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Malignant melanoma in situ.

T J Flotte1

  • 1Department of Dermatology, Massachusetts General Hospital, Boston 02114.

Human Pathology
|December 1, 1990
PubMed
Summary

Diagnosing melanoma in situ remains controversial due to subjective criteria. Further studies are needed to establish objective diagnostic standards for melanoma and atypical melanocytic lesions.

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Area of Science:

  • Dermatopathology
  • Oncology

Background:

  • Malignant melanoma in situ diagnosis is generally agreed upon.
  • The biologic behavior of radial and vertical growth phases of melanoma differs significantly.
  • Controversies exist regarding melanoma diagnostic criteria and the existence of atypical melanocytic lesions.

Purpose of the Study:

  • To address the controversies in diagnosing malignant melanoma in situ.
  • To propose that objective criteria for melanoma diagnosis are lacking, with current agreement based on subjective criteria.
  • To advocate for the recognition of atypical melanocytic lesions.

Main Methods:

  • Review of current diagnostic criteria for melanoma in situ.
  • Analysis of the subjective versus objective basis for melanoma diagnosis.
  • Proposal of an analogy between melanocytic and keratinocytic lesions for atypical diagnoses.

Main Results:

  • Diagnostic agreement for melanoma in situ is largely achieved through subjective criteria used by dermatopathologists.
  • Controversy arises in lesions classified as melanoma by some criteria but not others.
  • The concept of atypical melanocytic lesions is proposed, drawing parallels with established keratinocytic lesion diagnoses.

Conclusions:

  • Reliable and reproducible objective criteria for melanoma diagnosis have not been established.
  • Subjective criteria contribute to diagnostic agreement, but also fuel controversy.
  • Further research on the sensitivity and specificity of clinical and histologic features correlating with biologic behavior is essential for resolving diagnostic issues.

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