A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).
One of my favorite dermatopathologists! I would really like to train under you but it's hard for Filipino pathologists to do fellowship in the US. Videos like this really help! Melanocytic lesions are intimidating. This made things easier to understand! Thank you! 😊😊😊
Very informative indeed ..if I may ask to understand more about melanoma mimicking dysplastic nevus . single cells between rate ridges are concerning even though they are basally located
If there are many of them and if multiple inter rete spaces are involved, that can be worrisome especially in sun damaged skin. It is nuanced. it really depends on context.
@@JMGardnerMD ...if we would go to melanoma in situ mimicking dysplastic nevus in no sun exposed skin what is the recommended free lateral surgical margin and does it differ between MIS sub types ...many thanks
Great Videos. Could you please share your diagnostic approach to difficult spitzoid tumors. What part does molecular diagnostic play for you? Financially molecular diagnostic is not a regular service in europe and isn't done on a regular basis. Thanks for answering in advance and many thanks for the great material here.
Ah such a complicated topic! Even experts struggle and disagree. I think Spitzoid lesions are one area where H&E morphology sometimes falls short. My general rule is that I show any spitzoid lesions to at least one of my dermpath colleagues for consultation. For cases that have atypical features, I usually do send the case for NGS molecular analysis or send out for additional expert consultation. For atypical lesions I also tend to use descriptive language such as “atypical spitzoid neoplasm, favor ___ (atypical Spitz Nevus or Spitz melanoma etc) with a comment explaining whether I favor benign or malignant, what feature is worrying me, and recommending excision with negative margins. Sometimes molecular testing allows, a more definitive and less descriptive answer, but even with molecular testing, it is not always easy to solve these cases with certainty. Also, the older a patient is, my threshold for atypical features gets lower. In other words, I allow for more “atypia” in spitzoid lesions in kids than in adults. I’m sure you can find lots of expert to disagree with my approach. Because the experts disagree with each other on this topic as the literature has repeatedly shown. It is a really complicated area of dramatic pathology that most of us still struggle with (and we will probably always struggle with it!). Check out Tim McCalmont’s Kiko posts about melanocytic lesions. He has tons of great practical info and tips. kikoxp.com/posts/13964/public. See also this great UA-cam channel with lots of melanocytic videos from Arnaud de la Fouchardiere: youtube.com/@formationsetenseignementce2784?si=HwOk2Yl-njHWbdhl
Since "spindly" melanocytes also appear in benign nevus as type 3 (neurotized) melanocytes, how can we make sure that we dont fall into the trap of "seeing" maturation in a desmoplastic melanoma and misdiagnosing it as benign nevus? (especially if in-situ component is missing)
Desmoplastic melanoma usually has nuclear atypia and lymphoid aggregates. I have lots of videos about desmoplastic melanoma that provide many additional clues.
Thank you so much for all your fabulous videos..I have a question how to differentiate between lentigenous nevi and junctional nevi ¿ are they the same lesion ¿
I think of Lentiginous nevus as a subtype of junctional nevus (although sometimes I see that pattern in the junctional component of compound nevi also). It’s a pattern with elongated rete and abundant solitary melanocytes in those rete. Abundant pigment is often present in basal keratinocytes. The pattern has a lot of overlap with dysplastic nevus. It looks kind of like a dysplastic nevus without any significant nuclear atypia. That’s how I use the term.
Thank u sir..explained everything in a very simplified manner..very useful..Is the second part of this video available sir.. the remaining nevi entities ?
There is not a second part of this video. But I do have other videos about nevus and melanocytic lesions. Nevus 101 video kikoxp.com/posts/3740. Melanoma 101 video kikoxp.com/posts/3764 more here: A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).
Awesome video! Thank you so much. Question about the melanoma mimicking dysplastic nevus: would that be considered lentigo maligna melanoma and not just lentigo maligna given the vertical growth aspect (seen at 57:26) of the lesion into the sweat duct? Thanks again!
Thx! No that is melanoma in situ involving the sweat duct. It is growing down but because it is inside the epithelium of the duct, it is still in situ not invasive. Vertical growth phase refers to invasive growth.
10:17 EST I shave been diagnosed with lichen simplex. I never had any issues or symptoms until my GYN did a biopsy on my vagina. Shortly afterwards I began to itch so bad it was unbearable. The cream helps but did my doctor have activated the itching. I had no problems until he did the biopsy?
A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).
Thank you once again for selflessly sharing your knowledge.
One of my favorite dermatopathologists! I would really like to train under you but it's hard for Filipino pathologists to do fellowship in the US. Videos like this really help! Melanocytic lesions are intimidating. This made things easier to understand! Thank you! 😊😊😊
I am studying dentistry and some of your videos help me a lot with my oral pathology
I would like to appreciate your time and patience and support dear Doctor Gardber
Thanks It is a pleasure to learn difficult entities in such an easy, simple and enjoyable lectures thank you very much!
Muy didáctico el contenido, gracias.
Cannot hear the other persons sound..so we are missing out the description part. Is there anyway we can increase the volume.?
Thank you for your teaching. It is helping me a lot!
How would you grade the atypia in this dysplastic nevus and how grading might affect treatment please
Very informative indeed ..if I may ask to understand more about melanoma mimicking dysplastic nevus . single cells between rate ridges are concerning even though they are basally located
If there are many of them and if multiple inter rete spaces are involved, that can be worrisome especially in sun damaged skin. It is nuanced. it really depends on context.
@@JMGardnerMD ...if we would go to melanoma in situ mimicking dysplastic nevus in no sun exposed skin what is the recommended free lateral surgical margin and does it differ between MIS sub types ...many thanks
I enjoy these videos so much
Great Videos. Could you please share your diagnostic approach to difficult spitzoid tumors. What part does molecular diagnostic play for you? Financially molecular diagnostic is not a regular service in europe and isn't done on a regular basis. Thanks for answering in advance and many thanks for the great material here.
Ah such a complicated topic! Even experts struggle and disagree. I think Spitzoid lesions are one area where H&E morphology sometimes falls short. My general rule is that I show any spitzoid lesions to at least one of my dermpath colleagues for consultation. For cases that have atypical features, I usually do send the case for NGS molecular analysis or send out for additional expert consultation. For atypical lesions I also tend to use descriptive language such as “atypical spitzoid neoplasm, favor ___ (atypical Spitz Nevus or Spitz melanoma etc) with a comment explaining whether I favor benign or malignant, what feature is worrying me, and recommending excision with negative margins. Sometimes molecular testing allows, a more definitive and less descriptive answer, but even with molecular testing, it is not always easy to solve these cases with certainty. Also, the older a patient is, my threshold for atypical features gets lower. In other words, I allow for more “atypia” in spitzoid lesions in kids than in adults. I’m sure you can find lots of expert to disagree with my approach. Because the experts disagree with each other on this topic as the literature has repeatedly shown. It is a really complicated area of dramatic pathology that most of us still struggle with (and we will probably always struggle with it!). Check out Tim McCalmont’s Kiko posts about melanocytic lesions. He has tons of great practical info and tips. kikoxp.com/posts/13964/public. See also this great UA-cam channel with lots of melanocytic videos from Arnaud de la Fouchardiere: youtube.com/@formationsetenseignementce2784?si=HwOk2Yl-njHWbdhl
Good talks！Thank you!
Thank you doctor, good explanations
Since "spindly" melanocytes also appear in benign nevus as type 3 (neurotized) melanocytes, how can we make sure that we dont fall into the trap of "seeing" maturation in a desmoplastic melanoma and misdiagnosing it as benign nevus? (especially if in-situ component is missing)
Desmoplastic melanoma usually has nuclear atypia and lymphoid aggregates. I have lots of videos about desmoplastic melanoma that provide many additional clues.
Thank you so much for all your fabulous videos..I have a question how to differentiate between lentigenous nevi and junctional nevi ¿ are they the same lesion ¿
I think of Lentiginous nevus as a subtype of junctional nevus (although sometimes I see that pattern in the junctional component of compound nevi also). It’s a pattern with elongated rete and abundant solitary melanocytes in those rete. Abundant pigment is often present in basal keratinocytes. The pattern has a lot of overlap with dysplastic nevus. It looks kind of like a dysplastic nevus without any significant nuclear atypia. That’s how I use the term.
Thank u sir..explained everything in a very simplified manner..very useful..Is the second part of this video available sir.. the remaining nevi entities ?
There is not a second part of this video. But I do have other videos about nevus and melanocytic lesions. Nevus 101 video kikoxp.com/posts/3740. Melanoma 101 video kikoxp.com/posts/3764 more here: A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).
Awesome video! Thank you so much. Question about the melanoma mimicking dysplastic nevus: would that be considered lentigo maligna melanoma and not just lentigo maligna given the vertical growth aspect (seen at 57:26) of the lesion into the sweat duct? Thanks again!
Thx! No that is melanoma in situ involving the sweat duct. It is growing down but because it is inside the epithelium of the duct, it is still in situ not invasive. Vertical growth phase refers to invasive growth.
@@JMGardnerMD Thank you so much! You deserve a teaching award for all of these videos. My whole residency uses your videos. Thank you!!!
My favourite too. ❤❤👍🏾👍🏾👍🏾❤️👍🏾
Masson was in university de Montréal not mcgill
Thank you for catching my mistake!
U r welcome, u have the best set of teaching skills by all means simple, understandable, practical and all bases covered!!!
👍🏾👍🏾👍🏾👍🏾👍🏾👍🏾👍🏾👍🏾👍🏾
Please dr in witch type of nevus we can find giant cells?
Congenital pattern nevi often have multinucleated giant cells. See my Nevus 101 video kikoxp.com/posts/3740
@@JMGardnerMD thank you dr
10:17 EST I shave been diagnosed with lichen simplex. I never had any issues or symptoms until my GYN did a biopsy on my vagina. Shortly afterwards I began to itch so bad it was unbearable. The cream helps but did my doctor have activated the itching. I had no problems until he did the biopsy?