association with blue nevus: a clinical and pathologic study of 24 cases and comprehensive review of the literature

Unusual variants of malignant melanoma

Perineural Pattern of Aggregation of Cellular Blue Nevus: Probable Histoarchitectural Reminiscence of Histogenesis

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