HPI: 77 yo woman in fair general health with 5 mo history of evolving lesion on bridge of nose.
O/E: 1.5 x1.0 macule with slight play of color bridge nose.
Clinical photos: Arrows show original biopsy sites.
1) 2 x 3 mm punch bx taken from areas indicated by arrows. "Mild to moderate atypical melanaocytic hyperplasia with focal pagetoid spread.
2) Incisional biopsy of most (not all) of residual lesion. "Lentiginous melanocytic hyperplasia best interpreted as 'melanoma in situ.' In the appropriate clinical setting complete reexcision is recommended for further evaluation and management."
(Biopsies were signed out by two different dermatopathologists at the same facility.)
Photomicrographs courtesy of Dr. Deon Wolpowitz, Boston University, Department of Skin Pathology.
|Mart 1 Positive|
Discussion: Clearly, a more complete excision would be problematic. This lesion would appear to have minimal potential to metastasize and the plan here would be either wait and watch or imiquimod. What would your approach be?
What is highlighted here is the subtle change of diagnosis from atypical melanocytic hyperplasia to M.I.S. Semantics certainly makes a difference.
Questions: Would you refer to a Mohs surgeon or treat with imiquimod? What is the risk for invasion in such a lesion?
About MART 1 Stain: MART-1 has nothing to do with prognosis or treatment. It is basically a staining tool to identify melanoma cells in a tissue sample. Having MART-1 positive means melanocytes showed up on the sample and the pathology can confirm melanoma. MART-1 is specific to melanoma so when cells stain positive, there are melanocytes there. It also shows normal melanocytes, but if it stains positive in a tissue sample that shouldn't contain melanocytes (tumors), then you have a key to diagnosis