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Clinical history
41-year-old with a changing pigmented lesion on the back.
Specimen
Excision biopsy · Stain: H&E
Microscopic description
Asymmetric proliferation of atypical melanocytes with pagetoid upward scatter, confluent junctional nests of varying size and shape, and dermal mitoses.
Diagnostic question
Which architectural and cytological features favour melanoma over a dysplastic naevus?
Reveal differential diagnosis
Dysplastic naevus with severe atypia
Recurrent naevus
Spitz naevus
Reveal final diagnosis
Superficial spreading melanoma, Breslow thickness 0.9 mm
Learning points
Asymmetry, poor circumscription and pagetoid spread favour melanoma
Dermal mitoses and lack of maturation are important
Report Breslow thickness, ulceration and margins
Self-assessment
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All whole-slide images in this library are anonymised and used under appropriate licence. Cases are provided for education only and must not be used for clinical diagnosis.