PMC3881078_01
Close-up of eroded nodule with surrounding erythema.
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A 78-year-old Caucasian woman presented with an ulcerated nodule in the right pretibial region (Figure 1).
The nodule on the right leg appeared in association with a speckled lentiginous nevus (nevus spilus).
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It had grown in a large pre-existing, congenital pigmented lesion that, according to the patient, existed since birth (Figure 2).
Extension of the nevus spilus that crosses the midline.
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It extended over the right leg and the right side of the abdomen and the lower back, skipping the buttock and the back of the thigh, and crossed the midline (Figure 3).
Close-up of nevus spilus maculosus.
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Close up it consisted of multiple dark-brown macules on a light brown, cafe-au-lait-like background (Figure 4).
Punch biopsy of the speckled lentiginous nevus. The biopsy was taken from the thigh. Mild acanthosis and hyper-pigmentation of basal keratinocytes is present but there is no marked proliferation of melanocytes.
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A punch biopsy of the nevus showed elongation of rete ridges and hyperpigmentation of basal keratinocytes but no substantial proliferation of melanocytes (Figure 5).
Histopathology of the ulcerated melanoma arising in the nevus spilus maculosus. Large and pleomorphic tumor cells are arranged in irregular nests and sheets in the dermis.
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Histopathology of the nodule showed a nodular melanoma with an invasion thickness of 4.5 mm (Figure 6).