This case is of interest because, as often happens with small biopsies of acral lentiginous melanomas, what is seen here is not representative of that which was found in the excisional specimen. Extensive deep invasion of the reticular dermis by confluent masses of melanoma cells was found in the excisional specimen, and the perivascular/perineural pattern found in this biopsy was not apparent. Inguinal lymph nodes contained tumor, and this patient died with extensive metastatic melanoma about a year after this biopsy was obtained.
 

	Scan power view of  biopsy.
	Low power view showing contiguous, lentiginous spanning of multiple rete ridges by melanocytes that are several layers thick. This is characteristic of the intraepidermal component of melanomas having a lentiginous radial growth phase. Pigmented cells are in the superficial dermis, but these could either be macrophages or melanoma cells.
	High power view of above.
	Low power view from the deep part of the biopsy. Pigmented cells are found around the nerve in the blue rectangle as well as around some of the nerves outside the rectangle. Pigmented cells were also found in contact with sweat ducts in  this biopsy. Periductal spread is sometimes seen in acral lentiginous melanomas.
	High power view of above showing the area in the blue rectangle. Melanoma cells swirl around a nerve and are found adjacent to a blood vessel. Nuclear detail is obscured by the melanin, but this pattern of pigmented cells found in the deep part of a biopsy having evidence of the radial growth phase of a melanoma constitute compelling evidence that this is invasive melanoma.

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