Letters to the Editor
The case report by Hoffman, Hartschuh, and Flux, titled, “Combined Nevus with Dermally Located Pagetoid Cells in the Perianal Region: A New Variant of Site-Related Histological Atypia” in the August issue of this journal was of considerable interest.
Their case study is a welcome addition to our limited body of knowledge concerning nevi of special sites and combined nevi. However, we disagree with their use of the term “pagetoid” to refer to dermally located melanocytes. If we understand correctly, readers now are asked to accept that pagetoid melanocytes can be recognized not by their location in the epidermis, the currently accepted definition, but instead by nonspecific and minimal morphologic features: “…abundant pale cytoplasm with dusty melanin.”
Pagetoid melanocytes are recognized by their presence and “scatter” within the epidermis. Pagetoid melanocytes are, by definition, intraepidermal. Their cytomorphologic features vary considerably from case to case. To claim that they can be recognized simply by “abundant pale cytoplasm with dusty melanin” is, to say the least, a challenging concept. Many melanomas that involve the dermis may have melanocytes with these features. Are we to believe that they are pagetoid cells? To do so would make the term pagetoid no longer meaningful.