| The tumour should
contain more than 50% balloon cells. There are distinct areas of
characteristic melanoma cells and prominent mitoses. Occasional
intraepidermal pagetoid spread may be present.
The main differential diagnosis
is
balloon cell naevus.
The cytoplasmic features of the
balloon cells observed in balloon cell melanoma resemble those noticed
in balloon cell naevus, but the presence of nuclear pleomorphism, atypia,
and mitoses and the absence of intervening stroma help distinguish
balloon cell melanoma.
Microscopically, balloon cell melanoma also must be differentiated from
other clear cell tumours such as
clear cell sarcoma (malignant melanoma of soft
parts),
hibernoma,
xanthelasma
,
sebaceous neoplasms, metastatic renal
cell carcinoma,
porocacinoma,
(malignant) granular cell tumour,
granular (clear) cell basal cell carcinoma,
clear cell syringoma, and
atypical fibroxanthoma.
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Clear cell carcinoma of skin
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