My approach to atypical melanocytic lesions

Histological assessment of melanocytic naevi constitutes a substantial proportion of a dermatopathologist’s daily workload. Although they may be excised for cosmetic reasons, most lesions encountered are clinically atypical and are biopsied or excised to exclude melanoma. Although dysplastic naevi are most often encountered, cytological atypia may be a feature of several other melanocytic lesions, including genital type naevi, acral naevi, recurrent naevi, and neonatal or childhood naevi. With greater emphasis being given to cosmetic results, and because of an ever increasing workload, several “quicker and less traumatising” techniques have been introduced in the treatment and diagnosis of atypical naevi including punch, shave, and scoop shave biopsies. A major limitation to all of these alternatives is that often only part of the lesion is available for histological assessment and therefore all too frequently the pathologist’s report includes a recommendation for complete excision so that the residual lesion can be studied. Complete or large excision of all clinically atypical naevi permits histological assessment of the entire lesion, and in most cases spares the patient the need for further surgical intervention.

[1]  K. Smith,et al.  HMB-45 staining in benign and malignant melanocytic lesions. A reflection of cellular activation. , 1991, The American Journal of dermatopathology.

[2]  D. Sawyer,et al.  Intraepidermal Merkel cell carcinoma with no dermal involvement. , 2000, The American Journal of dermatopathology.

[3]  J. Mones,et al.  Melanomas in Prepubescent Children: Review Comprehensively, Critique Historically, Criteria Diagnostically, and Course Biologically , 2003, The American Journal of dermatopathology.

[4]  R. Bergman,et al.  Immunohistochemical Study of p53 Protein Expression in Spitz Nevus as Compared with Other Melanocytic Lesions , 1995, The American Journal of dermatopathology.

[5]  J. Callen,et al.  Atypical melanocytic nevi. Clinical and histopathologic predictors of residual tumor at reexcision. , 1992, Journal of the American Academy of Dermatology.

[6]  M. Evans,et al.  Cytogenetics of an atypical Spitz nevus metastatic to a single lymph node. , 1998, Pediatric pathology & laboratory medicine : journal of the Society for Pediatric Pathology, affiliated with the International Paediatric Pathology Association.

[7]  L. Medeiros,et al.  Cyclin D1 overexpression in Spitz nevi: an immunohistochemical study. , 1999, The American Journal of dermatopathology.

[8]  P. Humphrey,et al.  Concurrent Ki-67 and p53 Immunolabeling in Cutaneous Melanocytic Neoplasms: An Adjunct for Recognition of the Vertical Growth Phase in Malignant Melanomas? , 2000, Modern Pathology.

[9]  A. D. Dei Tos,et al.  Morphological Analysis of Nevoid Melanoma: A Study of 20 Cases With A Review of the Literature , 2001, The American Journal of dermatopathology.

[10]  H. Skelton,et al.  Spindle Cell and Epithelioid Cell Nevi with Atypia and Metastasis (Malignant Spitz Nevus) , 1989, The American journal of surgical pathology.

[11]  S. Diaz-Cano,et al.  Critical analysis of histologic criteria for grading atypical (dysplastic) melanocytic nevi. , 2001, American journal of clinical pathology.

[12]  Kazuaki Tanaka,et al.  Pagetoid Self‐Healing Langerhans Cell Histiocytosis in an Infant , 1999, Pediatric dermatology.

[13]  K. Mai,et al.  Pagetoid variant of actinic keratosis with or without squamous cell carcinoma of sun-exposed skin: a lesion simulating extramammary Paget's disease. , 2002, Histopathology.

[14]  M. A. Everett,et al.  Pigmented lesions in actinically damaged skin. Histopathologic comparison of biopsy and excisional specimens. , 1996, Archives of dermatology.

[15]  E. R. Farmer,et al.  NIH Consensus conference. Diagnosis and treatment of early melanoma. , 1992, JAMA.

[16]  Donald R. Miller,et al.  Melanoma incidence and mortality among US whites, 1969-1999. , 2002, JAMA.

[17]  M. Mihm,et al.  Nevoid melanoma: a clinicopathological study of seven cases of malignant melanoma mimicking spindle and epithelioid cell nevus and verrucous dermal nevus. , 1995, Human pathology.

[18]  P. H. Mckee,et al.  Eccrine Porocarcinoma (Malignant Eccrine Poroma): A Clinicopathologic Study of 69 Cases , 2001, The American journal of surgical pathology.

[19]  M. Tronnier,et al.  UV‐Irradiated Melanocytic Nevi Simulating Melanoma In Situ , 1995, The American Journal of dermatopathology.

[20]  M. Weinstock,et al.  Reliability of the Histopathologic Diagnosis of Melanocytic Dysplasia , 1997 .

[21]  K. Busam,et al.  Pagetoid Spitz Nevus: Intraepidermal Spitz Tumor with Prominent Pagetoid Spread , 1995, The American journal of surgical pathology.

[22]  P. Leboit,et al.  A diagnosis for maniacs. , 2000, The American Journal of dermatopathology.

[23]  R. Barr,et al.  Analysis of heterogeneity of atypia within melanocytic nevi. , 2003, Archives of dermatology.

[24]  D. Pinkel,et al.  Molecular cytogenetic analysis of Spitz nevi shows clear differences to melanoma. , 1999, The Journal of investigative dermatology.

[25]  D. Elder,et al.  Risk of melanoma and other cancers in melanoma-prone families. , 1993, The Journal of investigative dermatology.

[26]  D. Weedon,et al.  Spindle and epithelioid cell nevi in children and adults. A review of 211 cases of the spitz nevus , 1977, Cancer.

[27]  D. Coit,et al.  Sentinel Lymph Node Biopsy in Patients With Diagnostically Controversial Spitzoid Melanocytic Tumors , 2002, The American journal of surgical pathology.

[28]  R. Bergman,et al.  The Pattern of HMB‐45 Antibody Staining in Compound Spitz Nevi , 1995, The American Journal of dermatopathology.

[29]  G. Wood,et al.  Molecular aspects of melanocytic dysplastic nevi. , 2002, The Journal of molecular diagnostics : JMD.

[30]  D. Pinkel,et al.  Mutations and copy number increase of HRAS in Spitz nevi with distinctive histopathological features. , 2000, The American journal of pathology.

[31]  G. Wood,et al.  Comprehensive analysis of 112 melanocytic skin lesions demonstrates microsatellite instability in melanomas and dysplastic nevi, but not in benign nevi , 2001, Journal of cutaneous pathology.

[32]  W. Clark,et al.  A natural history of melanomas and dysplastic nevi , 2002, Cancer.

[33]  P. Herreid,et al.  Age distribution of Spitz nevus vs malignant melanoma. , 1996, Archives of dermatology.

[34]  R. Vollmer,et al.  Correlating architectural disorder and cytologic atypia in Clark (dysplastic) melanocytic nevi. , 1999, Human pathology.

[35]  Okun Mr Melanoma resembling spindle and epithelioid cell nevus. , 1979 .

[36]  C. Gelmetti,et al.  Clear Cell Papulosis (Pagetoid Papulosis) in a Non-Asian Patient , 2001, Dermatology.

[37]  T. Flotte,et al.  Cutaneous melanoma and atypical spitz tumors in childhood , 1995, Cancer.

[38]  J. Kril,et al.  A Zonal Comparison of MIB1-Ki67 Immunoreactivity in Benign and Malignant Melanocytic Lesions , 2000, The American Journal of dermatopathology.

[39]  O. Larsson,et al.  Immunohistochemical markers for distinguishing Spitz nevi from malignant melanomas. , 1997, Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc.

[40]  S. Suster,et al.  Verrucous pseudonevoid melanoma , 1987, Journal of surgical oncology.

[41]  M A Weinstock,et al.  Reliability of the histopathologic diagnosis of melanocytic dysplasia. The Dysplastic Nevus Panel. , 1997, Archives of dermatology.

[42]  M. Okun Melanoma Resembling Spindle and Epithelioid Cell Nevus: Report of Three Cases , 1979 .

[43]  W. Clark,et al.  Early melanoma. Histologic terms. , 1991, The American Journal of dermatopathology.

[44]  L. Golitz,et al.  Melanocytic nevi with focal atypical epithelioid cell components: a review of seventy-three cases. , 1994, Journal of the American Academy of Dermatology.

[45]  A. Kopf,et al.  Quantification of Histologic Features of Dysplastic Nevi , 1990, The American Journal of dermatopathology.

[46]  R. Marks,et al.  DO ALL MELANOMAS COME FROM “MOLES”? A STUDY OF THE HISTOLOGICAL ASSOCIATION BETWEEN MELANOCYTIC NAEVI AND MELANOMA , 1990, The Australasian journal of dermatology.

[47]  M. Mihm,et al.  Atypical Spitz nevi/tumors: lack of consensus for diagnosis, discrimination from melanoma, and prediction of outcome. , 1999, Human pathology.

[48]  Min W. Lee,et al.  Pagetoid Merkel cell carcinoma: epidermal origin of the tumor , 1998, Journal of cutaneous pathology.