{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T10:38:47Z","timestamp":1778755127946,"version":"3.51.4"},"reference-count":16,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,7,12]],"date-time":"2019-07-12T00:00:00Z","timestamp":1562889600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007915","name":"Baylor College of Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007915","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Cutan Pathol"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Melanoma, particularly nevoid melanoma, can masquerade as benign. Helpful differentiating features include nuclear pleomorphism, atypia, prominent nucleoli, absent maturation, and increased mitotic figures. These can be subtle and easily missed unless carefully sought. Thus, the \u201cpuffy shirt appearance\u201d concept was born from a <jats:italic>Seinfeld<\/jats:italic> episode in which the namesake character unintentionally agreed to wear a pirate\u2010like puffy shirt. Consequently, he found himself out of place, sporting an outfit with \u201ctoo much shirt in too little space\u201d. Similarly, at low\u2010power, nevoid melanoma appears to have \u201ctoo many cells in too little space\u201d. This is more pronounced and easier to appreciate when there is an associated nevus, where crowded, subtly malignant melanocytes stand out from the evenly distributed, more spaced out benign melanocytes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twelve practicing dermatopathologists familiar with the puffy shirt concept in the context of melanoma were surveyed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Hundred percent of participants found it most helpful as a triaging tool, prompting additional work up including higher magnification evaluation, additional levels, consultation, and\/or immunohistochemistry.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The crowded cells in the \u201cpuffy shirt appearance\u201d catch the eye and should provoke a more thorough inspection of the lesion. This sign is not pathognomonic for melanoma, but prompts more careful evaluation and helps prevent misdiagnosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cup.13531","type":"journal-article","created":{"date-parts":[[2019,6,25]],"date-time":"2019-06-25T21:33:02Z","timestamp":1561498382000},"page":"805-809","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["\u201cPuffy shirt appearance\u201d: Cell crowding at low magnification may represent nevoid melanoma"],"prefix":"10.1111","volume":"46","author":[{"given":"Amanda B.","family":"Moyer","sequence":"first","affiliation":[{"name":"Departments of Pathology &amp; Immunology Baylor College of Medicine  Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6515-1828","authenticated-orcid":false,"given":"A. Hafeez","family":"Diwan","sequence":"additional","affiliation":[{"name":"Departments of Pathology &amp; Immunology Baylor College of Medicine  Houston Texas"},{"name":"Department of Dermatology Baylor College of Medicine  Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,7,12]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/DAD.0b013e3181b34a19"},{"issue":"3","key":"e_1_2_6_3_1","first-page":"203","article-title":"\"Triggered trap\": nevoid malignant melanoma","volume":"15","author":"McNutt NS","year":"1998","journal-title":"Semin Diagn Pathol"},{"issue":"3","key":"e_1_2_6_4_1","first-page":"112","article-title":"Recurrence of nevoid melanoma originally diagnosed as benign nevus","volume":"101","author":"Collina G","year":"2009","journal-title":"Pathologica"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.2340\/00015555-2634"},{"key":"e_1_2_6_6_1","unstructured":"https:\/\/www.youtube.com\/watch?v=3qWFSBqAxR4"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/93.6.731"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000372-200106000-00001"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00509234"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0560.1995.tb01146.x"},{"issue":"3","key":"e_1_2_6_11_1","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1002\/j.1098-2388.1993.tb00005.x","article-title":"Melanoma mimicking dermal and Spitz's nevus (\"nevoid\" melanoma)","volume":"9","author":"Wong TY","year":"1993","journal-title":"Semin Surg Oncol"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cll.2011.03.002"},{"issue":"3","key":"e_1_2_6_13_1","first-page":"421","article-title":"Less common variants of cutaneous melanoma","volume":"3","author":"Barnhill RL","year":"2012","journal-title":"Emerging Cancer Therapeutics"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2015.07.003"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-200012000-00003"},{"issue":"3","key":"e_1_2_6_16_1","first-page":"451","article-title":"Nevoid malignant melanoma","volume":"32","author":"McNutt NS","year":"1999","journal-title":"Rev Esp Pathol"},{"key":"e_1_2_6_17_1","first-page":"433","article-title":"Letter to the editor","volume":"100","author":"Collina G","year":"2008","journal-title":"Pathologica"}],"container-title":["Journal of Cutaneous Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fcup.13531","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cup.13531","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/cup.13531","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cup.13531","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T01:27:37Z","timestamp":1694222857000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cup.13531"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,12]]},"references-count":16,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1111\/cup.13531"],"URL":"https:\/\/doi.org\/10.1111\/cup.13531","archive":["Portico"],"relation":{},"ISSN":["0303-6987","1600-0560"],"issn-type":[{"value":"0303-6987","type":"print"},{"value":"1600-0560","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,12]]},"assertion":[{"value":"2019-04-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-06-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-07-12","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}