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CURRENT ISSUEGIORNALE ITALIANO DI DERMATOLOGIA E VENEREOLOGIA

A Journal on Dermatology and Sexually Transmitted Diseases

Official Journal of the Italian Society of Dermatology and Sexually Transmitted Diseases
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,014

Frequency: Bi-Monthly

ISSN 0392-0488

Online ISSN 1827-1820

 

Giornale Italiano di Dermatologia e Venereologia 2007 April;142(2):83-97

CUTANEOUS MALIGNANCY UPDATE: MELANOMA IN 2007 

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Current perspectives on the pathologic diagnosis and reporting of melanocytic tumors

Tan K.-B. 1,2, Murali R. 1,3,4,5, Thompson J. F. 3,4,6, Arnold C. J. 1,3,4, Mccarthy S. W. 1,3,4, Scolyer R. A. 1,3,4,5

1 Department of Anatomical Pathology Royal Prince Alfred Hospital, Sydney, Australia
2 Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore National University Hospital, Singapore
3 Sydney Melanoma Unit, Sydney Cancer Centre Royal Prince Alfred Hospital, Sydney, Australia
4 Melanoma and Skin Cancer Research Institute Sydney, Australia
5 Discipline of Pathology, Faculty of Medicine The University of Sydney, Sydney, Australia
6 Discipline of Surgery, Faculty of Medicine The University of Sydney, Sydney, Australia

One of the major goals in the pathologic evaluation of melanocytic tumors is to distinguish benign lesions (nevi) from malignant ones (melanomas). Although this may appear to be a simple task, the assessment of melanocytic tumors can be one of the most difficult of all areas of pathologic diagnosis. Histologic features favoring a benign diagnosis are symmetry, circumscription, a V-shaped silhouette, dermal maturation and absence of mitoses. Poor circumscription, lateral or peripheral pagetoid epidermal spread, expansile dermal growth, high cellularity, necrosis, nuclear pleomorphism and frequent or abnormal mitoses raise the possibility of malignancy. Although most tumors are readily diagnosable with the application of standard criteria, there are unusual variants of both nevi and melanomas that require awareness of pathologic diagnostic pitfalls and careful clinicopathologic correlation to avoid misdiagnosis. The performance of a complete excision biopsy, wherever possible, is crucial for the optimal pathologic assessment of challenging lesions. For melanomas, the pathology report should include all pathologic factors that are important in determining the patient’s prognosis and management. The use of a formatted synoptic pathology report can facilitate this and present the required information to the clinician clearly. The use of the sentinel lymph node biopsy is now well established in the management of patients with melanoma, as is the usefulness of fine needle biopsy in the assessment of clinically-suspected metastatic melanoma. Determining the prognosis of patients with melanoma requires integration of all pertinent clinicopathologic features and this may be aided by the use of computer programs in the future. Molecular diagnostic techniques may further refine the diagnosis of challenging lesions and provide more accurate prognostic estimates.

language: English


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