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ATLAS OF TUMOR PATHOLOGY

Third Series
Fascicle 2

MELANOCYTIC TUMORS OF THE SKIN

by

DAVID E. ELDER, M.B., Ch.B., F.R.C.P.A.
Department of Pathology and Laboratory Medicine
University of Pennsylvania School of Medicine
Philadelphia, Pennsylvania 19104

and

GEORGE F. MURPHY, M.D.
Department of Dermatology
University of Pennsylvania School of Medicine
Philadelphia, Pennsylvania 19104

Published by the
ARMED FORCES INSTITUTE OF PATHOLOGY
Washington, D.C.

Under the Auspices of
UNIVERSITIES ASSOCIATED
FOR RESEARCH AND EDUCATION
IN PATHOLOGY, INC.
Bethesda, Maryland
1991

Accepted for Publication
1990

Available from the American Registry of Pathology
Armed Forces Institute of Pathology
Washington, D.C. 20306-6000
ISSN 0160-6344

ATLAS OF TUMOR PATHOLOGY

EDITOR
JUAN ROSAI, M.D.
Department of Pathology
Memorial Sloan-Kettering Cancer Center
New York, New York 10021-6007

ASSOCIATE EDITOR
LESLIE H. SOBIN, M.D.
Armed Forces Institute of Pathology
Washington, D.C. 20306-6000


EDITORIAL ADVISORY BOARD

John G. Batsakis, M.D.
U.T. M.D. Anderson Cancer Center
Houston, Texas 77030

Ronald A. DeLellis. M.D.
Tufts University School of Medicine
Boston, Massachusetts 02111

Glauco Frizzera, M.D.
Armed Forces Institute of Pathology
Washington D.C. 20306-6000

Leonard B. Kahn, M.D.
Long Island Jewish Hospital
New Hyde Park, New York 11042

Richard L. Kempson, M.D.
Stanford University Medical School
Stanford, California 94305

Lance A. Liotta, M.D., Ph.D.
National Cancer Institute
Bethesda, Maryland 20892

Paul Peter Rosen. M.D.
Memorial Sloan-Kettering Cancer Center
New York, New York 10021

Robert E. Scully. M.D.
Harvard Medical School and
Massachusetts General Hospital
Boston, Massachusetts 02114

Sharon Weiss, M.D.
University of Michigan School of Medicine
Ann Arbor, Michigan 48109-0602


EDITORS' NOTE

The Atlas of Tumor Pathology has a long and distinguished history. It was
first conceived at a Cancer Research Meeting held in St. Louis in September
1947 as an attempt to standardize the nomenclature of neoplastic diseases. The
first series was sponsored by the National Academy of Sciences-National
Research Council. The organization of this Sisyphean effort was entrusted to
the Subcommittee on Oncology of the Committee on Pathology, and Dr. Arthur
Purdy Stout was the first editor-in-chief. Many of the illustrations were
provided by the Medical Illustration Service of the Armed Forces Institute of
Pathology, the type was set by the Government Printing Office, and the final
printing was done at the Armed Forces Institute of Pathology (hence the
colloquial appellation "AFIP Fascicles"). The American Registry of Pathology
purchased the Fascicles from the Government Printing Office and sold them
virtually at cost. Over a period of 20 years, approximately 15,000 copies each
of nearly 40 Fascicles were produced. The worldwide impact that these
publications have had over the years has largely surpassed the original goal.
They quickly became among the most influential publications on tumor pathology
ever written, primarily because of their overall high quality but also because
their low cost made them easily accessible to pathologists and other students
of oncology the world over.

Upon completion of the first series, the National Academy of Sciences-National
Research Council handed further pursuit of the project over to the newly
created Universities Associated for Research and Education in Pathology
(UAREP). A second series was started, generously supported by grants from the
AFIP, the National Cancer Institute, and the American Cancer Society. Dr.
Harlan I. Firminger became the editor-in-chief and was succeeded by Dr.
William H. Hartmann. The second series Fascicles were produced as bound
volumes instead of loose leaflets. They featured a more comprehensive coverage
of the subjects, to the extent that the Fascicles could no longer be regarded
as "atlases" but rather as monographs describing and illustrating in detail
the tumors and tumorlike conditions of the various organs and systems.

Once the second series was completed, with a success that matched that of the
first, UAREP and AFIP decided to embark on a third series. A new
editor-in-chief and an associate editor were selected, and a distinguished
editorial board was appointed. The mandate for the third series remains the
same as for the previous ones, i.e., to oversee the production of an eminently
practical publication with surgical pathologists as its primary audience, but
also aimed at other workers in oncology. The main purposes of this series are
to promote a consistent, unified, and biologically sound nomenclature; to
guide the surgical pathologist in the diagnosis of the various tumors and
tumor-like lesions; and to provide relevant histogenetic, pathogenetic, and
clinicopathologic information on these entities. Just as the second series
included data obtained from ultrastructural (and, in the more recent
Fascicles, immunohistochemical) examination, the third series will, in
addition, incorporate pertinent information obtained with the newer molecular
biology techniques. As in the past, a continuous attempt will be made to
correlate, whenever possible, the nomenclature used in the Fascicles with that
proposed by the World Health Organization's International Histological
Classification of Tumors. The format of the third series has been changed in
order to incorporate additional items and to ensure a consistency of style
throughout. Close cooperation between the various authors and their respective
liaisons from the editorial board will be emphasized to minimize unnecessary
repetition and discrepancies.

To its everlasting credit, the participation and commitment of the AFIP to
this venture is even more substantial and encompassing than in previous
series. It now extends to virtually all scientific, technical, and financial
aspects of the production.

The task confronting the organizations and individuals involved in the third
series is even more daunting than in the preceding efforts because of the
ever-increasing complexity of the matter at hand. It is hoped that this
combined effort — of which, needless to say, that represented by the authors
is first and foremost — will result in a series worthy of its two illustrious
predecessors and will be a suitable introduction to the tumor pathology of the
twenty-first century.


Juan Rosai, M.D.
Leslie H. Sobin, M.D.


DEDICATION

This book is dedicated to the memory of Vincent J. McGovern, M.D., who was the
Director of the Fairfax Institute of Pathology at the Royal Alfred Hospital in
Sydney, Australia, for many years. A prolific and original writer, an
indefatigable traveler, and a linguist, his intellectual legacy ranges across
the entire spectrum of human diseases, specifically skin pathology and
melanoma. His influence was worldwide. He was cherished not only for his
personal warmth but also as a generous host, a fascinating raconteur, and a
classical pianist of great flair. His ideas live on in his many publications,
in this volume, and in the hearts of his friends, students, and colleagues
around the world.

ACKNOWLEDGMENTS

The development and completion of this Fascicle was dependent upon a diverse
array of people whose expertise, devotion, and support made it all possible.
First, we are grateful to Dr. Herbert Z. Lund, whose Fascicles on skin tumors
written some 30 years ago provided a solid base for the formulation of this
work. Drs. Wallace Clark and Martin C. Mihm provided us with much of the
training, knowledge, and analytical sense that prompted us to dare to
undertake such a challenge, and for these critical tools, we thank them.
Clinical photographs and data are crucial to the comprehensive understanding
of melanocytic neoplasia, and we are indebted to the patients and staff of the
University of Pennsylvania Pigmented Lesion Clinic, including Jean Thompson,
R.N., and Marie Synnestvedt, M.S., as well as Drs. Wallace Clark, Dupont
Guerry IV, Allan Halpern, Ralph Hamilton, John Daly, Lynn Schucter, and Donato
LaRossa for their invaluable assistance in these and other matters.
Coordination of terminology used in this Fascicle with that of the new WHO
Histological Classification of Skin Tumors, currently in preparation, is being
accomplished with the collegial interaction and guidance of Dr. Peter Heenan.
Preparation of photomicrographs was facilitated by the expert assistance of
Mr. William Witmer and Ms. Diana Whitaker, and the histotechnologists of the
Departments of Pathology and Dermatology of the University of Pennsylvania
provided tissue specimens of excellent quality. Dr. Leslie Sobin of the AFIP
graciously provided written material not readily available to us upon demand.
Drs. Sharon Weiss and Juan Rosai and outside reviewers unknown to us
generously and selflessly gave time, effort, and expertise so that a roughly
hewn draft could evolve into a finished work.

Finally, we thank our wives, Peggy and Sharon, and our children, Kate,
Kenneth, Erin, and Emily, for their love, patience, faith, and encouragement,
without which this Acknowledgment would not have needed to be written.


David E. Elder, M.B., Ch.B., F.R.C.P.A.
George F. Murphy, M.D.

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