Histopathologic features of cases diagnosed as subungual melanoma in situ. A-C, Case 7. A, Scanning magnification shows a poorly circumscribed and heavily pigmented lesion involving the nail matrix epithelium. B, Atypical melanocytes are epithelioid to dendritic with large atypical nuclei, profoundly obscured by abundant melanin pigment. C, Melan-A immunostain supports confluent growth and pagetoid scatter. D and E, Case 9. D, Prominent lentiginous and pagetoid growth of atypical melanocytes with enlarged, hyperchromatic, and angulated nuclei. E, Atypical melanocytic nuclei are highlighted by MiTF immunostain. (A, B, and D, Hematoxylin-eosin stain; C, Melan-A stain; E, MiTF stain; original magnifications: A, ×20; B-E, ×400.)Dr. Dr. Sameer Khatri along with the Department of Pathology's Drs. Min Wang, Paul Harms, Douglas Fullen, Aleodor Andea, and May Chan, in collaboration with other U-M and extramural colleagues, have published the paper, Subungual Atypical Lentiginous Melanocytic Proliferations in Children and Adolescents: A Clinicopathologic Study, in the Journal of the American Academy of Dermatology (JAAD).
Melanonychia, characterized by longitudinal pigmented streak or diffuse pigmentation of the nail plate, may be caused by benign or malignant melanocytic proliferation among other etiologies. Atypical subungual melanocytic proliferations are rare in children and adolescents but often present a significant diagnostic challenge to dermatopathologists, in part owing to limited experience. Khatri et al. reported 11 subungual atypical lentiginous melanocytic proliferations occurring in pediatric patients, all of which demonstrated some degree of clinical atypia and histologic features indistinguishable from adult subungual melanoma in situ.
Fluorescence in situ hybridization (FISH) using a melanoma probe set was positive in 1 of 4 tested cases. Three lesions recurred without further adverse outcome. The study concluded that routine histopathology does not predict molecular abnormalities or recurrence. Given the rarity of reported adverse outcome in the literature and in this cohort, it was recommended that clinicians maintain a high threshold for biopsy while closely monitoring melanonychia in pediatric patients. Once a subungual atypical lentiginous melanocytic proliferation is diagnosed on biopsy, FISH might aid in risk stratification. Awareness of this rare group of lesions is crucial for facilitating future investigation into its biologic behavior.
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To read the paper in its entirety, visit the JAAD.
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Breast team reviewing a patient's slide. (From left to right) Ghassan Allo, Fellow; Laura Walters, Clinical Lecturer; Celina Kleer, Professor. See Article 2014Department Chair |
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Autopsy Technician draws blood while working in the Wayne County morgue. See Article 2016Department Chair |
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Dr. Sriram Venneti, MD, PhD and Postdoctoral Fellow, Chan Chung, PhD investigate pediatric brain cancer. See Article 2017Department Chair |
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Director of the Neuropathology Fellowship, Dr. Sandra Camelo-Piragua serves on the Patient and Family Advisory Council. 2018Department Chair |
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INSIDE PATHOLOGYAbout Our NewsletterInside Pathology is an newsletter published by the Chairman's Office to bring news and updates from inside the department's research and to become familiar with those leading it. It is our hope that those who read it will enjoy hearing about those new and familiar, and perhaps help in furthering our research. CONTENTS
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Residents Ashley Bradt (left) and William Perry work at a multi-headed scope in our new facility. 2019Department Chair |
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Dr. Kristine Konopka (right) instructing residents while using a multi-headed microscope. 2020Department Chair |
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Patient specimens poised for COVID-19 PCR testing. 2021Department Chair |
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Dr. Pantanowitz demonstrates using machine learning in analyzing slides. 2022Department Chair |
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(Left to Right) Drs. Angela Wu, Laura Lamps, and Maria Westerhoff. 2023Department Chair |
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Illustration representing the various machines and processing used within our labs. 2024Department Chair |
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MLabs, established in 1985, functions as a portal to provide pathologists, hospitals. and other reference laboratories access to the faculty, staff and laboratories of the University of Michigan Health System’s Department of Pathology. MLabs is a recognized leader for advanced molecular diagnostic testing, helpful consultants and exceptional customer service.