Clinicopathologic Correlation in Melanocytic Lesions

  • Chapter
  • First Online:
Pathology of Challenging Melanocytic Neoplasms

Abstract

The majority of melanocytic lesions can be diagnosed with ease by a pathologist; however, a number of cases are histopathologically challenging and have the potential for diagnostic error. In addition to the gross morphologic features, clinical factors that should be considered in the histopathologic evaluation and final diagnosis of these lesions include the age of the patient, the site of the lesion, the presence of an underlying skin condition, as well as history of pregnancy, trauma, or UV irradiation. For instance, the incidence of malignant melanoma increases with age, making this diagnosis highly unlikely in young children. Lentiginous proliferation of melanocytes in conjunction with cytologic atypia is not uncommon in congenital nevi, or nevi of special sites, thereby causing the potential for misdiagnosis of these lesions as malignant melanoma when the clinical history is omitted. Clinical information not only increases the level of diagnostic confidence of the pathologist, regardless of their level of expertise, but it also changes the histopathologic diagnosis in a number of cases. This chapter will focus on a number of scenarios where clinicopathologic correlation is critical in accurately diagnosing challenging melanocytic lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
EUR 29.95
Price includes VAT (Germany)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
EUR 85.59
Price includes VAT (Germany)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
EUR 117.69
Price includes VAT (Germany)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info
Hardcover Book
EUR 106.99
Price includes VAT (Germany)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Huynh PM, Grant-Kels JM, Grin CM. Childhood melanoma: update and treatment. Int J Dermatol. 2005;44:715–23.

    Article  PubMed  Google Scholar 

  2. Dulon M, Weichenthal M, Blettner M, Breibart M, Hetzer M, Greinert R, et al. Sun exposure and number of nevi in 5- to 6-year old European children. J Clin Epidemiol. 2002;55:1075–81.

    Article  PubMed  Google Scholar 

  3. Zayour M, Lazova R. Congenital nevi. Clin Lab Med. 2011;31:267–80.

    Article  PubMed  Google Scholar 

  4. Barnhill RL, Fleischli M. Histopathologic features of congenital melanocytic nevi in infants 1 year of age or younger. J Am Acad Dermatol. 1995;33(5 Pt 1):780–5.

    Article  CAS  PubMed  Google Scholar 

  5. Tannous ZS, Mihm MC, Sober AJ, Duncan LM. Congenital melanocytic nevi: clinical and histopathologic features, risk of melanoma and clinical management. J Am Acad Dermatol. 2005;52:197–203.

    Article  PubMed  Google Scholar 

  6. Barnhill RL. Congenital melanocytic nevi and associated neoplasms, congenital and childhood melanoma. In: Barnhill R, editor. Pathology of melanocytic nevi and malignant melanoma. Boston: Butterworth-Heinemann; 1995. p. 65–96.

    Google Scholar 

  7. Clark WH, Reimer RR, Greene MH, Ainsworth AM, Mastrangelo MJ. Origin of familial malignant melanomas from heritable melanocytic lesions: ‘the B-K mole syndrome’. Arch Dermatol. 1978;114:732–8.

    Article  PubMed  Google Scholar 

  8. Tucker MA, Greene MH, Clark WH, Kraemer KH, Fraser MC, Elder DE. Dysplastic nevi on the scalp of pre-pubertal children from melanoma-prone families. J Pediatr. 1983;103:65–9.

    Article  CAS  PubMed  Google Scholar 

  9. Bonifazi E, Bilancia M, Berloco A, Ciampo L, De Roma MR. Malignant melanoma in children aged 0–12. Review of 289 cases of the literature. Eur J Pediatr Dermatol. 2001;11:157–75.

    Google Scholar 

  10. Ferrari A, Bono A, Baldi M, Collini P, Casanova M, Pennacchioli E, Terenziani M, Marcon I, Santinami M, Bartoli C. Does melanoma behave differently in younger children than in adults? A retrospective study of 33 cases of childhood melanoma from a single institution. Pediatrics. 2005;115:649–54.

    Article  PubMed  Google Scholar 

  11. Leman JA, Evans A, Mooi W, MacKie RM. Outcomes and pathological review of a cohort of children with melanoma. Br J Dermatol. 2005;152(6):1321–3.

    Article  CAS  PubMed  Google Scholar 

  12. Kossard S, Commens C, Symons M, Doyle J. Lentiginous dysplastic naevi in the elderly: a potential precursor for malignant melanoma. Australas J Dermatol. 1991;32:27–37.

    Article  CAS  PubMed  Google Scholar 

  13. Agusti-Mejias A, Badia FM, Ruiz RG, Martinez VO. Alegre de Miquel V. Atypical lentiginous nevus: a clinical and histopathologic study of 14 cases. Actas Dermosifiliogr. 2012;103(5):394–400.

    Article  CAS  PubMed  Google Scholar 

  14. King R, Page RN, Googe PB, Mihm Jr MC. Lentiginous melanoma: a histopathologic pattern of melanoma to be distinguished from lentiginous nevus. Mod Pathol. 2005;18:1397–401.

    Article  PubMed  Google Scholar 

  15. Davis T, Zembowicz A. Histopathologic evolution of lentiginous melanoma: a report of five new cases. J Cutan Pathol. 2007;34:296–300.

    Article  PubMed  Google Scholar 

  16. Ferrara G, Zalaudek I, Argenziano G. Lentiginous melanoma: a distinctive clinicopathologic entity. Histopathology. 2008;52:523–5.

    Article  CAS  PubMed  Google Scholar 

  17. Weedon D. Lentiginous melanoma. J Cutan Pathol. 2009;36:1232.

    Article  PubMed  Google Scholar 

  18. Kossard S. Atypical lentiginous junctional nevi of the elderly and melanoma. Australas J Dermatol. 2002;43:93–101.

    Article  PubMed  Google Scholar 

  19. Kossard S, Wilkinson B. Small cell (nevoid) melanoma: a clinicopathologic study of 131 cases. Australas J Dermatol. 1997;38:54–8.

    Article  Google Scholar 

  20. King R. Lentiginous melanoma. Arch Pathol Lab Med. 2011;135:337–41.

    PubMed  Google Scholar 

  21. Hosler GA, Moresi JM, Barrett TL. Nevi with site-related atypia: a review of melanocytic nevi with atypical histopathologic features based on anatomic site. J Cutan Pathol. 2008;35:889–98.

    Article  PubMed  Google Scholar 

  22. MacKie RM, English J, Atchison TC, Fitzsimons CP, Wilson P. The number and distribution of benign pigmented moles (melanocytic nevi) in a healthy British population. Br J Dermatol. 1985;113:167.

    Article  CAS  PubMed  Google Scholar 

  23. Kopf AW. Pigmented lesions of the palms and soles. Med Rec Ann. 1964;57:511.

    Google Scholar 

  24. Cook DL. Melanocytic nevi of special sites. Diagn Histopathol. 2010;16(7):309–16.

    Article  Google Scholar 

  25. Boyd A, Rapini R. Acral melanocytic neoplasms: a histopathologic analysis of 158 lesions. J Am Acad Dermatol. 1994;31:740–5.

    Article  CAS  PubMed  Google Scholar 

  26. Cheung WL, Smoller BR. Dermatopathology updates on melanocytic lesions. Dermatol Clin. 2012;20:617–22.

    Article  Google Scholar 

  27. Clark WH, Hood AF, Tucker MA, Jampel RM. Atypical melanocytic nevi of the genital type with a discussion of reciprocal parenchymal-stromal interactions in the biology of neoplasia. Hum Pathol. 1998;29:S1.

    Article  PubMed  Google Scholar 

  28. Christensen WN, Friedman KJ, Woodruff JD, Hood AE. Histopathologic characteristics of vulvar nevocellular nevi. J Cutan Pathol. 1987;14:87–91.

    Article  CAS  PubMed  Google Scholar 

  29. Gleason BC, Hirsch MS, Nucci MR, Schmidt BA, Zembowicz A, Mihm MC, McKee PH, Brenn T. Atypical genital nevi: a clinicopathologic analysis of 56 cases. Am J Surg Pathol. 2008;32:51–7.

    Article  PubMed  Google Scholar 

  30. Dunton CJ, Kautzy M, Hanau C. Malignant melanoma of the vulva: a review. Obstet Gynecol Surv. 1995;50:739–46.

    Article  CAS  PubMed  Google Scholar 

  31. Alexander A, Harris RM, Grossman D, Bruggers CS, Leachman SA. Vulvar melanoma: diffuse melanosis and metastasis to the placenta. J Am Acad Dermatol. 2004;50:293–8.

    Article  PubMed  Google Scholar 

  32. Ronglioletti F, Urso C, Batolo D, Chimenti S, Fanti PA, Filotico R, Gianotti R, Innocenzi D, Lentini M, Tomasini C, Pippione M, Rebora A. Melanocytic nevi of the breast: a histopathologic case-control study. J Cutan Pathol. 2004;31:137–40.

    Article  Google Scholar 

  33. Ronglioletti F, Ball RA, Marcus R, Barnhill RL. Histopathological features of flexural melanocytic nevi: a study of 40 cases. J Cutan Pathol. 2000;27:215–7.

    Article  Google Scholar 

  34. Saad AG, Patel S, Mutasim DF. Melanocytic nevi of the auricular region: histopathologic characteristics and diagnostic difficulties. Am J Dermatopathol. 2005;27:111–5.

    Article  CAS  PubMed  Google Scholar 

  35. Lazova R, Lester B, Glusac RJ, Handerson T, McNiff J. The characteristic histopathologic features of nevi on and around the ear. J Cutan Pathol. 2005;32:40–4.

    Article  PubMed  Google Scholar 

  36. Fabrizi G, Pagliarello C, Parente P, Massi G. Atypical nevi of the scalp in adolescence. J Cutan Pathol. 2007;34:365–9.

    Article  PubMed  Google Scholar 

  37. Lanschuetzer CM, Emberger M, Laimer M, Diem A, Bauer JW, Soyer HP, Hintner H. Epidermolysis bullosa nevi reveal distinctive dermoscopic pattern. Br J Dermatol. 2005;153(1):97–102.

    Article  CAS  PubMed  Google Scholar 

  38. Cash SH, Dever TT, Hyde P, Lee J. Epidermolysis bullosa nevus: an exception to the clinical and dermoscopic criteria for melanoma. Arch Dermatol. 2007;143(9):1164–7.

    Article  PubMed  Google Scholar 

  39. Bauer JW, Schaeppi H, Kaserer C, Hantich B, Hintner H. Large melanocytic nevi in hereditary epidermolysis bullosa. J Am Acad Dermatol. 2001;44(4):577–84.

    Article  CAS  PubMed  Google Scholar 

  40. Soltani K, Pepper MC, Simjee S, Apatoff BR. Large acquired nevocytic nevus induced by the Koebner phenomenon. J Cutan Pathol. 1984;11(4):296–9.

    Article  CAS  PubMed  Google Scholar 

  41. Hoss DM, McNutt NS, Carter DM, Rothaus KO, Kenet BJ, Lin AN. Atypical melanocytic lesions in epidermolysis bullosa. J Cutan Pathol. 1994;21(2):164–9.

    Article  CAS  PubMed  Google Scholar 

  42. Stavrianeas NG, Katoulis AC, Moussatou V, Bozi E, Petropoulou H, Limas C, Georgala S. Eruptive large melanocytic nevus in a patient with hereditary epidermolysis bullosa simplex. Dermatology. 2003;207(4):402–4.

    Article  CAS  PubMed  Google Scholar 

  43. Gallardo F, Toll A, Malvehy J, Mascaro-Gally JM, Lloreta J, Barranco C, Pujol R. Large atypical melanocytic nevi in recessive dystrophic epidermolysis bullosa: clinicopathological, ultrastructural, and dermoscopic study. Pediatr Dermatol. 2005;22(4):338–43.

    Article  PubMed  Google Scholar 

  44. Carlson JA, Wu XC, Slominski A, Weismann K, Crowson AN, Malfetano J, Prieto V, Mihm MC. Melanocytic proliferations associated with lichen sclerosus. Arch Dermatol. 2002;138:77–87.

    Article  PubMed  Google Scholar 

  45. Weinstock MA. Malignant melanoma of the vulva and vagina in the United States: patterns of incidence and population-based estimates of survival. Am J Obstet Gynecol. 1994;171:1225–30.

    Article  CAS  PubMed  Google Scholar 

  46. Tasseron EW, van der Esch EP, Hart AA, Brutel de la Riviere G, Aatsen EJ. A clinicopathologic study of 30 melanomas of the vulva. Gynecol Oncol. 1992;46:170–5.

    Article  CAS  PubMed  Google Scholar 

  47. Raber G, Mempel V, Jackisch C, Hundeiker M, Heinecke A, Kürzl R, Glaubitz M, Rompel R, Schneider HP. Malignant melanoma of the vulva: report of 89 patients. Cancer. 1996;78:2353–8.

    Article  CAS  PubMed  Google Scholar 

  48. Ragnarsson-Olding BK, Kanter-Lewensohn LR, Lagerlof B, Nilsson BR, Ringborg UK. Malignant melanoma of the vulva in a nationwide, 25-year study of 219 Swedish females: clinical observations and histopathologic features. Cancer. 1999;86:1273–84.

    Article  CAS  PubMed  Google Scholar 

  49. Creasman WT, Philips JL, Menck HR. A survey of hospital management practices for vulvar melanoma. J Am Coll Surg. 1999;188:670–5.

    Article  CAS  PubMed  Google Scholar 

  50. Bragdate MG, Rollason TP, McConkey CC, Powell J. Malignant melanoma of the vulva: a clinicopathological study of 50 women. Br J Obstet Gynaecol. 1990;97:124–33.

    Article  Google Scholar 

  51. Piura B, Egan M, Lopes A, Monaghan JM. Malignant melanoma of the vulva: a clinicopathologic study of 18 cases. J Surg Oncol. 1992;50:234–40.

    Article  CAS  PubMed  Google Scholar 

  52. Winton GB, Lewis CW. Dermatoses of pregnancy. J Am Acad Dermatol. 1982;6:977–98.

    Article  CAS  PubMed  Google Scholar 

  53. Pamley T, O’Brien TJ. Skin changes during pregnancy. Clin Obstet Gynecol. 1990;33:713–7.

    Article  Google Scholar 

  54. Pennoyer JW, Grin CM, Driscoll MS, Dry SM, Walsh SJ, Gelineau JP, Grant-Kels JM. Changes in size of melanocytic nevi during pregnancy. J Am Acad Dermatol. 1997;36(3 Pt 1):378–82.

    Article  CAS  PubMed  Google Scholar 

  55. Grin CM, Rojas AI, Grant-Kels JM. Does pregnancy alter melanocytic nevi? J Cutan Pathol. 2001;28:389–92.

    Article  CAS  PubMed  Google Scholar 

  56. Sanchez JL, Figueroa LD, Rodriguez E. Behavior of melanocytic nevi during pregnancy. Am J Dermatopathol. 1984;6:89–91.

    Article  PubMed  Google Scholar 

  57. Foucar E, Bentley TJ, Laube DW, Rosai J. A histopathologic evaluation of nevocellular nevi during pregnancy. Arch Dermatol. 1985;121:350–4.

    Article  CAS  PubMed  Google Scholar 

  58. Chan MP, Chan MM, Tahan SR. Melanocytic nevi in pregnancy: histopathologic features and Ki-67 proliferation index. J Cutan Pathol. 2010;37:843–51.

    Article  PubMed  Google Scholar 

  59. Leleux TM, Prieto VG, Diwan AH. Aberrant expression of HMB-45 in traumatized melanocytic nevi. J Am Acad Dermatol. 2012;67(3):446–50.

    Article  CAS  PubMed  Google Scholar 

  60. Selim MA, Vollmer RT, Herman CM, Pham TTN, Turner JW. Melanocytic nevi with nonsurgical trauma: a histopathologic study. Am J Dermatopathol. 2007;29:134–6.

    Article  PubMed  Google Scholar 

  61. Adeniran AJ, Prieto VG, Chon S, Duvic M, Diwan AH. Atypical histopathologic and immunohistochemical findings in melanocytic nevi after liquid nitrogen cryotherapy. J Am Acad Dermatol. 2009;61(2):341–5.

    Article  PubMed  Google Scholar 

  62. Dummer R, Kempf W, Burg G. Pseudo-melanoma after laser therapy. Dermatology. 1998;197:71–3.

    Article  CAS  PubMed  Google Scholar 

  63. Lee HW, Ahn SJ, Lee MW, Choi JH, Moon KC, Koh JK. Pseudomelanoma following laser therapy. J Eur Acad Dermatol Venereol. 2006;20:342–4.

    Article  PubMed  Google Scholar 

  64. Tronnier M, Wolff HH. UV-irradiated melanocytic nevi simulating melanoma in situ. Am J Dermatopathol. 1995;17(1):1–6.

    Article  CAS  PubMed  Google Scholar 

  65. Tronnier M, Smolle J, Wolff HH. Ultraviolet irradiation induces acute changes in melanocytic nevi. J Invest Dermatol. 1995;104:475–8.

    Article  CAS  PubMed  Google Scholar 

  66. Crotty KA, Menzies SW. Dermoscopy and its role in diagnosing melanocytic lesions: a guide for pathologists. Pathology. 2004;36(5):470–7.

    Article  PubMed  Google Scholar 

  67. Nardone B, Martini M, Busam K, Marghoob A, West D, Gerami P. Integrating clinical/dermoscopic findings and fluorescence in situ hybridization in diagnosing melanocytic neoplasms with less than definitive histopathologic features. J Am Acad Dermatol. 2012;66:917–22.

    Article  PubMed  Google Scholar 

  68. Ferrara G, Argenziano G, Giorgio CM, Zalaudek I, Kittler H. Dermoscopic-pathologic correlation: apropos of six equivocal cases. Semin Cutan Med Surg. 2009;28:157–64.

    Article  CAS  PubMed  Google Scholar 

  69. Bauer J, Metzler G, Rassner G, Garbe C, Blum A. Dermatoscopy turns histopathologist’s attention to the suspicious area in melanocytic lesions. Arch Dermatol. 2001;137:1338–40.

    Article  CAS  PubMed  Google Scholar 

  70. Ferrara G, Argenyi Z, Argenziano G, Cerio R, Cerroni L, Di Blasi A, et al. The influence of clinical information in the histopathologic diagnosis of melanocytic skin neoplasms. PLoS One. 2009;4(4):e5375.

    Article  PubMed Central  PubMed  Google Scholar 

  71. Argenziano G, Puig S, Zalaudek I, Sera F, Corona R, Alsina M, et al. Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer. J Clin Oncol. 2006;24:1877–82.

    Article  PubMed  Google Scholar 

  72. Salerni G, Carrera C, Lovatto L, Marti-Laborda RM, Isern G, Palou J, Alos L, Puig S, Malvehy J. Characterization of 1152 lesions excised over 10 years using total-body photography and digital dermatoscopy in the surveillance of patients at high risk for melanoma. J Am Acad Dermatol. 2012;67:836–45.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christopher R. Shea .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Basko-Plluska, J.L., Prieto, V.G., Reed, J.A., Shea, C.R. (2015). Clinicopathologic Correlation in Melanocytic Lesions. In: Shea, C., Reed, J., Prieto, V. (eds) Pathology of Challenging Melanocytic Neoplasms. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1444-9_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1444-9_3

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1443-2

  • Online ISBN: 978-1-4939-1444-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Navigation