PMC6381895_01
a Invasive melanoma of the right medial lower leg before treatment. b No clinical evidence of residual melanoma after treatment with 5% topical imiquimod.
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F1
So far, about 4 years after initial presentation, the patient is well with no trace of residual melanoma (Fig. 1b).
a Atypical melanocyte infiltrate in the superficial dermis. Pagetoid spreading is also identified. H&E. x40. b A dramatic increase of melanocytes is noted at the dermo-epidermal junction. Enlarged, atypical melanocytes are immunohistochemically identified in the mid dermis. Melan-A, x20. c The periphery of the lesion shows the presence of nests of atypical melanocytes at the dermo-epidermal junction, in keeping with in situ melanoma.
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F2
The final pathology report, following a second opinion from a different pathology hospital department, was conclusive for an invasive superficial spreading malignant melanoma with Breslow thickness 0.8 mm, at least with a radial in situ component (Fig. 2a-c).
Biopsies taken after treatment show the presence of melanocytes scattered along the basal membrane. Melan-A x20. The rete ridges appear flattened. No atypical melanocytes are identified, neither in the dermis nor at the dermo-epidermal junction.
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F3
There was evidence of lichenoid inflammation, superficial dermal fibrosis, and a perivascular chronic inflammatory cell infiltrate (Fig. 3).