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Editorial |

Nested Melanoma, A Newly Defined Entity

Claus Garbe, MD1; Gisela Metzler, MD1
[+] Author Affiliations
1Department of Dermatology, Eberhard Karls University of Tübingen, Germany
JAMA Dermatol. 2013;149(8):905-906. doi:10.1001/jamadermatol.2013.4305.
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Three cases of nested melanoma have been documented in detail by Longo and colleagues.1 Clinically, we see flat, asymmetrically shaped lesions with irregular pigmentation, measuring 5 to 10 mm in diameter, on heavily sun-damaged skin, which are highly suggestive of melanoma. Dermoscopy reveals irregular dots and globules, a multicomponent overall structure, irregular blotches, and sometimes atypical pigment network, which are all indicative for melanoma. Confocal microscopy did not add much, revealing the presence of a “clod” pattern made of large compact nests with variable atypia. Taken all together, we would clinically diagnose superficial spreading melanoma in heavily sun-damaged skin.

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Figure.
Histopathologic Images (Original Magnification ×200 for All Panels)

A, Sharply circumscribed junctional nests of nevoid melanocytes within chronically sun-damaged skin; pagetoid spread of melanocytes is missing (hematoxylin-eosin). B, Melan A immunostaining shows nested melanocytes without pagetoid spread of cells in the epidermis. C, For comparison, a benign junctional melanocytic nevus in a newborn with distinct cell nests (hematoxylin-eosin).

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