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Reed nevus. Reprinted from Gardner J. Survival Guide To Dermatopathology, Pathology Survival Guides Series 1. Innovative Pathology Press, Arlington Virginia; 2019 [2] with permission from Copyright 2019 Innovative Pathology Press. (A) Reed nevus. A small, thin, and circumscribed lesion ends in a nest abruptly at both peripheral borders. (B) Junctional nests show vertically oriented spindle cells with fine melanin pigment. The nests of these cells are hanging down from the acanthotic epidermis like "bunches of bananas." A melanophage band can be seen underlying the lesion, giving the lesion a dark pigmentation clinically. (C) Nests of spindle cells are sometimes seen running horizontally parallel to the epidermis from rete to rete, giving a "bridging" appearance similar to dysplastic nevus. (D) The melanocytes have plump spindled nuclei that resemble spindled melanocytes of Spitz nevus; that is why it is considered a variant of Spitz nevus. The underlying papillary dermis has darkly pigmented melanophages.
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Melanocytic lesions have a wide morphological spectrum, ranging from benign nevi to malignant melanoma. In contrast to a diagnosis of a benign nevus, a diagnosis of melanoma could mean intensive treatment, lifetime monitoring, and a worse prognosis. Therefore, melanocytic tumors are notoriously challenging and associated with a high risk of litigat...
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Blue nevus is a benign melanocytic lesion, typically asymptomatic and of unknown etiology. Several histologic and clinical variants have been distinguished, the most frequent being common blue nevus, cellular blue nevus, and combined blue nevus. Although melanocytic nevi with a satellite lesion are usually suggestive of locally advanced malignant m...
Citations
... The early accurate diagnosis of melanoma is crucial to improve clinical outcomes, ensuring that patients receive appropriate treatment before the cancer progresses. Despite efforts to improve diagnostic approaches, the misdiagnosis and improper staging of melanoma remain well-recognized issues in dermatopathology [4]. In Australia, general practitioners commonly provide a clinical diagnosis that relies on the visual inspection of pigmented lesions following the ABCDE (asymmetry, border irregularity, color variation, large diameter, and evolution) rule [5,6]. ...
Background:
Early diagnosis is the key to improving outcomes for patients with melanoma, and this requires a standardized histological assessment approach. The objective of this survey was to understand the challenges faced by clinicians when assessing melanoma cases, and to provide a perspective for future studies.
Methods:
Between April 2022 and February 2023, national and international dermatologists, pathologists, general practitioners, and laboratory managers were invited to participate in a six-question online survey. The data from the survey were assessed using descriptive statistics and qualitative responses.
Results:
A total of 54 responses were received, with a 51.4% (n = 28) full completion rate. Of the respondents, 96.4% reported ambiguity in their monthly melanoma diagnosis, and 82.1% routinely requested immunohistochemistry (IHC) testing to confirm diagnosis. SOX10 was the most frequently requested marker, and most respondents preferred multiple markers over a single marker. Diagnostic and prognostic tests, as well as therapeutic options and patient management, were all identified as important areas for future research.
Conclusions:
The respondents indicated that the use of multiple IHC markers is essential to facilitate diagnostic accuracy in melanoma assessment. Survey responses indicate there is an urgent need to develop new biomarkers for clinical decision making at multiple critical intervention points.
... Histologic subtypes of melanoma can be difficult to distinguish with traditional hematoxylin and eosin (H&E) staining due to the disease's heterogeneity [29]. Also, melanoma has a number of histological imitators, so telling the two apart can be challenging [30]. Immunohistochemistry (IHC) has also been widely employed to interpret difficult cases as knowledge of the molecular mechanisms behind melanogenesis has increased and molecular biomarkers have been developed to aid in melanoma detection [31]. ...
... An ambiguous lesion can be traced back to its melanocytic origin by testing it for melanocytic markers, which are proteins involved in melanin synthesis, melanosome biogenesis, or melanocyte differentiation. Contrarily, cell cycle activity in a lesion can be assessed with the help of proliferation markers [30]. Counting mitotic figures (mitosis/mm 2 ) is now the gold standard for measuring tumor proliferation; however, new studies have shown that immunohistochemistry (IHC) detection of proliferative markers can be a robust biomarker of proliferative activity with prognostic significance [33]. ...
Melanoma arises from melanocyte cells. Melanoma spreads faster than basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) if not diagnosed and treated early. Melanocyte tumors cause malignant melanoma. The preponderance of these cells is in the skin, gut, and eye. Melanoma is a rare kind of skin cancer, although it causes 75% of skin cancer deaths. Melanocytes create melanin, a dark pigment, in the skin. Despite years of lab and clinical research, early surgical removal of tiny cancers remains the most successful treatment. The deadliest skin cancer is melanoma. Skin melanocytes are involved. Melanocytes produce skin pigment melanin. Melanin protects skin against ultraviolet (UV) radiation. Skin cancer is the most common form in the United States. When diagnosed early, skin cancer can be treated with topical medications, office therapies, or outpatient surgery. Dermatologists treat skin disorders and conditions. Skin cancer causes less than 1% of cancer fatalities. Detection and treatment of melanoma in its early stages are typically curable. Once melanoma spreads further into the skin or other organs, it becomes incurable and potentially lethal. Early detection of melanoma in the United States is anticipated to result in a 5-year survival rate of roughly 99%.
... Histologic subtypes of melanoma can be difficult to distinguish with traditional hematoxylin and eosin (H&E) staining due to the disease's heterogeneity [29]. Also, melanoma has a number of histological imitators, so telling the two apart can be challenging [30]. Immunohistochemistry (IHC) has also been widely employed to interpret difficult cases as knowledge of the molecular mechanisms behind melanogenesis has increased and molecular biomarkers have been developed to aid in melanoma detection [31]. ...
... An ambiguous lesion can be traced back to its melanocytic origin by testing it for melanocytic markers, which are proteins involved in melanin synthesis, melanosome biogenesis, or melanocyte differentiation. Contrarily, cell cycle activity in a lesion can be assessed with the help of proliferation markers [30]. Counting mitotic figures (mitosis/mm 2 ) is now the gold standard for measuring tumor proliferation; however, new studies have shown that immunohistochemistry (IHC) detection of proliferative markers can be a robust biomarker of proliferative activity with prognostic significance [33]. ...
Melanoma arises from melanocyte cells. Melanoma spreads faster than basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) if not diagnosed and treated early. Melanocyte tumors cause malignant melanoma. The preponderance of these cells is in the skin, gut, and eye. Melanoma is a rare kind of skin cancer, although it causes 75% of skin cancer deaths. Melanocytes create melanin, a dark pigment, in the skin. Despite years of lab and clinical research, early surgical removal of tiny cancers remains the most successful treatment. The deadliest skin cancer is melanoma. Skin melanocytes are involved. Melanocytes produce skin pigment melanin. Melanin protects skin against ultraviolet (UV) radiation. Skin cancer is the most common form in the United States. When diagnosed early, skin cancer can be treated with topical medications, office therapies, or outpatient surgery. Dermatologists treat skin disorders and conditions. Skin cancer causes less than 1% of cancer fatalities. Detection and treatment of melanoma in its early stages are typically curable. Once melanoma spreads further into the skin or other organs, it becomes incurable and potentially lethal. Early detection of melanoma in the United States is anticipated to result in a 5-year survival rate of roughly 99%.
... Second, melanoma and benign nevus share many characteristics, leading to some confusion during histopathological diagnosis [21]. For example, blue nevus, combined nevus, deep penetrating nevus, and atypical Spitz nevus exhibit unusual maturation patterns [21]. ...
... Second, melanoma and benign nevus share many characteristics, leading to some confusion during histopathological diagnosis [21]. For example, blue nevus, combined nevus, deep penetrating nevus, and atypical Spitz nevus exhibit unusual maturation patterns [21]. Atypical Spitz nevus can also exhibit cellular atypia and poor circumscription [21]. ...
... For example, blue nevus, combined nevus, deep penetrating nevus, and atypical Spitz nevus exhibit unusual maturation patterns [21]. Atypical Spitz nevus can also exhibit cellular atypia and poor circumscription [21]. These are all benign lesions and, therefore, do not require aggressive treatment. ...
Simple Summary
In this paper, we investigate the application of deep learning for classifying whole-slide images of cutaneous histopathological specimens into melanoma and non-melanoma. To do so, we used a total of 66 images (33 melanomas and 33 non-melanomas) to train models and evaluated them on 90 whole-slide images (40 melanomas and 50 non-melanomas). The best model achieved ROC–AUC at 0.821 for the whole-slide image level and 0.936 for the tile level.
Abstract
Although the histopathological diagnosis of cutaneous melanocytic lesions is fairly accurate and reliable among experienced surgical pathologists, it is not perfect in every case (especially melanoma). Microscopic examination–clinicopathological correlation is the gold standard for the definitive diagnosis of melanoma. Pathologists may encounter diagnostic controversies when melanoma closely mimics Spitz’s nevus or blue nevus, exhibits amelanotic histopathology, or is in situ. It would be beneficial if diagnosing cutaneous melanocytic lesions can be automated by using deep learning, particularly when assisting surgical pathologists with their workloads. In this preliminary study, we investigated the application of deep learning for classifying cutaneous melanoma in whole-slide images (WSIs). We trained models via weakly supervised learning using a dataset of 66 WSIs (33 melanomas and 33 non-melanomas). We evaluated the models on a test set of 90 WSIs (40 melanomas and 50 non-melanomas), achieving ROC–AUC at 0.821 for the WSI level and 0.936 for the tile level by the best model.
... Malignant melanoma also presents as an amelanotic lesion which makes it difficult to identify, especially in pale-skinned individuals. 1,9 The similar clinical features of seborrheic keratosis, melanocytic nevus and melanoma is a challenge for clinicians to differentiate between malignant and benign lesions through history and physical examination. Predilection for benign tumors is mostly found on the upper eyelid, while malignant tumors are more commonly found on the lower eyelid. ...
... Seborrheic keratosis is a benign intraepidermal neoplasm that develops from epidermal keratinocytes. 5,9 The presentation features of seborrheic keratosis preparations are welldefined coin-like pigmented lesions in which keratin and epidermal basal cells are present. There is a picture of massive keratin (hyperkeratosis) and cysts filled with keratin (horn cysts) and keratin invagination into the main locus (invagination cysts), if there is squamous inflammation it will differentiate to form whirling foci resembling a vortex (eddy squamous) which is a typical appearance of seborrheic keratosis. ...
Seborrheic keratosis is a benign tumor originating from keratinocytes. In this case, a 51-year-old woman with a lump on the left upper eyelid that was growing rapidly, accompanied by itchiness since 1 month. The lumps appeared to be blackish brown, with uneven edges that clinically similar to nevus and malignant melanoma lesions. To rule out the possibility of a nevus, malignant melanoma and other malignancies, excisional biopsy was performed as a diagnostic and treatment management. The similar clinical appearance between benign and malignant lesions is a consideration in performing an excisional biopsy. Histopathological examination in this case, confirmed the diagnosis of seborrheic keratosis as a gold standard that will determine further management. Keywords: Seborrheic keratosis, nevus, malignant melanoma, misdiagnosis
Introduction. Recurrent nevus is a benign proliferation of melanocytes that occurs at the site of non-radical removal of a previously existing nevus. Recurrence rates range from 0.3% to 28% and most often occur within 6 weeks to 6 months after removal. Clinically recurrent nevus is characterized by uneven pigmentation with uneven edges in the area of the scar. Walton et al. began researching the phenomenon of recurrent nevus in 1957. In 1975, Kornberg and Ackerman reported that a pigmented recurrent nevus can resemble superficially spreading melanoma both clinically and histologically, and proposed the term pseudomelanoma to describe this benign phenomenon. Currently, the term is rarely used, but it motivates a thorough examination of patients with such a problem. Case presentation. Patient A. complained about the presence of a formation in the area of the outer surface of the right forearm, which has existed for many years, it was injured several times, but has recently changed the colour. On examination, a nodule up to 0.5 cm in size, heterogeneously pigmented, with peripheral erythema was found in the indicated place. During dermoscopy, chaotic unevenly distributed pigmentation, consisting of dots, globules, forming a cellular structure in a scattered manner is determined, zones of segmental radial lines are present as well. The vascular pattern in the central part of the formation is not defined, on the periphery it is represented by slightly noticeable point vessels. Digital post-processing using machine learning technology was carried out to improve visualization of blood supply. Multiple point, curved, and convoluted vessels with few branches around the formation, and several central vessels in the pigment cells are determined. Surgical removal of the tumor was performed with involvement of the erythema zone, taking into account the peculiarities of pigmentation and vascular pattern. The pathogistological structure is presented in the photomicrograph. The epidermis has a typical structure, with areas of slight acanthosis; hyperpigmentation of the basal layer is also observed. In the dermis, foci of brown pigment deposition, single lymphocytes, there are areas of intradermal lobular-horizontal fibrosis with angiomatosis and scattered lymphocytic infiltration. Taking into account the clinical data, there is a recurrence of a melanocytic nevus on the background of a skin scar (Recurrent neavus). Teaching point. Dermoscopy allows obtaining additional data for the differential diagnosis of recurrent nevus and recurrent melanoma. A recurrent nevus is characterized by relative symmetry of formation and a pattern of segmental radial lines. The formation is limited to the area of the scar and does not go beyond it. Also, in the case of recurrent melanoma, a continuous growth in dynamics and a later appearance of recurrence from the moment of intervention will be obvious. Conclusions. As clinical practice demonstrates, under certain circumstances, recurrent pigmentation can be observed in cases of nevi that have been traumatized. It will be visible both dermoscopically and pathohistologically. Sometimes it is difficult even for experts to distinguish between a highly irritated nevus and a melanoma.
