Analysis of Heterogeneity of Atypia Within Melanocytic Nevi

Barr, Ronald J.; Linden, Kenneth G.; Rubinstein, Gennady; Cantos, Kenneth A.

doi:10.1001/archderm.139.3.289

Cited by 19 publications

(16 citation statements)

References 13 publications

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“…In general [15,34,42,43,123], the dysplastic nevus is considered a lesion with irregularly shaped and confluent nests at the junction, where nests are unevenly mingled with melanocytes in single units (so-called lentiginous array). Rete ridges are unevenly spaced and sized but always present.…”

Section: Dysplastic Nevus Vs Superficial Spreading Melanomamentioning

confidence: 99%

Melanocytic nevi simulant of melanoma with medicolegal relevance

Massi

2007

Virchows Arch

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A group of melanocytic benign nevi are prone to be misdiagnosed as nodular or superficial spreading melanoma. This review illustrates the most frequent forms of these nevi in direct comparison with their malignant morphologic counterparts. The nevi are: hyper-cellular form of common nevus to be distinguished from nevoid melanoma, Spitz nevus (vs spitzoid melanoma), Reed nevus (vs melanoma with features of Reed nevus), cellular atypical blue nevus (vs melanoma on blue nevus), acral nevus (vs acral melanoma), Clark dysplastic nevus (vs superficial spreading melanoma), desmoplastic nevi (vs desmoplastic melanoma), benign proliferative nodules in congenital nevi (vs melanoma on congenital nevi), epithelioid blue nevus (vs animal type melanoma) and regressed nevus (vs regressed melanoma). For each single 'pair' of morphological look-alikes, a specific set of morphological, immunohistochemical and genetic criteria is provided.

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Section: Dysplastic Nevus Vs Superficial Spreading Melanomamentioning

confidence: 99%

Melanocytic nevi simulant of melanoma with medicolegal relevance

Massi

2007

Virchows Arch

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“…Host response is characterized by a lymphocytic infiltrate, fibroplasia, capillary/endothelial hyperplasia, and/or incontinence of pigment. All of these factors are considered together while evaluating sufficient multiple microscopic fields and sections of the histopathologic specimen to arrive at a diagnosis with a corresponding assigned level of atypia (Supplementary Figure S1) (see (18) for details on the description and grading of levels of atypia). The level of atypia was graded in a standard fashion on a discrete scale of seven levels of atypia, with zero for no atypia and six for melanoma.…”

Section: Methodsmentioning

confidence: 99%

A Randomized, Double-Blind, Placebo-Controlled Phase II Clinical Trial of Lovastatin for Various Endpoints of Melanoma Pathobiology

Linden

Leachman

Zager

et al. 2014

Cancer Prevention Research

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Based on large cardiovascular clinical trials of lipid lowering agents that showed a considerable decrease in incidence of primary melanomas in the active agent arm, we have carried out a randomized, double-blind clinical trial examining the impact of lovastatin on various biomarkers of melanoma pathogenesis. Subjects with at least two clinically atypical nevi, were randomized to receive oral lovastatin or placebo for a six month period. Clinical, histopathologic, and molecular biomarkers were evaluated for change in the two groups. 80 subjects were randomized, evaluable, and included in the analyses. Lovastatin showed no benefit in comparison to placebo in the primary endpoint of decreasing the level of histopathologic atypia, nor in any of the secondary endpoints of decreasing clinical atypia, impact on nevus number, nor in showing significant changes in any of the molecular biomarkers. There were no significant differences in adverse event profiles for lovastatin compared to placebo. The lovastatin arm did show a significant and considerable decrease in total serum cholesterol and serum LDL levels compared to placebo, an expected result. This finding bolsters confidence in subject compliance. Given the results of this trial, it is concluded that if lovastatin were to lower the incidence of melanoma, it would appear not to be doing so by reversing atypia of precursor atypical nevi over the six month time frame studied. Further research into the pathogenesis of melanoma and in other potential chemopreventive agents is needed.

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“…If the margin is substantially involved, advising a complete excision is essential, particularly in patients over the age of 30. 31 We adhere to the standard recommendation of 5 mm margins in all severely atypical naevi that involve the margin. We include in our reports a measurement to the closest margin in severely atypical naevi that are completely excised.…”

Section: Dysplastic Naevusmentioning

confidence: 99%

“…In addition, a recent study by Barr and colleagues documented that 35.9% of atypical naevi show variations in the degree of atypia from one area to another. 31 Thus, the clinician who incompletely samples a dysplastic naevus with mild atypia that extends to margins cannot be reassured that the residual lesion is not of higher grade. In the paper by Cohen et al, one lesion (in an older patient) had melanoma in the re-excision specimen.…”

Section: Clinical Considerations Including Treatment Aspectsmentioning

confidence: 99%

My approach to atypical melanocytic lesions

Culpepper

Granter²,

McKee³

2004

J Clin Pathol

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Histological assessment of melanocytic naevi constitutes a substantial proportion of a dermatopathologist’s daily workload. Although they may be excised for cosmetic reasons, most lesions encountered are clinically atypical and are biopsied or excised to exclude melanoma. Although dysplastic naevi are most often encountered, cytological atypia may be a feature of several other melanocytic lesions, including genital type naevi, acral naevi, recurrent naevi, and neonatal or childhood naevi. With greater emphasis being given to cosmetic results, and because of an ever increasing workload, several “quicker and less traumatising” techniques have been introduced in the treatment and diagnosis of atypical naevi including punch, shave, and scoop shave biopsies. A major limitation to all of these alternatives is that often only part of the lesion is available for histological assessment and therefore all too frequently the pathologist’s report includes a recommendation for complete excision so that the residual lesion can be studied. Complete or large excision of all clinically atypical naevi permits histological assessment of the entire lesion, and in most cases spares the patient the need for further surgical intervention.

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Analysis of Heterogeneity of Atypia Within Melanocytic Nevi

Cited by 19 publications

References 13 publications

Melanocytic nevi simulant of melanoma with medicolegal relevance

Melanocytic nevi simulant of melanoma with medicolegal relevance

A Randomized, Double-Blind, Placebo-Controlled Phase II Clinical Trial of Lovastatin for Various Endpoints of Melanoma Pathobiology

My approach to atypical melanocytic lesions

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