title: Focal invasiveness in complete histological analyses of a large acral lentiginous melanoma.
abstract: BACKGROUND
  Acral lentiginous melanoma is a melanoma with poor prognosis which is frequently diagnosed at an advanced stage. Since the thickness of tumour is one of the main prognostic factors, this case can exemplify how important complete histological analyses looking for focal invasiveness can be.
  
  
  METHODS
  A 77 year-old woman with a black spot with slow progressive growth on the left plantar region. She sought medical attention due to the expansion onto the dorsal surface of toes. The lesion had irregular borders and had spread to half the plantar surface. Histopathology confirmed the clinical suspicion of acral lentiginous melanoma Clark level IV and 2.6 mm Breslow thickness. The surgical specimen was entirely processed for histological evaluation, requiring 53 slides. Tumor dermal invasion was detected in only three out of 53 glass slides as the invasiveness was not identified by clinical, dermatoscopy or macroscopy exams.
  
  
  CONCLUSIONS
  Sectioning through the entire lesion is considered very important to determinate the appropriate stage of the disease and the correct treatment and patient follow-up.
  The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1513617994148349 .
authors.affiliation: Department of Pathology, Botucatu Medical School, Paulista State University (UNESP), Rubião Júnior s/n 18618-970, Botucatu, SP, Brazil. josecandidojr@yahoo.com.br.
authors.forename: José Cândido Caldeira
authors.initials: JC
authors.lastname: Xavier-Júnior
authors.affiliation: UNESP- Universidade Estadual Paulista Radiology and Dermatology Department, Botucatu, SP, Brazil. tania_mia8@yahoo.com.br.
authors.forename: Tania
authors.initials: T
authors.lastname: Munhoz
authors.affiliation: UNESP- Universidade Estadual Paulista Radiology and Dermatology Department, Botucatu, SP, Brazil. vaseunesp@yahoo.com.br.
authors.forename: Vinicius
authors.initials: V
authors.lastname: Souza
authors.affiliation: UNESP- Universidade Estadual Paulista Radiology and Dermatology Department, Botucatu, SP, Brazil. elopires@fmb.unesp.br.
authors.forename: Eloísa Bueno Pires
authors.initials: EB
authors.lastname: de Campos
authors.affiliation: UNESP- Universidade Estadual Paulista Radiology and Dermatology Department, Botucatu, SP, Brazil. hstolf@fmb.unesp.br.
authors.forename: Hamilton Ometto
authors.initials: HO
authors.lastname: Stolf
authors.affiliation: Department of Pathology, Botucatu Medical School, Paulista State University (UNESP), Rubião Júnior s/n 18618-970, Botucatu, SP, Brazil. mmarques@fmb.unesp.br.
authors.forename: Mariângela Esther Alencar
authors.initials: ME
authors.lastname: Marques
mesh_terms: D000368:Aged; D001706:Biopsy; D005260:Female; D006801:Humans; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012878:Skin Neoplasms; D016896:Treatment Outcome; D000096142:Cutaneous Malignant Melanoma