PMC3420798_01
Gross view of the skin lesion on the plantar. The lesion measures 6 x 5 cm with an ulcerated area at the base of fourth and fifth metatarsal involving the interdigital cleft and extending to the forefoot.
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fig1
Physical exam was unremarkable except for an ulcer on the plantar aspect on his right forefoot measuring 6 x 5 cm with an ulcerated area at the base of fourth and fifth metatarsal involving the interdigital cleft and extending to the forefoot (Figure 1).
Thickened epidermis ulcerated with many heavily pigmented malignant melanocytes (H and E Stains, 40x).
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fig2
The tumor had an ulcerated surface that permeated the papillary and reticular dermis without permeation of subcutaneous tissue, suggestive of a Clarke level 4 (Figures 2, 3, 4, and 5).
Epidermis and dermis with pigmented malignant melanocytes (H and E stains, 100x).
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fig3
The tumor had an ulcerated surface that permeated the papillary and reticular dermis without permeation of subcutaneous tissue, suggestive of a Clarke level 4 (Figures 2, 3, 4, and 5).
Atypical tumor cells, some pigmented, some not, with large irregular nuclei with large nucleoli. Spindled and round tumor cells. Heavy cytoplasmic melanin pigment (H and E stains, 400x).
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fig4
The tumor had an ulcerated surface that permeated the papillary and reticular dermis without permeation of subcutaneous tissue, suggestive of a Clarke level 4 (Figures 2, 3, 4, and 5).
Dermal involvement of tumor cells with uninvolved adjacent deep dermis (H and E stains, 40x).
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fig5
The tumor had an ulcerated surface that permeated the papillary and reticular dermis without permeation of subcutaneous tissue, suggestive of a Clarke level 4 (Figures 2, 3, 4, and 5).
Right groin sentinel lymph node with heavy tumor cell involvement (H and E stains, 40x).
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fig6
Patient's sentinel lymph node biopsy was positive for lymph node metastasis (Figures 6 and 7), and his tumor staging, according to the American Joint Committee on Cancer (AJCC) system of TNM (tumor, node, and metastasis) classification, was stage IIIb (T3bN1bM0).
Tumor cells contrasted with benign lymphocytes of lymph node (Hand E stains, 400x).
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fig7
Patient's sentinel lymph node biopsy was positive for lymph node metastasis (Figures 6 and 7), and his tumor staging, according to the American Joint Committee on Cancer (AJCC) system of TNM (tumor, node, and metastasis) classification, was stage IIIb (T3bN1bM0).