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UNDIFFERENTIATED MELANOMA  An amelanotic undifferentiated malignant spindle...
Published: 01 February 2024
UNDIFFERENTIATED MELANOMA Figure 21-8 UNDIFFERENTIATED MELANOMA An amelanotic undifferentiated malignant spindle cell neoplasm is seen. It was initially interpreted as sarcoma by a soft tissue pathologist, but the diagnosis was revised to metastatic melanoma after sequence analysis revealed UV signatures and an NRAS Q61R mutation identical to the mutation in the patient’s prior primary melanoma located draining to the site of the undifferentiated tumor. More about this image found in UNDIFFERENTIATED MELANOMA An amelanotic undifferentiated malignant spindle...
Book Chapter
Series: Atlases of Tumor and Non-Tumor Pathology, Series 5
Volume: 19
Published: 01 February 2024
10.55418/9781933477428-09
ISBN-10: 1-933477-42-3
ISBN: 978-1-933477-42-8
... or absent  Melanophages common  Often part of a combined nevus (usually with a small conventional nevus) Differential Diagnosis  Plexiform Spitz nevus  Blue nevus  Pigmented epithelioid melanocytoma  Melanoma Molecular Genetic Findings  Mutations of beta-catenin pathway...
Book Chapter
Series: Atlases of Tumor and Non-Tumor Pathology, Series 5
Volume: 19
Published: 01 February 2024
10.55418/9781933477428-18
ISBN-10: 1-933477-42-3
ISBN: 978-1-933477-42-8
... in melanophages and stromal cells. D: The epithelioid melanocytes diffusely express PRAME (preferentially expressed antigen in melanoma). The tumor carried a GNAQ 209L mutation. Melanoma Associated with Dermal Melanocytosis. Melanoma also arises in association with dermal or subcutaneous melanocytosis...
Book Chapter
Series: Atlases of Tumor and Non-Tumor Pathology, Series 5
Volume: 19
Published: 01 February 2024
10.55418/9781933477428-19
ISBN-10: 1-933477-42-3
ISBN: 978-1-933477-42-8
... with a molecular pathway characteristic of Spitz neoplasms, such as kinase fusions or HRAS mutations ( Table 19-1 ) ( 3 – 7 ). A “true” Spitz melanoma is not supposed to harbor a driver mutation of a conventional melanoma, such as BRAF, NRAS, or NF1. Table 19-1 FEATURES OF SPITZOID...
Book Chapter
Series: Atlases of Tumor and Non-Tumor Pathology, Series 5
Volume: 19
Published: 01 February 2024
10.55418/9781933477428-20
ISBN-10: 1-933477-42-3
ISBN: 978-1-933477-42-8
... lentiginous (rare) Differential Diagnosis  Acquired nevi in special sites (scalp, acral, genital area, conjunctiva)  Melanocytic nevi with pagetoid melanocytosis Molecular Genetic Findings  Similar to adult melanoma   BRAF mutation   TERT promoter mutation...
Images
PRIMARY BLUE MELANOMA  An expansile tumor nodule is present in the subcutis...
Published: 01 February 2024
PRIMARY BLUE MELANOMA Figure 18-7 PRIMARY BLUE MELANOMA An expansile tumor nodule is present in the subcutis. The tumor carried a GNAQ 209L mutation. By clinical history, the patient had a blue nevus for many years, which had changed. More about this image found in PRIMARY BLUE MELANOMA An expansile tumor nodule is present in the subcutis...
Book Chapter
Series: Atlases of Tumor and Non-Tumor Pathology, Series 5
Volume: 19
Published: 01 February 2024
10.55418/9781933477428-14
ISBN-10: 1-933477-42-3
ISBN: 978-1-933477-42-8
...  Acral nevus  Acral lentigo  Clear cell sarcoma Molecular Genetic Findings  Genomic complexity common  BRAF, NRAS, NF1, TERT mutations less common than in sun-exposed melanomas ACRAL MELANOMA Figure 14-1 ACRAL MELANOMA A: There is a large pigmented patch on the heel. B...
Images
MELANOMA ARISING IN ASSOCIATION WITH A BLUE NEVUS  A: A nodule of epithelio...
Published: 01 February 2024
MELANOMA ARISING IN ASSOCIATION WITH A BLUE NEVUS Figure 18-1 MELANOMA ARISING IN ASSOCIATION WITH A BLUE NEVUS A: A nodule of epithelioid melanocytes is associated with melanophages as well as pigmented slender and dendritic melanocytes in the surrounding dermis. B,C: The epithelioid melanocytes display nuclear atypia (B) and lack nuclear expression of BAP1 (C), which is retained in melanophages and stromal cells. D: The epithelioid melanocytes diffusely express PRAME (preferentially expressed antigen in melanoma). The tumor carried a GNAQ 209L mutation. More about this image found in MELANOMA ARISING IN ASSOCIATION WITH A BLUE NEVUS A: A nodule of epithelio...
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CONVENTIONAL MELANOMA WITH SPITZOID FEATURES  A: Silhouette of the neoplasm...
Published: 01 February 2024
CONVENTIONAL MELANOMA WITH SPITZOID FEATURES Figure 19-1 CONVENTIONAL MELANOMA WITH SPITZOID FEATURES A: Silhouette of the neoplasm with a predominant nested growth pattern. B: The tumor cells carry a NRAS Q61R mutation and are uniformly immunoreactive with the antibody SP174. C: The tumor cells display some spitzoid cytologic features; a few clefts are seen between junctional nests and epidermis. D: The tumor cells harbor a number of chromosomal aberrations assessed by single nucleotide polymorphism (SNP) array. More about this image found in CONVENTIONAL MELANOMA WITH SPITZOID FEATURES A: Silhouette of the neoplasm...
Book Chapter
Series: Atlases of Tumor and Non-Tumor Pathology, Series 5
Volume: 19
Published: 01 February 2024
10.55418/9781933477428-16
ISBN-10: 1-933477-42-3
ISBN: 978-1-933477-42-8
.... However, it is typically expressed by mixed DM. Its sensitivity for pure DM is low ( 19 ). MOLECULAR GENETIC FINDINGS DM of chronically sun-damaged skin is characterized by a high mutation burden ( 20 ). Common mutations involve NF1, TP53, and NFkB inhibitor epsilon ( 20 , 21 ). DM...
Book Chapter
Series: Atlases of Tumor and Non-Tumor Pathology, Series 5
Volume: 19
Published: 01 February 2024
10.55418/9781933477428-08
ISBN-10: 1-933477-42-3
ISBN: 978-1-933477-42-8
..., but unlike other nevi, are also usually positive for gp100 (HMB-45) ( 3 , 4 ). Most harbor mutations in GNAQ and GNA11, while mutations of CYSTLTR2 or PLCB4 or gene fusions involving GRIM1 or PRKCA are less common ( 2 , 5 – 11 ). DERMAL MELANOCYTOSES Dermal melanocytoses...
Book Chapter
Series: Atlases of Tumor and Non-Tumor Pathology, Series 5
Volume: 19
Published: 01 February 2024
10.55418/9781933477428-11
ISBN-10: 1-933477-42-3
ISBN: 978-1-933477-42-8
... of expression of the protein product of the PRKAR1A gene (the gene that often shows germline mutations in patients with Carney complex) ( fig. 11-4 ) ( 6 ). Some PEMs express BRAF V600E. PIGMENTED EPITHELIOID MELANOCYTOMA Figure 11-4 PIGMENTED EPITHELIOID MELANOCYTOMA A: Silhouette of a heavily...
Book Chapter
Series: Atlases of Tumor and Non-Tumor Pathology, Series 5
Volume: 19
Published: 01 February 2024
10.55418/9781933477428-17
ISBN-10: 1-933477-42-3
ISBN: 978-1-933477-42-8
...  Molecular Genetic:   Genomic aberrations are common (cytogenetic tests are often positive)   NRAS mutations and noncoding mutations are common a Classic type of nevoid melanoma (melanoma simulating a small acquired or congenital nevus). CLINICAL FEATURES Nevoid melanomas occur at any...
Book Chapter
Series: Atlases of Tumor and Non-Tumor Pathology, Series 5
Volume: 19
Published: 01 February 2024
10.55418/9781933477428-10
ISBN-10: 1-933477-42-3
ISBN: 978-1-933477-42-8
...) lack nuclear BAP1 expression. BAP1-inactivated melanocytic tumors (BIMT) commonly harbor BRAF V600E mutations, but they may also be associated with NRAS or other mutations. The presence of multiple BIMTs may reflect a BAP1 germline mutation and related tumor predisposition...
Book Chapter
Series: Atlases of Tumor and Non-Tumor Pathology, Series 5
Volume: 19
Published: 01 February 2024
10.55418/9781933477428-21
ISBN-10: 1-933477-42-3
ISBN: 978-1-933477-42-8
... presence of expression of S-100 protein, SOX10, and other differentiation antigens supporting melanocytic differentiation). In problematic cases, molecular studies (e.g., UV signature mutation, detection of driver mutations associated with melanoma) are helpful. UNDIFFERENTIATED MELANOMA...
Book Chapter
Series: Atlases of Tumor and Non-Tumor Pathology, Series 5
Volume: 19
Published: 01 February 2024
10.55418/9781933477428-02
ISBN-10: 1-933477-42-3
ISBN: 978-1-933477-42-8
... nodular aggregates of atypical melanocytes with nuclear atypia, high mitotic rate, and/or necrosis) Molecular Genetic Findings  Somatic NRAS mutation (codon 61) most commonly  Somatic BRAF mutation (codon V600) more commonly in small CMN  Multiple CMN and NCM caused...
Book Chapter
Series: Atlases of Tumor and Non-Tumor Pathology, Series 5
Volume: 19
Published: 01 February 2024
10.55418/9781933477428-12
ISBN-10: 1-933477-42-3
ISBN: 978-1-933477-42-8
... driver mutation: BRAF, especially BRAF V600E a PRAME = preferentially expressed antigen in melanoma; FISH = fluorescence in situ hybridization; CGH/SNP = comparative genomic hybridization/single nucleotide polymorphism. SUPERFICIAL SPREADING MELANOMA Figure 12-1 SUPERFICIAL...
Book Chapter
Series: Atlases of Tumor and Non-Tumor Pathology, Series 5
Volume: 19
Published: 01 February 2024
10.55418/9781933477428-04
ISBN-10: 1-933477-42-3
ISBN: 978-1-933477-42-8
... ). MOLECULAR GENETIC FINDINGS Most dysplastic nevi harbor BRAF V600E mutations; some carry NRAS mutations ( 15 ). A few dysplastic nevi also harbor other or additional mutations ( 16 , 17 ). A TERT aberration in a “high-grade dysplastic nevus” should prompt concerns about a possible melanoma...
Book Chapter
Series: Atlases of Tumor and Non-Tumor Pathology, Series 5
Volume: 19
Published: 01 February 2024
10.55418/9781933477428-03
ISBN-10: 1-933477-42-3
ISBN: 978-1-933477-42-8
...  Mutation analysis   Most carry BRAF mutations, some NRAS mutations, and few other mutations The term lentiginous junctional nevus is used for lesions in which many solitary units of melanocytes and nests are present in association with a pigmented epidermis that displays...
Book Chapter
Series: Atlases of Tumor and Non-Tumor Pathology, Series 5
Volume: 19
Published: 01 February 2024
10.55418/9781933477428-15
ISBN-10: 1-933477-42-3
ISBN: 978-1-933477-42-8
... is identified. MOLECULAR GENETIC FINDINGS Different driver mutations can be found in nodular melanoma. NRAS mutations seem to be more common in nodular melanomas compared to superficial spreading, acral, or lentigo maligna melanomas ( 10 , 11 ). A wide range of chromosomal copy number changes...