Clear-cell melanocytic lesions with balloon-cell and sebocyte-like melanocytes: a unifying concept.

Melanocytes may assume unique shapes and sizes but rarely have clear cytoplasm. We studied 28 melanocytic lesions that contained clear-cell melanocytes of the balloon-cell and sebocyte-like types. Clear-cell melanocytes were found more commonly in females (64%) than in males (36%), with predominance in females younger than 50 years (79%) and predominance in males older than 50 years (67%). They were distributed evenly throughout the body but were not found on acral sites. Clear-cell melanocytes were most prevalent in congenital nevi (18 or 72%) but were also found in 5 Clark nevi, 2 Meischer nevi, 1 Unna nevus, 1 atypical intra-epidermal proliferation, and 1 melanoma. The clear cells were distributed diffusely in 86% of the lesions and focally in 14%. The overall percentage of clear-cell melanocytes was 56%. The percentage of balloon cells was 57% and sebocyte-like melanocytes 32%. Clear cells with morphologic features of both balloon cells and sebocyte-like melanocytes, that is, intermediate cells, were present in all lesions with an overall percentage of 12%. The presence of melanocytes of both the balloon-cell and sebocyte-like types and the finding of clear-cell melanocytes with intermediate features in all lesions lends support to the theory that balloon-cell and sebocyte-like melanocytes may represent morphologic expressions of the same alteration in melanogenesis.

Tumor with the features of both squamous cell carcinoma and melanoma (melanocarcinoma).

Combined tumors of malignant melanoma (MM) and squamous cell carcinoma (SCC) are extremely rare and have unknown biological potential. Different theories of their development, including collision and dual/divergent differentiation, are proposed. Although some observations suggest an indolent course for such tumors, a case of MM metastasis was reported in a patient who initially presented with a combined MM-SCC tumor. Re-excisions of such tumors may show MM in situ and should be treated accordingly. Herein we present another case of a combined MM-SCC tumor in a 78 male patient with lentigo maligna seen after complete re-excision of the tumor.