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Histologic examination showed a nodular neoplastic lesion with infiltrating margins in the epidermis&#44; extending into the reticular dermis&#46; The neoplastic cells were medium to large in size and had pronounced pleomorphism&#44; with several cells with irregular nuclei&#44; granular chromatin&#44; prominent nucleoli&#44; and abundant cytoplasm interspersed with smaller cells with hyperchromatic nuclei and amphophilic cytoplasm &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Also identified was dispersed melanic pigment that was positive with Fontana-Masson stain&#46; There were 2 mitoses in 10 high-power fields &#40;&#215;<span class="elsevierStyleHsp" style=""></span>40&#41;&#46; The most striking finding was the presence of large channels with a cavernous vascular appearance filled with erythrocytes and surrounded by neoplastic cells &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Immunohistochemical staining of the neoplastic cells was positive for S-100 protein&#44; HMB-45&#44; and MiTF-1&#44; and uniformly negative for CD31 &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46; The cells were also positive for D2-40 &#40;podoplanin&#41; and negative for keratin AE1 and AE3 and p63&#46; The Ki-67 proliferation index was 5&#37; to 10&#37;&#46; Based on the above findings&#44; a diagnosis of angiomatoid nodular melanoma was established&#44; with a Clark level of IV&#44; a Breslow thickness of 1&#46;35<span class="elsevierStyleHsp" style=""></span>mm&#44; absence of vertical growth phase&#44; a moderate lymphocytic infiltrate at the base&#44; no evidence of vascular or perineural invasion&#44; or microsatellitosis&#44; and tumor-free lateral and deep margins&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0020" class="elsevierStylePara elsevierViewall">Alder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> published the first description of angiomatoid melanoma in 1997&#46; They reported the case of a 44-year-old man with melanoma metastasis to the forehead skin and sacral vertebra&#46; The origin of the primary tumor was unknown&#46; The metastasis on the forehead showed clusters of cells forming cavernous spaces containing numerous erythrocytes and lined by neoplastic cells that stained positive for HMB-45 and S-100 protein and negative for vascular markers&#46; The authors proposed the name <span class="elsevierStyleItalic">angiomatoid melanoma</span> to describe this variant of melanoma&#46; Three additional cases have since been reported<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3&#44;4</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Pseudovascular spaces have been described in benign pigmented nevi&#44; and attributed to artifacts of tissue processing or trauma during the biopsy procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> Alterations in elastic fibers and&#47;or collagen in the nevi could reduce the resistance of the dermis to the mechanical stress of the biopsy procedure&#44; leading to the formation of these spaces&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In a study of invasive uveal melanomas with pseudovascular spaces&#44; Maniotis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> demonstrated the absence of endothelial cells by light microscopy&#44; transmission electron microscopy&#44; and immunohistochemistry&#46; They also demonstrated in vitro that metastatic melanoma cells and invasive uveal melanoma cells &#40;unlike normal melanocytes or poorly differentiated melanomas&#41; could generate this pseudovascular growth pattern&#44; and proposed that melanoma cells might undergo genetic reversion to a pluripotent &#40;embryonic-like&#41; genotype&#46; The authors also suggested that melanoma cells could generate pseudovascular changes that would facilitate tumor invasion independently of tumor angiogenesis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The 4 cases of angiomatoid &#40;pseudovascular&#41; melanoma reported to date have all been characterized by aggressive behavior&#46; The case described herein is the second report of primary cutaneous melanoma with an angiomatoid pattern&#46; The first case was reported by Baron et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> in an 84-year-old man with a desmoplastic melanoma containing areas with an angiomatoid pattern&#46; The melanoma was located in the periorbital region and had recurred several times&#46; At the time of writing&#44; our patient has shown no signs of metastasis&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Diagnosis of angiomatoid melanoma must be confirmed by immunohistochemistry and identification of neoplastic cells with melanocytic markers&#46; The histologic presentation of this variant of melanoma poses numerous challenges and can lead to erroneous pathologic diagnosis as it can be confused with angiosarcoma or pseudovascular squamous cell carcinoma&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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        1 => array:2 [
          "identificador" => "xpalclavsec1558321"
          "titulo" => "Keywords"
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          "identificador" => "xres1774122"
          "titulo" => "Resumen"
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        3 => array:2 [
          "identificador" => "xpalclavsec1558322"
          "titulo" => "Palabras clave"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
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        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case Description"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Comment"
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        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conflicts of Interest"
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        8 => array:1 [
          "titulo" => "References"
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      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-07-31"
    "fechaAceptado" => "2014-09-10"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1558321"
          "palabras" => array:4 [
            0 => "Angiomatoid melanoma"
            1 => "Human Melanoma Black-45 &#40;HMB-45&#41;"
            2 => "Protein S-100"
            3 => "Angiosarcoma"
          ]
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      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1558322"
          "palabras" => array:4 [
            0 => "Melanoma angiomatoide"
            1 => "HMB-45"
            2 => "Prote&#237;na S-100"
            3 => "Angiosarcoma"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We report a case of angiomatoid melanoma on the right thigh of a 59-year-old man&#46; The histologic growth pattern of the tumor mimicked vascular proliferation&#44; and the cells lining the pseudovascular spaces were positive for protein S-100&#44; HMB-45&#44; and MITF-1&#46; The differential diagnosis is with angiosarcoma and pseudovascular adenoid squamous cell carcinoma&#46; The case we present is the fifth reported to date&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Presentamos un caso de melanoma angiomatoide localizado en la piel del muslo derecho en un hombre de 59 a&#241;os de edad&#46; La neoplasia mostr&#243; un patr&#243;n de crecimiento semejante a una proliferaci&#243;n vascular donde las c&#233;lulas que revest&#237;an esos espacios &#8220;pseudovasculares&#8221; fueron positivas a la prote&#237;na S-100&#44; al HMB45 y al MiTF1&#46; El diagn&#243;stico diferencial incluye el angiosarcoma y el carcinoma escamoso pseudovascular&#46; El caso que aqu&#237; informamos es el quinto de la literatura mundial&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ramos-Rodr&#237;guez G&#44; Ortiz-Hidalgo C&#46; Melanoma primario cut&#225;neo angiomatoide&#46; Un patr&#243;n morfol&#243;gico excepcional en los melanomas de piel&#46; Presentaci&#243;n de caso con revisi&#243;n de la literatura&#46; Actas Dermosifiliogr&#46; 2015&#59;106&#58;e13&#8211;e17&#46;</p>"
      ]
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        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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            "imagen" => "gr1.jpeg"
            "Alto" => 2246
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            "Tamanyo" => 1396797
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A&#44; Panoramic view of angiomatoid melanoma &#40;hematoxylin-eosin&#44; original magnification &#215;100&#41;&#46; B and C&#44; Higher-magnification view showing the pseudovascular spaces lined with neoplastic cells and numerous extravasated erythrocytes &#40;hematoxylin-eosin&#44; original magnification &#215;200&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2001
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            "Tamanyo" => 1031642
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        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A&#44; Immunohistochemical staining with keratin AE1 and AE3 showing positive results in the epithelium and negative neoplastic cells&#46; B&#44; Immunohistochemical staining with HMB-45&#44; with positivity for neoplastic cells and negativity for the epithelium&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
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            "Tamanyo" => 1223122
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A&#44; Immunohistochemical staining with D2-40 &#40;podoplanin&#41;&#46; B&#44; S-100 protein&#46; C&#44; MiTF-1 showing positive results for pseudovascular spaces&#46; D&#44; CD31 showing positive results only for small vessels &#40;negative staining for pseudovascular spaces&#41;&#46;</p>"
        ]
      ]
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        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Location&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Immunohistochemistry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#41; Intravertebral &#40;S1-S2&#41;2&#41; Forehead&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#41; Melanoma2&#41; Angiomatoid metastatic melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#41; S-100<span class="elsevierStyleSup">&#43;</span>&#44; HMB-45<span class="elsevierStyleSup">&#43;</span>&#44; vimentin<span class="elsevierStyleSup">&#43;</span>2&#41; S-100<span class="elsevierStyleSup">&#43;</span>&#44; HMB-45<span class="elsevierStyleSup">&#43;</span>&#44; vimentin<span class="elsevierStyleSup">&#43;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Periorbital region&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desmoplastic and amelanotic melanoma with an angiomatoid pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S100<span class="elsevierStyleSup">&#43;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#41; Right arm2&#41; Back &#40;paravertebral muscles&#41;&#44; lower left quadrant of the left breast&#44; neck&#44; subcutaneous tissue &#40;right shoulder&#44; psoas muscle&#44; medial gluteus&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#41; Melanoma&#44; Clark level III&#44; Breslow thickness 1&#46;1<span class="elsevierStyleHsp" style=""></span>mm2&#41; Angiomatoid metastatic melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#41; S-100<span class="elsevierStyleSup">&#43;</span>&#44; Melan A<span class="elsevierStyleSup">&#43;</span>&#44; HMB-45<span class="elsevierStyleSup">&#43;</span>2&#41; S-100<span class="elsevierStyleSup">&#43;</span>&#44; HMB-45<span class="elsevierStyleSup">&#43;</span>&#44; Melan A<span class="elsevierStyleSup">&#43;</span>&#44; CD56<span class="elsevierStyleSup">&#43;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#41; Third finger of the left hand2&#41; Axillary lymph node&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#41; Acral lentiginous melanoma&#44; Clark level III&#44; Breslow thickness 0&#46;55<span class="elsevierStyleHsp" style=""></span>mm2&#41; Angiomatoid metastatic melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#41; S-100<span class="elsevierStyleSup">&#43;</span>2&#41; S-100<span class="elsevierStyleSup">&#43;</span>&#44; CD56<span class="elsevierStyleSup">&#43;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right thigh skin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Angiomatoid nodular melanoma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">S-100<span class="elsevierStyleSup">&#43;</span>&#44; HMB 45<span class="elsevierStyleSup">&#43;</span>&#44; MiTF-1<span class="elsevierStyleSup">&#43;</span>Keratin AE1&#47;AE3<span class="elsevierStyleSup">&#8211;</span>&#44; CD31<span class="elsevierStyleSup">&#8211;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Current case&nbsp;\t\t\t\t\t\t\n
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e- Case Report
Primary Angiomatoid Melanoma as an Exceptional Morphologic Pattern in Cutaneous Melanoma. A Case Report and Review of the Literature
Melanoma primario cutáneo angiomatoide. Un patrón morfológico excepcional en los melanomas de piel. Presentación de caso con revisión de la literatura
G. Ramos-Rodrígueza, C. Ortiz-Hidalgob,c,
Corresponding author
cortiz@abchospital.com

Corresponding author.
a Departamento de Anatomía Patológica, Hospital Regional Lic. Adolfo López Mateos ISSSTE, México DF, Mexico
b Departamento de Patología Quirúrgica y Molecular, Centro Médico ABC, México DF, Mexico
c Departamento de Biología Celular y Tisular, Universidad Panamericana, México DF, Mexico
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Melanoma has diverse morphologic forms&#46; Among the most common forms are superficial spreading melanoma&#44; nodular melanoma&#44; acral lentiginous melanoma&#44; desmoplastic melanoma&#44; and lentigo maligna melanoma&#46; Some of the rarer forms&#44; which fall into the category of miscellaneous melanomas&#44; are melanomas with rosettes&#44; angiotropic melanoma&#44; animal-type melanoma&#44; myxoid melanoma&#44; chondroid melanoma&#44; osteogenic melanoma&#44; rhabdoid melanoma&#44; follicular melanoma&#44; nevoid melanoma&#44; and angiomatoid melanoma&#46; Angiomatoid melanoma was first described in metaplastic melanomas with clusters of neoplastic cells reminiscent of vascular channels&#46; Immunohistochemically&#44; this variant of melanoma is negative for vascular markers and positive for melanocytic markers&#46; The angiomatoid pattern has been described in just 4 cases of melanoma to date in the English literature&#46; The differential diagnosis is with angiosarcoma and pseudovascular squamous cell carcinoma&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe a case of primary angiomatoid melanoma on the right thigh of a 59-year-old man&#44; with no evidence of metastasis at the time of diagnosis&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case Description</span><p id="par0015" class="elsevierStylePara elsevierViewall">We present the case of a 59-year-old man with a skin lesion on his right thigh&#46; The patient reported that the lesion had been present for several months&#44; but he did not specify the exact time&#46; The clinical diagnosis was &#8220;probable hemangioma&#8221; and the lesion was completely excised&#46; Histologic examination showed a nodular neoplastic lesion with infiltrating margins in the epidermis&#44; extending into the reticular dermis&#46; The neoplastic cells were medium to large in size and had pronounced pleomorphism&#44; with several cells with irregular nuclei&#44; granular chromatin&#44; prominent nucleoli&#44; and abundant cytoplasm interspersed with smaller cells with hyperchromatic nuclei and amphophilic cytoplasm &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Also identified was dispersed melanic pigment that was positive with Fontana-Masson stain&#46; There were 2 mitoses in 10 high-power fields &#40;&#215;<span class="elsevierStyleHsp" style=""></span>40&#41;&#46; The most striking finding was the presence of large channels with a cavernous vascular appearance filled with erythrocytes and surrounded by neoplastic cells &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Immunohistochemical staining of the neoplastic cells was positive for S-100 protein&#44; HMB-45&#44; and MiTF-1&#44; and uniformly negative for CD31 &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46; The cells were also positive for D2-40 &#40;podoplanin&#41; and negative for keratin AE1 and AE3 and p63&#46; The Ki-67 proliferation index was 5&#37; to 10&#37;&#46; Based on the above findings&#44; a diagnosis of angiomatoid nodular melanoma was established&#44; with a Clark level of IV&#44; a Breslow thickness of 1&#46;35<span class="elsevierStyleHsp" style=""></span>mm&#44; absence of vertical growth phase&#44; a moderate lymphocytic infiltrate at the base&#44; no evidence of vascular or perineural invasion&#44; or microsatellitosis&#44; and tumor-free lateral and deep margins&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0020" class="elsevierStylePara elsevierViewall">Alder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> published the first description of angiomatoid melanoma in 1997&#46; They reported the case of a 44-year-old man with melanoma metastasis to the forehead skin and sacral vertebra&#46; The origin of the primary tumor was unknown&#46; The metastasis on the forehead showed clusters of cells forming cavernous spaces containing numerous erythrocytes and lined by neoplastic cells that stained positive for HMB-45 and S-100 protein and negative for vascular markers&#46; The authors proposed the name <span class="elsevierStyleItalic">angiomatoid melanoma</span> to describe this variant of melanoma&#46; Three additional cases have since been reported<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3&#44;4</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Pseudovascular spaces have been described in benign pigmented nevi&#44; and attributed to artifacts of tissue processing or trauma during the biopsy procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> Alterations in elastic fibers and&#47;or collagen in the nevi could reduce the resistance of the dermis to the mechanical stress of the biopsy procedure&#44; leading to the formation of these spaces&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In a study of invasive uveal melanomas with pseudovascular spaces&#44; Maniotis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> demonstrated the absence of endothelial cells by light microscopy&#44; transmission electron microscopy&#44; and immunohistochemistry&#46; They also demonstrated in vitro that metastatic melanoma cells and invasive uveal melanoma cells &#40;unlike normal melanocytes or poorly differentiated melanomas&#41; could generate this pseudovascular growth pattern&#44; and proposed that melanoma cells might undergo genetic reversion to a pluripotent &#40;embryonic-like&#41; genotype&#46; The authors also suggested that melanoma cells could generate pseudovascular changes that would facilitate tumor invasion independently of tumor angiogenesis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The 4 cases of angiomatoid &#40;pseudovascular&#41; melanoma reported to date have all been characterized by aggressive behavior&#46; The case described herein is the second report of primary cutaneous melanoma with an angiomatoid pattern&#46; The first case was reported by Baron et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> in an 84-year-old man with a desmoplastic melanoma containing areas with an angiomatoid pattern&#46; The melanoma was located in the periorbital region and had recurred several times&#46; At the time of writing&#44; our patient has shown no signs of metastasis&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Diagnosis of angiomatoid melanoma must be confirmed by immunohistochemistry and identification of neoplastic cells with melanocytic markers&#46; The histologic presentation of this variant of melanoma poses numerous challenges and can lead to erroneous pathologic diagnosis as it can be confused with angiosarcoma or pseudovascular squamous cell carcinoma&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Location&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Immunohistochemistry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#41; Intravertebral &#40;S1-S2&#41;2&#41; Forehead&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#41; Melanoma2&#41; Angiomatoid metastatic melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#41; S-100<span class="elsevierStyleSup">&#43;</span>&#44; HMB-45<span class="elsevierStyleSup">&#43;</span>&#44; vimentin<span class="elsevierStyleSup">&#43;</span>2&#41; S-100<span class="elsevierStyleSup">&#43;</span>&#44; HMB-45<span class="elsevierStyleSup">&#43;</span>&#44; vimentin<span class="elsevierStyleSup">&#43;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Periorbital region&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Desmoplastic and amelanotic melanoma with an angiomatoid pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S100<span class="elsevierStyleSup">&#43;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#41; Right arm2&#41; Back &#40;paravertebral muscles&#41;&#44; lower left quadrant of the left breast&#44; neck&#44; subcutaneous tissue &#40;right shoulder&#44; psoas muscle&#44; medial gluteus&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#41; Melanoma&#44; Clark level III&#44; Breslow thickness 1&#46;1<span class="elsevierStyleHsp" style=""></span>mm2&#41; Angiomatoid metastatic melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#41; S-100<span class="elsevierStyleSup">&#43;</span>&#44; Melan A<span class="elsevierStyleSup">&#43;</span>&#44; HMB-45<span class="elsevierStyleSup">&#43;</span>2&#41; S-100<span class="elsevierStyleSup">&#43;</span>&#44; HMB-45<span class="elsevierStyleSup">&#43;</span>&#44; Melan A<span class="elsevierStyleSup">&#43;</span>&#44; CD56<span class="elsevierStyleSup">&#43;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#41; Third finger of the left hand2&#41; Axillary lymph node&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#41; Acral lentiginous melanoma&#44; Clark level III&#44; Breslow thickness 0&#46;55<span class="elsevierStyleHsp" style=""></span>mm2&#41; Angiomatoid metastatic melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#41; S-100<span class="elsevierStyleSup">&#43;</span>2&#41; S-100<span class="elsevierStyleSup">&#43;</span>&#44; CD56<span class="elsevierStyleSup">&#43;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right thigh skin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Angiomatoid nodular melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S-100<span class="elsevierStyleSup">&#43;</span>&#44; HMB 45<span class="elsevierStyleSup">&#43;</span>&#44; MiTF-1<span class="elsevierStyleSup">&#43;</span>Keratin AE1&#47;AE3<span class="elsevierStyleSup">&#8211;</span>&#44; CD31<span class="elsevierStyleSup">&#8211;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Current case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cases of Angiomatoid Melanoma in the Literature&#46;</p>"
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    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:7 [
            0 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Morphologic diversity in malignant melanomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46;E&#46; Nakhleh"
                            1 => "M&#46;R&#46; Wick"
                            2 => "A&#46; Rocamora"
                            3 => "P&#46;E&#46; Swanson"
                            4 => "L&#46;P&#46; Dehner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ajcp/93.6.731"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Pathol"
                        "fecha" => "1990"
                        "volumen" => "93"
                        "paginaInicial" => "731"
                        "paginaFinal" => "740"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2346132"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Angiomatoid melanoma&#58; A case of metastatic melanoma mimicking a vascular malignancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Adler"
                            1 => "J&#46; Beckstead"
                            2 => "C&#46;R&#46; White Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00000372-199712000-00010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Dermatopathol"
                        "fecha" => "1997"
                        "volumen" => "19"
                        "paginaInicial" => "606"
                        "paginaFinal" => "609"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9415619"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Angiomatoid melanoma&#58; A novel pattern of differentiation in invasive periocular desmoplastic malignant melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Baron"
                            1 => "F&#46; Monzon"
                            2 => "N&#46; Galaria"
                            3 => "G&#46; Murphy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/hupa.2000.21063"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Pathol"
                        "fecha" => "2000"
                        "volumen" => "31"
                        "paginaInicial" => "1520"
                        "paginaFinal" => "1522"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11150378"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Angiomatoid metastatic melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46;G&#46; Zelger"
                            1 => "B&#46; Zelger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2004.30082.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2004"
                        "volumen" => "30"
                        "paginaInicial" => "336"
                        "paginaFinal" => "340"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14871230"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Identification of cells lining pseudovascular spaces of benign pigmented nevi"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Modlin"
                            1 => "C&#46; Taylor"
                            2 => "B&#46; Gottlieb"
                            3 => "T&#46; Rea"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00000372-198402000-00008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Dermatopathol"
                        "fecha" => "1984"
                        "volumen" => "6"
                        "paginaInicial" => "25"
                        "paginaFinal" => "29"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6367523"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vascular channel formation by human melanoma cells in vivo and in vitro&#58; Vasculogenic mimicry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;J&#46; Maniotis"
                            1 => "R&#46; Folberg"
                            2 => "A&#46; Hess"
                            3 => "E&#46;A&#46; Seftor"
                            4 => "L&#46;M&#46; Gardner"
                            5 => "J&#46; Pe&#8217;er"
                          ]
                        ]
                      ]
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Article information
ISSN: 15782190
Original language: English
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