Case 353 -- A male in his 20s with multiple "atypical" nevi

Contributed by Muammar Arida, MD and Drazen M. Jukic, MD, PhD
Published on line in June 2003


An otherwise healthy male in his 20s presented with a 0.95 cm shiny unequally pigmented erythematous papule in the left supraclavicular area to a private dermatology clinic. The clinical suspicion was that of pigmented basal cell carcinoma. The lesion was completely excised and submitted for histopathologic examination (see specimen #1). The lesion has been sent to our dermatopathology practice for a consultation. Several months later, in our hospital, the patient underwent excision of two clinically "atypical nevi" (specimen #2: midline lower back; specimen #3: left lower back). After about 2 months yet another pigmented lesion clinically suspicious for malignancy was excised from this patient's lower back (specimen #4)


Specimen #1 "Left supraclavicular":

Low power view reveals a well-circumscribed dome-shaped hypercellular dermal neoplasm with a prominent deep component that shows scattered pigmentation (Fig. 1-1). Closer inspection reveals two distinct cellular populations: First, smaller basophilic melanocytes with regular outlines and scant cytoplasm, and second, a confluent proliferation of moderately pleomorphic melanocytes with abundant amphophilic cytoplasm , round to oval nuclei, dispersed chromatin and prominent nucleoli. Several mitotic figures are observed in the deeper portion of this component (Figs. 1-2 and 1-3). Focal small nests composed of melanocytes of similar appearance are seen at the dermo-epidermal junction (Figs. 1-2 and 1-5). The distinct deep component also features nests of spindle and epithelioid melanocytes and scattered melanophages (Fig. 1-4).

The following Immuostains were performed:

Specimen #2 "Midline lower back":

This is a 0.3 cm densely cellular, mainly dermal neoplasm with overlying hyperplastic epidermis (Fig. 2-1). It is composed of large epithelioid melanocytes with abundant cytoplasm and "histiocytoid" and "rhabdoid" features (Fig. 2-2). A focal, but distinct junctional component is observed (Fig. 2-3). The deep portion of this neoplasm shows some features of probable congenital onset, such as smaller melanocytes that show maturation with progressive descent and splaying between the collagen bundles (Fig. 2-4). Three mitotic figures were seen in the dermal component (Fig. 2-5). Ki-67 immunostain stains about 5% of the melanocytes (Fig. 2-6).

Specimen #3 "Left lower back":

See figures 3-1 3-2 3-3 3-4

Specimen #4 "Lower back":

See figures 4-1, 4-2.


Case IndexCME Case StudiesFeedbackHome