[508] 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 Features of Nevi with Epithelioid Cytomorphology and Architectural Disorder
Histologic FeatureAll 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 Grade7564648610089
High N/C Ratio201836432533
Large Nucleoli554155715067
Coarse Chromatin384146435033
Intraepidermal Mitoses484164432533
Kamino Bodies353646295033
Pagetoid Lateral Spread504118142522
Lack of Lateral Circumscription686773865078
Clefts Around Nests2523929022
Bridging of >3 Rete188282145067
Focal Atrophy231818172511
Dermal Mitoses31282717014
Lack of Dermal Maturation80221871014

Conclusions: In this largest series to date of NECAD, there was no correlation between a wide array of histologic features and personal or family history of melanoma. While high grade morphology was more frequent in patients with a personal or family history of melanoma, this could not be statistically validated with this small data set. These findings raise the possibility that these lesions may not have the same prognostic significance as traditional dysplastic nevi.
Category: Dermatopathology

Wednesday, March 21, 2012 1:00 PM

Poster Session VI # 125, Wednesday Afternoon


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