Pagetoid spread is the upward movement of atypical melanocytes into the upper spinous or sub granular layers of the epidermis and is seen in melanoma. However it is also seen in the centre of Spitz nevi, in Reed or spindled cell nevi and in some acral nevi where the lesions are benign. Some nevi of special sites will also show this phenomenon. Usually though these are single cells rather than nests but Spitz nevi do have nests high up in the epidermis.
Other tumours showing Pagetoid spread.
Paget's disease of the nipple
Extramammary Pagets
Bowen's disease
Intra epidermal sebaceous carcinoma
Intraepidermal Merkel cell carcinoma
Rarely T cell lymphoma and histiocytosis will show pale cells in the epidermis in nests
To separate out these conditions you need to undertake immunoperoxidase studies with specific cell marker antibodies.
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