Melanocytic Dermpath Basics: Melanoma
80,243
Published 2018-05-23
Part 2 of my (in progress) video series about the pathology of melanocytic skin lesions. This video discusses the basic features and patterns that are commonly seen in melanoma, including asymmetry, pagetoid spread, confluent growth, abnormal/lack of maturation, severe cytologic atypia, and mitotic activity in the invasive dermal component. These are not hard and fast rules, just a helpful framework to serve as a starting point for understanding how to diagnose melanocytic lesions histologically. Exceptions exist for pretty much all of these things. Watch the video to learn more. 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/2ZhUyMa.
Here's an excellent example of confluent growth in an acral lentiginous melanoma (WSI digital whole slide image): kikoxp.com/posts/2813/. And here's a video explaining the case in more detail: kikoxp.com/posts/2836/.
Topics Discussed (click timestamp to jump to that part of the video):
Asymmetry- 6:40
Pagetoid Spread- 7:30
Severe Cytologic Atypia- 11:15
Mitotic Activity in Dermal Component- 16:00 and 1:07:50
Abnormal/Lack of Maturation- 21:53 and 1:09:40
Confluent Growth- 32:55
Breslow Depth- 49:05
Regression- 1:00:10
Ulceration- 1:03:20
Pattern of Metastatic or Recurrent Melanoma- 1:10:05
Melanoma subtypes:
Superficial Spreading- 29:10 (and before)
Acral Lentiginous- 30:24
Unzipping Sign (Melanocytic Blistering)- 37:30
Eccrine Duct Wrapping- 39:30
Lentigo maligna- 50:30
Immunostaining- 52:30
Nodular- 1:03:10
Other videos that will help you better understand this topic:
-Normal Skin Histology: • Normal Skin Histology - Explained by ...
-Nevus Basics: • Melanocytic Dermpath Basics: Benign N...
-Melanocytic Immunohistochemistry: • Melanocytic Dermpath Basics: Immunohi...
Disclaimers: As I said in the video, distinguishing nevus from melanoma is serious business. My video does 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. This video represents MY current views as of May 23, 2018. 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.
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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All Comments (21)
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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).
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Your videos are much better than any residency in the entire world. Thank you!
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This video is priceless. You are an extraordinary teacher. God bless you.
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You can not imagine how these videos help me at the beginning of adaptation to dermatopathology division. Many thanks Jerad.
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The way you teach is very effective, even if the subject may be very complicated and tricky. Thanks a lot for sharing your hints and tips from your personal experience, they’ll be very helpful.
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This video is priceless. Thank you.
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Excellent images and fantastic tutorial! Thank you Dr Gardner!
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Thank you very much for the in depth presentation of this topic. Hope to see more such videos in future.
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Thank you very much. This is such a difficult topic with a lot of problems and difficulties with interpretation. So useful to find a talk that encapsulates all the key features! Please continue with more topics... dysplastic naevi and their grading /vs lentiginous naevi, naevi of special sites and spitzoid melanocytic lesions (something that we have such high interobserver variation and will be really useful for generalists like myself).
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I'm happy for the existence of this video!! Thanks!!! We need more Path content on YouTube and you helped us, as students!!!
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Just wanted to say thank you for making these videos. You are awesome!
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Thanks so much for your fantastic lecture! Very clear and well-versed!
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Every few months I come back to this same video to remind myself of these basic principles! Thank you for at least the third time now!
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Never before seen such enthusiastic teaching and awesomely clear concepts!!
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Great video! this came up exactly when i needed some info on melanoma.
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Thank you so much. Nevus and Melanoma both topics are explained very nicely.
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Very great show, thank you
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Thank you so much for your precious videos. They are actually the best lectures in dermpath online. 🙏
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Fantastic tutorials. Your tutorials make the patient's and pathologist's life better!! Thank you
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Wonderfully informative presentation! Thank you.
