Nevi with Epithelioid Cytomorphology and Architectural Disorder
Jennifer Kaplan, Steven R Tahan. Beth Israel Deaconess Medical Center, Boston
Background: Dysplastic nevi (dysN) were recognized over 30 years ago as melanocytic proliferations with distinctive architectural and cytologic features in families with relatively high incidence of melanoma. Numerous descriptions of dysN have been published; however nevi with epithelioid cytologic features and architectural disorder (NACED) have not been as well described.
Design: To further understand the clinical and histologic characteristics of NACED, we reviewed all 40 identified cases of NACED diagnosed at our institution from 1997 to 2010. Medical records were reviewed, and patients were separated into categories based on personal history of multiple dysN, personal history of malignant melanoma in situ and/or invasive melanoma, and family history of melanoma. Histologic sections were reviewed and 23 pathologic features were compared among the groups of patients.
Results: No single histologic feature statistically correlated with personal history of multiple dysN or melanoma, family history of melanoma, or lack of personal or family history. 89% of patients with a personal or family history of melanoma had lesions that were categorized to have overall high-grade morphology. Conversely, only 64% of patients without a personal or family history of melanoma had similar lesions (Table).
|Histologic Feature||All Patients (%)||No Personal or Family History of Melanoma (%)||Multiple DysN (%)||Personal History of MMIS or Melanoma (%)||Family History of Melanoma (%)||Personal or Family History of Melanoma (%)|
|Overall High Grade||75||64||64||86||100||89|
|High N/C Ratio||20||18||36||43||25||33|
|Pagetoid Lateral Spread||50||41||18||14||25||22|
|Lack of Lateral Circumscription||68||67||73||86||50||78|
|Clefts Around Nests||25||23||9||29||0||22|
|Bridging of >3 Rete||18||82||82||14||50||67|
|Lack of Dermal Maturation||80||22||18||71||0||14|