Rethinking Melanocytic Tumors: A Critical Appraisal of the WHO Classification and the Myth of Nevus-to-Melanoma...

The recent WHO classification of melanocytic tumors introduces a refined molecular and histopathological framework suggesting distinct pathways and precursor lesions for all melanoma subtypes. While conceptually appealing, its clinical applicability is increasingly questioned.

This review critically examines the transformation theory from benign nevi to melanoma, highlighting inconsistencies between the proposed models and real-life practice.

Through illustrative cases and key epidemiological evidence, we evaluated the validity of current models proposing intermediate lesions in melanoma development.

We argue that most melanomas arise de novo and that the so-called intermediate lesions, such as dysplastic nevi and atypical Spitz tumors, may mimic melanoma but are not true biological precursors.

We propose a simplified, clinically oriented reclassification of melanocytic lesions based on morphologic ambiguity and actual behavior, aiming to guide therapeutic decisions and reduce diagnostic overinterpretation.