Junctional Lentiginous Dysplastic Nevus
These lesions typically occur in the elderly on sun exposed areas. Many of these lesions will progress to melanoma in situ. Many people believe that is what they are from the beginning. They present as large variably pigmented macules particularly on the upper back. Histologically they show both lentiginous proliferation of melanocytes with variable junctional nesting with the melanocytes showing a degree of atypia. The latter is difficult to get a consensus amongst pathologists looking at the same lesion! Hence junctional lentiginous dysplastic (atypical) nevus. There is no Pagetoid upward spread. If any Pagetoid spread is seen then the lesion will be reported as melanoma in situ! You can clinically make a diagnosis of melanoma in situ before the pathologist is able to do so through H/E histology.
Look at the presentation below and then view this Virtual Slide
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