Melanocytic Dermpath: Cellular Blue Nevus vs Deep Penetrating Nevus/Melanocytoma

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).
Part of my in-progress series on melanocytic dermatopathology. Cellular blue nevus and deep penetrating nevus are both unusual
benign variants of nevus. Their depth, cellularity, and cytologic features can sometimes cause them to be confused with melanoma if one is not familiar with these entities. Watch the video to learn more. Thanks to my dermpath fellow, Dr. Ed Fulton, for selecting the topic for this video. Also many thanks to my awesome medical student, Gray Orman, for transcribing this entire video so that closed captions would be available for viewers who need them! You can download the entire transcript of the video as a .docx here: bit.ly/31CkAL1.
Disclaimers: If you haven't seen my basic melanocytic dermpath video about benign nevi, please be sure to watch it first, especially the disclaimers discussed in the first 5 minutes or so: • Melanocytic Dermpath B... . As I said in that video, distinguishing nevus from melanoma is serious business. My videos do not replace the need for getting an expert consultation should you encounter a difficult melanocytic lesion in your practice. Also, melanocytic dermpath has areas of controversy with differing strongly held points of view. by various experts in the field. Each of my videos represents MY current views as of the date each given video was published. My views have changed since I started practice, and I suspect (and hope) that they will continue to evolve over time. You (or your mentors) may do things differently than I do. That's ok by me. I'm just sharing the way I currently think of melanocytic lesions with the hope that viewers may find it useful. My goal is to educate, not to create dogma.
Please check out my Soft Tissue Pathology & Dermatopathology survival guide textbooks: 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).

[@quentinnakonechny9346]

Thank you Jerad. That was a great presentation on a diagnostic dilemma.

[@pavelboico9283]

I don't understand how you doing this, guys. For me those slides are strait from previous lecture on melanoma! So eye opening! And we, clinicians, expect you to make diagnosis from shave biopsy... so much to think about

[@dhinchakpillu]

Thanks for concise description

[@fayghazvini]

Thanks for excellent presentation.

[@pnaratasoy1724]

It was a very impressive presentation. Thank you. ı hava learnt a lot😊

[@SandhyaRamachandran]

great one as usual :) tanx a lot

[@dr.tintinthein8566]

Thank you very much

[@sushmitha1948]

Wonderfully explained. Could you please make a video of Spitz Nevis and it's variants.

[@sushmitha1948]

Nevus

[@kazumithumargondalia9171]

And that was superb....

[@yasirmohammedali]

Hi ... Thanks for the video

[@ncorry8491]

Thanks

[@alirezaghanadan4965]

Thank you so much dear jerald. I think its a combined nevus of congenital nevus and cellular blue nevus but how do you think about proliferating nodule of congenital nevus?

[@kinludovico]

Thank you Dr. Gardner :), I hope we will hear from you more about other melanocytes lesions. I have a question: B. Bastian would see the DPN as a "dysplastic lesion" or, as they published recently, as "an intermediate stage in the step-wise progression from nevus to melanoma", would you recommend any further follow-up for those lesions after excision? kind regards :)

[@JMGardnerMD]

Well Boris Bastian knows more about melanocytic lesions than I ever will, that's for sure. So I am no one to argue with him. And I have not yet read the full paper from their group about DPN. But speaking from my own experience and knowledge: 1. I have thought of DPN merely as an unusual distinct pattern benign nevus, but I have not understood them to be dysplasia or pre-malignancy. 2. I have seen a few melanomas that mimicked DPN, but I cannot recall seeing a melanoma that arose out of a previously-biopsied DPN. 3. I do not routinely recommend re-excision for DPN (unless it has a lot of atypia or I am not certain that it is a truly a DPN), I leave that up to my dermatology colleagues to decide. Some of them do a small re-excision but some of them do not. Again, I'm not sure any of this is the one right way; it's just the way I have done things up until now.

[@hazalizol3516]

Thank you sir, it was really helpful. Cellular blue nevus cells look to me epitheloid (especially in the middle of the lesion), so when should we call a lesion "epithelioid blue nevus" and as you said, cellular blue nevus can have pleomorphic cells and some mitoses, so when should we call a lesion "atypical cellular blue nevus"?

[@ibtihalpathology5416]

Hi Dr. Jared and thank you for this lecture.. my question is How can I assess the cellular feature In case of heavily pigmented cellular nevus in a young male pt ?

[@JMGardnerMD]

Melanin bleaching with potassium permanganate can be helpful in those cases. Wipes out the melanin so you can see nuclei more easily.

[@jackt9535]

Very nice case presentation as usual ! In difficult cases do you use Betacatenin and decide it's DPN when melanocytes show a nuclear expression (and unclear, CTNNB1 mutation)?

[@JMGardnerMD]

Yes I do use beta catenin sometimes for these and find it pretty helpful. Although my understanding is that it can be positive in melanoma too. So it can help support DPN but doesn’t prove benign via malignant.

[@ericaayomo]

Thanks a lot, from Brazil....I have suggestion.....acral nevus and displastic nevus.

[@JMGardnerMD]

Thanks! Those are both on my to do list. Hopefully in next few months

[@ericaayomo]

Jerad, is it possible to have mitosis in deep penetrating nevus?

[@JMGardnerMD]

Yes. Occasional mitoses can be seen in DPN

[@TheMinimi2302]

What about betacatenin in DPN

[@shizza82]

Does a Deep Penetrating Nevus have to be removed if it is non cancerous? Could it one day become cancerous if not removed?

[@JMGardnerMD]

It’s a bit complicated. Yes technically this could happen to a deep penetrating nevus (or any nevus actually). DPN are often considered more atypical than a usual common nevus/mole. So most dermatologists I have worked with tend to remove them completely just to be on the safe side.

[@shizza82]

​@@JMGardnerMD Thank you for your reply. I had biopsy done on a mole on my nose and the lab results don't seem conclusive about whether it has "potential" signs of melanoma or if it's just a DPN, which I found strange. The 2 skin cancer doctors that inspected my mole before the biopsy said it looked fine and no need for one, but the aesthetic skin doctor wanted to biopsy it before she removed it. Still really confused and concerned now about the results.