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Histopathologic criteria for conventional Spitz nevi, atypical Spitz tumors, and melanoma

Histopathologic criteria for conventional Spitz nevi, atypical Spitz tumors, and melanoma
  Conventional Spitz tumors Atypical Spitz tumors Melanoma
Architecture
Diameter <5 to 6 mm ≥5 to 6 mm ≥10 mm
Outline Symmetric (wedge shaped) Asymmetric Asymmetric
Circumscription Sharp, lateral circumscription Often poor circumscription Poor circumscription
Epidermal hyperplasia Present Effacement of the epidermis may be present Absent, or effacement of the epidermis may be present
Maturation with dermal depth Present Possibly diminished or lack of zonation and maturation Lack of zonation and maturation often present
Eosinophilic hyaline globules (Kamino bodies) Present Absent or few Typically absent
Cellular density Orderly, nondisruptive infiltration of collagen by melanocytes High cellular density High cellular density
Cytology
Cellular population Uniform spindle and/or epithelioid Spindle and/or epithelioid cells showing increasing cytologic atypia Spindle and/or epithelioid cells showing increasing cytologic atypia and pleomorphism
Cytoplasm Opaque or ground glass cytoplasm Granular versus ground glass cytoplasm Granular or mixed cytoplasm
Nuclear-to-cytoplasmic ratio Low nuclear-to-cytoplasmic ratio Increasingly high nuclear-to-cytoplasmic ratio High nuclear-to-cytoplasmic ratio
Chromatin pattern Nuclei with open, delicate chromatin pattern Loss of delicate or dispersed chromatin pattern Loss of delicate or dispersed chromatin pattern
Nucleoli Uniform nucleoli Increasingly prominent nucleoli Large nucleoli
Pleomorphism Rare May be present Usually present
Hyperchromatism Absent May be present Present
Proliferation
Mitotic rate

<2/mm2

Absent or rare mitoses in deep dermis

Lack of atypical mitoses

2 to 6/mm2 (particularly >6/mm2)

Deep or marginal dermal mitoses may be present

2 to 6/mm2 (particularly >6/mm2)

Deep or marginal dermal mitoses frequently present
Proliferative index (Ki-67 expression)  <2% 2 to >10% Often >15 to 30%
Adapted from: Barnhill RL. The Spitzoid lesion: rethinking Spitz tumors, atypical variants, 'Spitzoid melanoma' and risk assessment. Mod Pathol 2006; 19 Suppl 2:S21.
Graphic 85847 Version 4.0

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