Histopathologic correlation of high-risk MelaFind^TM lesions: a 3-year experience from a high-risk pigmented lesion...

A significant number of pigmented lesions are biopsied to rule out melanoma, but most will be benign. MelaFind^TM is a highly sensitive, noninvasive computer-assisted system to aid in clinical diagnosis of melanoma.

A total of 140 high-risk patients were followed by one expert dermatologist. Biopsies were blindly and independently evaluated by two dermatopathologists and given histologic severity scores (HSS, 0-12) based on the histologic features of melanoma/dysplastic nevi and compared to pathologic diagnoses and MelaFind^TM scores.

MelaFind^TM reduced the biopsy number of clinically ambiguous lesions (923 scanned to 253 biopsied, 73% reduction). Biopsied cases were usually benign (135/253, 53.4%, HSS = 2.8-3.2). Dysplastic nevi with varying degrees of atypia were observed next most commonly (80/253, 31.6%, HSS = 4.7-5.2 for mild dysplasia and 7-7.6 for moderate to severe dysplasia). Melanomas comprised 11/253 (4.3%) of biopsies (HSS = 9.3-10.7). Twenty-four cases were given miscellaneous diagnoses not within the dysplastic nevus-melanoma spectrum (9.5%, HSS = 1.3). Dermal fibrosis was the most commonly identified worrisome histologic feature (177/253, 70%), closely followed by other known atypical features. Nonthreatening histologic features in benign lesions with high MelaFind^TM disorganization scores were common. The HSS differed significantly depending on pathologic diagnosis severity, while the MelaFind^TM score did not (benign = 2.2; mildly atypical = 4.8; moderately to severely atypical = 2.3; in-situ or invasive melanoma = 3.1).

MelaFind^TM unequivocally reduced the number of biopsies, but banal lesions had histologic attributes resulting in high-risk MelaFind^TM scores, and MelaFind^TM does not correlate with degree of cytologic atypia. Knowledge of these limitations should increase bidirectional confidence when making clinicopathologic correlations in high-risk patients.