Acral Lentiginous Melanoma Dermatopathology

Check out the WSI digital slide here: kikoxp.com/posts/2813/
A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).
Please check out my Dermatopathology survival guide textbook: bit.ly/2Te2haB ‬
This video is geared towards medical students, pathology or dermatology residents, or practicing pathologists or dermatologists. Of course, this video is for educational purposes only and is not formal medical advice or consultation.
Presented by Jerad M. Gardner, MD. Please subscribe to my channel to be notified of new pathology teaching videos.
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[@JMGardnerMD]

A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).

[@nathankenworthy4453]

Love your content Dr. Gardner!

[@angelcalzadapedroza8890]

Excelnete explicación Dr

[@yuyang676]

It is really helpful to understand how to diagnosis acral lentiginous melanoma by reading survival guide to dermatopathologya and watching this video

[@rayan3212]

Amazing.. Thanks very much

[@JohnDoe-fk6uu]

thank you so much foe your videos. You make things easier for us, derm residents to grasp dempath! :) Love, from Philippines!

[@ramadanshatwan2205]

Nice video. Many thanks

[@treeshadesong1302]

Thank you very much. I'm freaking out about getting your comment on Facebook for my case. It's really amazing^^. You're a really good mentor to me.

[@JMGardnerMD]

Thanks for the kind words. So glad I could help!

[@vicksfw]

Thank you for your inspirational videos on melanoma and other nevi sir. I got interest and learnt useful thingsin melanoma after watching these videos. By the way my students are also inspired by this content sir.

[@JMGardnerMD]

My best wishes to you and your students. 😊 also check out these videos: kzbin.info/www/bejne/bn-Teo2QpatrqtU & kzbin.info/www/bejne/oHy9daSAmt9soNk

[@evelyne7071]

The regression melanocytes are very discohesive, with lots of that brightly colored collagen, that on the surface of the skin would look like scar; white areas under external microscopic investigation. I’d like to see someone do a study that counts the numbers of nuclear invaginations in relation to the degree of other malignant characteristics, that make this huge lesion a melanoma. Do nuclear invaginations correspond to any other malignant characteristics ? Do benign nevi have fewer ?……I know it’s a pipe dream of min. Great pictures/high power.

[@rajanchopra2193]

Excellent discussion and useful clues; many thanks Dr Gardner for discussing Melanocytic blister effect, pagetoid melanocytes in acral lesion and regression collagen. Kindly also consider a request for your discussion of the immunohistochemisty usage including PRAME and p16 in the Melanocytic lesions workup; that shall be quite helpful. Best regards

[@JMGardnerMD]

I’m still learning about PRAME. only recently started using it. So I will have to wait a bit to acquire more experience. Here’s a video about IHC basics in melanocytic lesions. kzbin.info/www/bejne/gKqxn55jgsmJp6c

[@amalikalmosa]

Thanks Dr. Gardner for this nice explanation. How can we distinguish between benign recurring nevus after excision and benign nevus with superimposed acral lentigenous melanoma?

[@JMGardnerMD]

sometimes it is difficult. Biggest things that help me tell recurrent nevus from melanoma. 1. is the atypia confined to the space over the scar (favor recurrent nevus) or does it extend beyond the scar (worries me for melanoma)? 2. find out for sure if a biopsy has been done at this site and ideally review the pathology from that biopsy. 3. if you are lucky, a recurrent nevus may still have areas of obviously benign residual nevus in the dermis adjacent and/or deep to the biopsy scar. I discuss this more and show examples in my dermpath survival guide book: bit.ly/2Te2haB ‬

[@evelyne7071]

One more question about the mechanism of regression: The scarring that is evidence of regression. These areas are devoid of melanocytes. Is it because there were melanocytes that were there before but they have now metastasized to another area and have left scarring in their wake due to displacement. The melanocytes take off and leave behind “a wound” that needs to be fixed by fibroblasts....thus a scar. If this is not the mechanism, then what happens?.....And, is regression a sure sign that metastasis has already occurred ? And, does it mean that that area was full scale melanoma before ?

[@evelyne7071]

In the last part of the discussion of the newer immuno-stains that you have recently been using, on high power, there seemed to be many intranuclear invaginations....Do pathologists ever consider this cytological feature as a sign of not only a melanocyte, but a malignant one as well ?

[@JMGardnerMD]

We see those vacuoles in both benign and malignant melanocytes often. But many different types of cells can have nuclear pseudo-inclusions So that feature alone doesn’t prove that something is a melanocyte in my opinion. But it can be a useful close to make me think of melanocytes.

[@evelyne7071]

I was always told that intranuclear inclusions in histological specimen were just a result of formalin shrinkage/fixation. But in cytology, an intranuclear inclusion is definitely a malignant characteristic......Of course, I’ve never seen a “benign” melanocyte in a cytological specimen......Why would have I ?

[@parallel_andrex3905]

I have a little little black dot and it looks like dead skin please help

[@JMGardnerMD]

Please see your dermatologist for any questions about your skin. Best wishes. Jerad

[@sumanranadas1752]

Is it deady ??? Sir

[@lovelyjubbly34]

Bob Marley died because of it

[@MyLandmasterAlt2]

This is the cancer that killed Bob Marley

[@JMGardnerMD]

That is correct. Such a loss at such a young age.