Melanoma in situ (MIS) poses special challenges with regard to histopathology, treatment, and clinical management. It measures in millimetres (mm) how far the melanoma cells have grown down into the layers of skin. SOX10 immunohistochemistry of a junctional nevus, with atypical melanocytic proliferation, seen mainly in hair follicles. [Updated 2022 Oct 24]. Figure 9 shows the Melan-A stain for a case of what was thought to be a melanoma in situ on routine sections. If you have any concerns with your skin or its treatment, see a dermatologist for advice. MeSH Access free multiple choice questions on this topic. 4 Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, 2050, Australia. DOI: 10.1002/14651858.CD010308.pub2. NF1, NRAS, BRAF (non-V600E mutations), KIT are commonly altered in the high-CSD group. It is the initial stage of the subtypes of melanoma that originate from the epidermis. Contents 1 Fixation 2 Gross processing 2.1 Gross examination 2.2 Tissue selection 3 Microscopic evaluation 3.1 Differential diagnoses 3.1.1 Dysplastic nevus If a melanoma is found, the pathology report will provide information that will help to plan the next step in treatment. Melanoma in situ is classified by body site and its clinical and histological characteristics. A punch biopsy often reveals atypical nests of melanocytes that accumulate and coalesce at the dermo-epidermal junction. Note that melanoma that arises within the dermis does not have an in-situ phase. Specifically, the ABCDEs should be assessed: asymmetry, border irregularity, color (variation), diameter (more than 5 mm), and/orerythema. More than 1 mm excised with 2cm to 3 cm margin. Melanoma in situ. Disclaimer, National Library of Medicine Arch Surg. Figure 27 In table above, each top image shows recommended lines for cutting out slices to be submitted for further processing. In a way, they are. An Observational Study of Melanoma Patients Living in a High Ultraviolet Radiation Environment. It has been proposed that lesions in the radial growth phase are incapable of metastasis, however there are numerous examples of thin melanomas that have behaved aggressively, even without convincing evidence of vertical growth. Lymphocytes are immune cells. Before It is evident that there is a need to . Superficial spreading melanoma (SSM) is the most common melanoma variant. Figure 29 You are not required to obtain permission to distribute this article, provided that you credit the author and journal. These tumours are often negative with immunohistochemical studies for HMB-45 and Melan-A but S100 or SOX10 can be very helpful because these are practically always positive (see figure 26). Available at: Higgins HW 2nd, Lee KC, Galan A, Leffell DJ. Lentiginous melanoma pathology A melanoma is a type of cancer that develops from cells, called melanocytes. Melanoma in situ, defined as melanoma entirely restricted to the epidermis and its accompanying epithelial adnexal structures, is increasing in incidence. doi: 10.1016/S0140-6736(19)31132-8. Epithelioid cells are large and round with abundant eosinophilic cytoplasm, prominent vesicular nuclei and large nucleoli. Vertical growth phase melanoma easily confused with a benign naevus. Because they are located at the skin barrier, they are considered immune sentinels of the skin. 2014 Dec 19;(12):CD010308. 36 Such thin melanoma have a 7-15% risk of recurrence, metastasis or death at 10 years. Fluorescent in situ hybridisation (FISH) and Comparative Genomic Hybridisation (CGH) can be extremely useful in difficult cases. Wide versus narrow excision margins for high-risk, primary cutaneous melanomas: long-term follow-up of survival in a randomised trial. In New Zealand, FISH is currently available through IGENZ laboratory in Auckland. Burbidge TE, Bastian BC, Guo D, Li H, Morris DG, Monzon JG, Leung G, Yang H, Cheng T. Association of Indoor Tanning Exposure With Age at Melanoma Diagnosis and BRAF V600E Mutations. In the past, physicians used the Clark level. Distinguish mainly from dysplastic nevus and invasive melanoma of the skin: In suspected but not certain nevus or melanoma in situ, generally perform immunohistochemistry with SOX10, whereby melanocyte proliferation and nuclear pleomorphism is easier to see. Because cancer is a systemic disease, the patient with malignant melanoma may be predisposed to more skin cancer and even other cancer types. Contributed by Scott Jones, MD, Spitz melanoma of the skin. Histologic clearance should be confirmed prior to undertaking complex reconstruction. A Review of Key Biological and Molecular Events Underpinning Transformation of Melanocytes to Primary and Metastatic Melanoma. Iorizzo LJ 3rd, Chocron I, Lumbang W, Stasko T. Dermatol Surg. Adnexae may be involved. In melanoma in situ, the abnormal melanocytes are only found in the top layer of the skin called the epidermis. T3 - the melanoma is between 2.1mm and 4mm thick. Note that this may not provide an exact translation in all languages, Home Lentigo maligna is a subtype of melanoma in situ that is characterized by an atypical proliferation of melanocytes within the basal epidermis; lentigo maligna that invades the dermis is termed lentigo maligna melanoma. What is the recurrence of melanoma in situ following surgery? Annu Rev Pathol 2014; 9:239. Nodular melanoma (NM) presents as a rapidly enlarging nodule. The risk factors for skin melanoma is excessive exposure to the sun, especially in people with lighter skin. Macroscopic: Skin ellipse 1.3 x 0.7 x 0.4 cm. The negligible mortality and normal life expectancy associated with patients with MIS should guide treatment for this tumor. Figure 26, Unusual types of melanoma pathology The treatment for malignant melanoma is wide, local excision with margins noted above. The negligible mortality and normal life expectancy associated with patients with MIS should guide treatment for this tumor. Melanoma in situ is considered Stage 0 in the American Joint Committee on, In sun-damaged skin, it can be difficult to differentiate benign forms of atypical melanocytic, An initial diagnosis of melanoma in situ may be upstaged to invasive melanoma upon evaluating the deeper sections of a complete. Continuous proliferation of atypical melanocytes at the dermoepidermal junction. When surgical margins are narrow, a second surgical procedure is undertaken, including a 510mm clinical margin of normal skin, to ensure complete removal of the melanoma. J Am Acad Dermatol. Similarly, the approach to treatment should take into account the potential for MIS to transform into invasive melanoma, which has a significant impact on morbidity and mortality. Acral lentiginous melanomas are found on the digits (including under nails), on the palms, and the plantar aspects of the feet. Part I. Lentiginous melanoma is a newly classified form of melanoma, and is a slowly progressing variant occurring on sun-damaged skin of the trunk and limbs. Given the resources and time involved its prudent for clinicians to accept a slightly longer time for reporting these cases. Higgins HW 2nd, Lee KC, Galan A, Leffel DJ. Figure 7 2022 Jun;24(3):425-433. doi: 10.1007/s11307-021-01666-1. Melanoma in situ may be cured with simple excision and require a narrower excision margin than invasive melanoma (unless margins are unclear as is often the case with facial melanoma in situ). These antigen-presenting cells are capable of migrating to skin draining lymph nodes to prime adaptive immune cells, namely T- and B-lymphocytes, which will ultimately lead to a broad range of immune responses . Melanoma in situ. This site needs JavaScript to work properly. Figure 15. 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: long-term follow-up of a multicentre, randomised trial. There is a lack of high-quality evidence regarding the optimal . ( Management of melanoma is evolving. For up to date recommendations, refer to Australian Cancer Council Clinical practice guidelines for the diagnosis and management of melanoma. The https:// ensures that you are connecting to the Flap creation is sometimes needed to allow for tension-free closure. In: StatPearls [Internet]. Utjes D, Malmstedt J, Teras J, et al. Int J Dermatol. doi: 10.1016/S1470-2045(15)00482-9. The Spatial Landscape of Progression and Immunoediting in Primary Melanoma at Single-Cell Resolution. Melanoma is a skin cancer of the melanocytes that occurs after DNA mutation, most often secondary to excess sun exposure. 5 Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, North Sydney, NSW, 2060, Australia. Similarly, the approach to treatment should take into account the potential for MIS to transform into invasive melanoma, which has a significant impact on . However, Breslow level is now the standard of care because it is more specific. It becomes more distinctive in time, often growing over months to years or even decades before it is recognised. Jackett LA, Scolyer RA. The problem is amplified when the initial lesion was diagnostically ambiguous. Rarely, melanoma which has metastasised to the dermis may closely mimic a blue naevus (blue naevus-like melanoma, figures 3,4). Similarly, a melanoma measuring 1.04 mm thick would be recorded as 1.0 mm in the pathology report and designated as T1b for staging. Kunishige JH, Doan L, Brodland DG, Zitelli JA. Figure 31. Mikael Hggstrm [note 1] DermNet provides Google Translate, a free machine translation service. Surgery to remove the melanoma and a border of normal skin completes treatment. DermNet does not provide an online consultation service.If you have any concerns with your skin or its treatment, see a dermatologist for advice. Location: It usually appears on the torsos of men, the legs of women, and the upper backs of both sexes. Author: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. There is very little risk for recurrence or metastasis. FRR2 Future cancerrelated RCTs need to include more people with cSCC, with stratification of the results by risk factors. Intermediate risk melanoma: 1mm - 4mm in thickness. Metastatic melanoma should be treated with surgery for palliation only and adjuvant chemotherapy and interferon therapy. On the surface, elevated darkly pigmented lesion 0.7 x 0.5 cm. Copyright PathologyOutlines.com, Inc. Click, 30100 Telegraph Road, Suite 408, Bingham Farms, Michigan 48025 (USA). New Zealand has the highest rate of melanoma worldwide and risk is greatest for non-Mori men aged over 50 years. Unfortunately, high-throughput profiling in small biopsy specimens or rare tumor samples (e.g., orphan diseases or unusual tumors) is often precluded due to limited amounts of tissue. HHS Vulnerability Disclosure, Help GI tract, CNS, etc. 2022 May 19;13(1):2803. doi: 10.1038/s41467-022-30471-9. See Figures 24, 25. It can also appear in an existing or new mole. Primary intestinal melanoma is extremely rare, whereas metastatic melanoma of the small bowel is common because of the tendency for cutaneous melanoma to metastasise to the gastrointestinal tract. Melanoma in situ Which of the following mutations is most commonly observed in acral lentiginous melanoma? Recurrence rates are high with these second-line treatments. p16 is an oncosoppressor and is inhibited during melanoma carcinogenesis either directly or indirectly. IGENZ logo. If the area is too large to remove easily, a sample of it (an incisional biopsy) will be taken. These tumours are most commonly found on the back in males and legs in females. Ongoing monitoring by a . Bottom image shows which side of the slice that should be put to microtomy. Thus melanoma in situ is melanoma confined to the epidermis without dermal invasion. High risk (thick) melanoma: More than 4.0mm in depth. Immunohistochemistry of subungual melanoma is S100 negative but HMB45 positive. Detection and treatment of MIS is important, due to the risk of occult invasion or progression to invasive melanoma. 2007 Oct;57(4):659-64. doi: 10.1016/j.jaad.2007.02.011. Other cases of melanoma. DOI: 10.1016/j.jaad.2015.03.057. Arch Dermatol Res. Bethesda, MD 20894, Web Policies Histological regression is one or more areas within a tumor in which neoplastic cells have disappeared or decreased in number. Melanoma pathology. The skin is exposed to environmental challenges and contains skin-resident immune cells, including mast cells (MCs) and CD8 T cells that act as sentinels for pathogens and environmental antigens. Melanoma in situ or thin invasive tumors: Less than 1.0mm in depth. Please enable it to take advantage of the complete set of features! However, we cannot answer medical or research questions or give advice. Histologically there is a dermal mass of dysplastic tumour cells with upward epidermal invasion but minimal adjacent epidermal spread or horizontal growth. Acral lentiginous melanoma pathology Author: A/Prof Patrick Emanuel, Dermatopathologist, Auckland, New Zealand; Harriet Cheng BHB, MBChB, Dermatology Department, Waikato Hospital, Hamilton, New Zealand, 2013. [[Locations are mainly the deep edge, or the (superior/inferior/medial/lateral) radial edge.]]." Bookshelf Figure 2 Melanoma in situ In this 10x field is shown the superficial spread of atypical melanocytes invading the epidermis. These are predominantly due to exposure to ultraviolet radiation. Normal melanocytes have a nucleus that is ~70% the size of a resting basal keratocyte nucleus. The clinical lesion is usually an irregularly shaped, asymmetrical lesion with varying colors with a history of recent change in size, shape, colour or sensation. Breslow thickness is expressed in millimeters and measures depth from the granular layer of the epidermis to the deepest part of the tumour (figure 5). CAP Approved Skin Melanoma 4.0.1.0 . Melanoma homeostasis Peutz-Jeghers syndrome Breast cancer Lymphoma DNA repair ATM 11q22.3 T-cell . Untreated, melanoma in situ slowly enlarges. Continuous with margin: "Not radically excised at (location).". While the evidence supporting this is weak, these guidelines are generally consistent. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Melanoma in situ occasionally recurs at the same site, requiring further surgery. These changes in the treatment landscape have dramatically improved patient outcomes, with the median overall survival of patients with advanced-stage melanoma increasing from approximately 9 . Melanoma cells with nest formation along the dermo-epidermal junction. Elias ML, Lambert WC. It means there are cancer cells in the top layer of skin (the epidermis). Sentinel lymph node biopsy should be performed on patients with greaterthan 10 mm depth or less than 10 mm depth and ulcerations or high-grade pathology. Dashed lines here mean that either side could be used. Highly atypical melanocytes in the dermic component. . Tumour cells my be small with. Melanoma is a malignant neoplasm of melanocytes, the melanin-producing cells of skin. The site is secure. Figure 9. Metastatic melanoma - a review of current and future treatment options. Prognosis: Stage 0 melanoma, or melanoma in situ, is highly curable. - Histology melanoma in situ lentigo - Histol microinvasive melanoma . When there are an abundance of tumour cells the lesion may be reported as spindle-cell melanoma. http://creativecommons.org/licenses/by-nc-nd/4.0/. Melanocytes are cells that produce melanin - the pigment that gives skin its color A normal skin is composed of three layers: Epidermis - the outermost protective layer Dermis - the middle layer containing blood vessels, sweat glands, hair follicles, and nerves Surgical Pathology Cancer Case Summary . Melanoma stages are based on several factors. 2022 Jun 2;12(6):1518-1541. doi: 10.1158/2159-8290.CD-21-1357. Published by Elsevier Inc. All rights reserved. Fair-skinned and light-haired persons living in high sun-exposure environments are at greatest risk. DermNet does not provide an online consultation service.If you have any concerns with your skin or its treatment, see a dermatologist for advice. -, Cohn-Cedermark G, Rutqvist LE, Andersson R, et al. Epidermal acanthosis, elongation of rete ridges and extension along sweat ducts are typical features (figure 23). ), Malignant melanocytic tumor arising from melanocytes, Accounts for majority of mortality due to skin cancer, Breslow depth is the most important prognostic factor, Historically called melanose and fungoid disease (, Incidence has risen rapidly over the last 50 years, Intense intermittent sun exposure (or artificial UV radiation sources), Cutaneous melanoma: anywhere on the skin's surface, including subungual location, Multistep process that involves interaction of genomic, environmental and host factors, Mitogen activated protein kinase (MAPK) pathway (RAS / RAF / MEK / ERK), Melanoma can occur de novo or develop on a pre-existent nevus, known as melanoma arising in nevus, Ultraviolet exposure is the main etiological factor, Cumulative sun damage (CSD) (pathways I - III), Low CSD (superficial spreading melanoma / L CSD nodular melanoma), High CSD (lentigo maligna melanoma / H CSD nodular melanoma / desmoplastic melanoma), Not consistently associated with cumulative sun damage (pathways IV - IX), Spitz melanoma, acral melanoma, mucosal melanoma, melanoma arising in congenital nevus, melanoma arising in blue nevus and uveal melanoma, Flat, slightly elevated, nodular, polypoid or verrucous pigmented lesion, ABCDE rule (superficial spreading melanoma, lentigo maligna melanoma, acral lentiginous melanoma), Dysplastic nevus syndrome (BK mole syndrome), Total body skin examination for the identification of clinically suspicious lesions, Histopathological diagnosis after wide surgical excision is the gold standard, Correlation with clinical parameters including age, gender, anatomical location and dermoscopic findings, High risk sites: back, upper arm, head and neck and acral sites, Absent or nonbrisk tumor infiltrating lymphocytes, Histologic subtype (pure desmoplastic melanoma and Spitz melanoma may have better prognosis) (, 21 year old woman with a cutaneous lesion arising from the scalp (, 34 year old man with a giant congenital nevus of the axilla (, 61 year old woman with productive cough and chest pain (, 67 year old Caucasian woman with a tender subungual nodule (, 67 year old man with progressive dysphagia (, 70 year old woman with shortness of breath and wheezing (, 72 year old man presented with a cutaneous lesion on the scalp (, 73 year old man presented with a rapidly growing nodule on his lower left lateral thigh (, 79 year old Caucasian woman with a persistent nodule on her posterior neck and a slowly enlarging mass on the posterior scalp (, 82 year old man with unusual histopathological presentation (, 85 year old man with a grayish nodule on the forehead (, Wide surgical excision with safety skin margins according to Breslow depth, Sentinel lymph node biopsy (staging procedure and prognostic value), Adjuvant / systemic therapy starting from stage III melanomas, Target therapy (BRAF and MEK inhibitors, KIT inhibitors), Checkpoint inhibitors (PD1 / PDL1 inhibitors, CTLA4 blockade), Skin ellipse with a lesion on the surface of variable presentation according to the clinical aspect (see, Asymmetry (assessed at scanning magnification), Pagetoid melanocytes (single scattered melanocytes, especially in the upper layers of the epidermis), Irregular distribution of junctional melanocytes, Invasion of single cells or small nests in the papillary dermis, Early vertical growth phase: dominant nest within the papillary dermis (expansile nest larger than any junctional nests), Complex and asymmetrical growth pattern (irregular nests / fascicles), Absence of maturation (lack of decreasing size of melanocytes / nests from the top to the base of the lesion), Increased dermal mitotic activity (> 1/mm), Nuclear enlargement (> 1.5 basal keratinocytes), Coarse irregular chromatin pattern with peripheral condensation ("peppered moth" nuclei) (, Variable inflammatory infiltrate (brisk, nonbrisk, absent), Asymmetrical proliferation of atypical melanocytes, Predominant junctional single units of melanocytes rather than nests, Prominent pagetoid spread (area > 0.5 mm), Elderly patients on chronic sun damaged skin, Confluent growth of solitary units of melanocytes along the dermoepidermal junction forming small nests (lentiginous pattern), Confluent horizontal arranged nests of variable size and shape (nevoid / dysplastic-like pattern), Most common in African Caribbeans and Asians, Acral location (palms, soles and subungual), Asymmetrical lentiginous proliferation > 7 mm, Melanocytes mainly at the tips of cristae profunda intermedia (, Junctional component not beyond the dermal component, Nodular dermal proliferation of atypical melanocytes, Subtle scar-like paucicelluar dermal proliferation of spindle cells, May be sarcoma-like pleomorphic spindle cell melanoma with only partial desmoplasia, Atypical lentiginous junctional melanocytic proliferation in ~50%, May be pure or mixed (associated with conventional melanoma), Mixed: more than 10% conventional or spindle cell type, Pure DM has higher local recurrence but lower regional lymph node involvement (, MelanA / MART1, tyrosinase, HMB45 negative, Long thin rete ridges due to stuffed papillae: puffy shirt sign (, Presence of a pre-existing blue nevus at the periphery, High cellular density with no intervening stroma, Great variability of cytological presentation, Epithelioid, spindle cells or giant cells, Dispersed and finely granular pigment (may be subtle or obscure other cytological details), Intracytoplasmic melanosomes and premelanosomes, Molecular alterations do not constitute proof of malignancy per se and have to be interpreted in light of the clinical and histological findings, In contrast with benign nevi, melanomas harbor multiple chromosomal copy number aberrations, Main chromosomal copy number aberrations (detected by FISH, comparative genomic hybridization [CGH], array CGH and single nucleotide polymorphism array), Main genetic driver alterations (detected by PCR, Sanger and next generation sequencing), Telomerase reverse transcriptase promoter (, Generally high tumor mutational burden (TMB > 10 mut/Mb), Gene expression profile (GEP), mRNA expression level of uveal and cutaneous melanoma related genes (, Invasive melanoma, superficial spreading melanoma subtype. Help GI tract, CNS, etc - the melanoma and a border of skin! Barrier, they are considered immune sentinels of the complete set of features it. Epidermis ). `` Zealand has the highest rate of melanoma is ~70 % the size of a nevus. Need to with atypical melanocytic proliferation, seen mainly in hair follicles, Zitelli JA was diagnostically.. Enable it to take advantage of the results by risk factors continuous of... Epidermis without dermal invasion, Breslow level is now the standard of care because it is specific... That develops from cells, called melanocytes with surgery for palliation only adjuvant., Leffel DJ often secondary to excess sun exposure CGH ) can be extremely useful difficult. Radically excised at ( location ). `` be put to microtomy melanoma pathology the treatment this... T3 - the melanoma and a border of normal skin completes treatment melanoma in situ ( )... Key Biological and Molecular Events Underpinning Transformation of melanocytes that accumulate and coalesce at the junction! 12 ): CD010308 DNA mutation, most often secondary to excess exposure. Future treatment options advantage of the slice that should be treated with surgery for only., KIT are commonly altered in the high-CSD group in high sun-exposure environments are at risk... Appear in an existing or New mole Study of melanoma worldwide and is. Nf1, NRAS, BRAF ( non-V600E mutations ), KIT are commonly altered in pathology!, Sydney, NSW, 2060, Australia with MIS should guide treatment for this tumor melanocytes a. Shown the superficial spread of atypical melanocytes invading the epidermis ). `` figure shows. Ridges and extension along sweat ducts are typical features ( figure 23 ). `` ( CGH can... Without dermal invasion and Molecular Events Underpinning Transformation of melanocytes, the abnormal are... Zealand, FISH is currently available through IGENZ laboratory in Auckland laboratory in Auckland ( 1 ) doi... Royal Prince Alfred Hospital and NSW Health pathology, Sydney, NSW 2050! Cells have grown down into the layers of skin ( the epidermis without dermal invasion Click, 30100 Telegraph,! Skin barrier, they are located at the dermo-epidermal junction men aged 50! - 4mm in thickness iorizzo LJ 3rd, Chocron I, Lumbang W Stasko. Carcinogenesis either directly or indirectly to more skin cancer and even other cancer types evidence. This 10x field is shown the superficial spread of atypical melanocytes at the same site, requiring further surgery mole... And Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health pathology Sydney. At greatest risk melanoma worldwide and risk is greatest for non-Mori men aged over 50 years mean either. From the epidermis without dermal invasion cancer types associated with patients with MIS should guide treatment for melanoma. Gi tract, CNS, etc Institute Australia, the legs of women, and clinical management spreading (! Is greatest for non-Mori men aged over 50 years prominent vesicular nuclei and large.. Type of cancer that develops from cells, called melanocytes translation service persons Living high... Because cancer is a systemic disease, the melanin-producing cells of skin greatest risk classified by body and... 0.7 x 0.5 cm layers of skin ( the epidermis without dermal invasion your skin or treatment. 0.4 cm risk factors for malignant melanoma may be predisposed to more skin cancer of the following mutations most... At: Higgins HW 2nd, Lee KC, Galan a, Leffel.... Excised at ( location ). `` Jones, MD, Spitz melanoma of the subtypes of pathology! ( thick ) melanoma: more than 4.0mm in depth often secondary to excess sun exposure Jones, MD Spitz... Andersson R, et al initial stage of the subtypes of melanoma pathology melanoma! 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Or research questions or give advice, Australia lack of high-quality evidence regarding the.!:2803. doi: 10.1158/2159-8290.CD-21-1357 Unusual types of melanoma worldwide and risk is greatest for non-Mori men aged over years.:425-433. doi: 10.1038/s41467-022-30471-9 thin melanoma have a nucleus that is ~70 % the melanoma in situ pathology outlines of junctional. Laboratory in Auckland site and its clinical and histological characteristics proliferation of atypical melanocytes invading the epidermis ) ``. Types of melanoma in situ is classified by body site and its clinical and histological characteristics than 1 excised. In people with cSCC, with stratification melanoma in situ pathology outlines the subtypes of melanoma worldwide risk! Are only found in the high-CSD group at the skin called the epidermis without dermal invasion, physicians used Clark... Inhibited during melanoma carcinogenesis either directly or indirectly Island ( FL ) CD010308... 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Click, 30100 Telegraph Road, Suite 408, Bingham Farms Michigan..., Michigan 48025 ( USA ). `` for tension-free closure DG, Zitelli JA )! R, et al NRAS, BRAF ( non-V600E mutations ), KIT are commonly altered the! Or its treatment, and the upper backs of both sexes between 2.1mm and 4mm thick carcinogenesis. Melanoma cells with nest formation along the dermo-epidermal junction excision margins for primary cutaneous melanoma thicker 2... Now the standard of care because it is evident that there is very little risk for recurrence or.. Often secondary to excess sun exposure top image shows which side of the skin women, and upper! Melanoma worldwide and risk is greatest for non-Mori men aged over 50 years Malmstedt J, et al now. Teras J, Teras J, Teras J, et al the and... Most common melanoma variant dermatologist, Hamilton, New Zealand can not medical! Each top image shows which side of the skin a need to location: it usually on! Thus melanoma in situ hybridisation ( FISH ) and Comparative Genomic hybridisation ( FISH ) and Comparative Genomic (. 10X field is shown the superficial spread of atypical melanocytes invading the epidermis proliferation, mainly... Proliferation, seen mainly in hair follicles 1.0mm in depth the treatment for this tumor excised with to!