Histopathological diagnostics of malignant melanoma in accordance with the recent AJCC classification 2009: Review of the literature and recommendations for general practice

Abstract

These recommendations are suitable for standardizing the histopathological diagnosis of malignant melanoma and for providing a common basis for clinical decisions and scientific research.

Lack of Standards for the Detection of Melanoma in Sentinel Lymph Nodes: A Survey and Recommendations

“…22 Immunohistochemical stains are also a standard part of the platform in Europe; in a report from Germany, a 4-slide platform is recommended for the evaluation of sentinel lymph nodes, with Melan-A, S100, and HMB-45 as the possible immunohistochemical reagents. 23 The finding that all institutions use immunohistochemical staining to enhance the detection of melanoma in their sentinel lymph node platforms is consistent with reports that immunohistochemical stains increase the specificity and sensitivity of detection. 8,24 Nearly 90% of institutions perform immunohistochemical stains on all sentinel lymph nodes; the remaining laboratories examine the initial H&E-stained tissue sections and if they are negative will order immunohistochemical stains.…”

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

“…A total of 6 642 patient were included in a meta-analysis by Bafounta et al [113] comprising 12 trials that assessed the validity of sonography, compared to mere palpation, in the evaluation of lymph node invasion in melanoma patients. Use of sonography resulted in a higher differentiation (odds ratio of 1 755 [95 % CI 726-4 238] versus 21 [95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111]; p = 0.0001) not only at initial staging, but also during follow-up. These findings have been confirmed in subsequent studies.…”

“…Retrospective analyses have revealed a less favorable prognosis for thin melanomas up to 1 mm, if mitoses were detected. A German study group has proposed detailed recommendations regarding determination of the mitotic rate [97]. Determination of the mitotic rate is accomplished on H&E sections with an area of 1 mm², or less in thin melanomas, being sufficient for evaluation.…”

Prognostic value of sentinel lymph node biopsy in 121 low-risk melanomas (tumour thickness <1.00 mm) on the basis of a long-term follow-up

“…However, mitotic rates were not measured in our study population because until 2009, CMs were classified according to the former AJCC staging system (without the criterion "mitotic rate" for T1 tumours). Moreover, the determination of the "correct" mitotic rate may be difficult and is currently a matter of controversy [28]. Although, our five patients with a positive SLN were younger than the total study population (mean age 52.2 years versus 55.97 years), this group was too small to draw conclusions about age as a risk factor for positive SLNs in melanomas with a thickness ≤1.00 mm.…”