Reliability of the Histopathologic Diagnosis of Malignant Melanoma in Childhood

Wechsler, Janine; Bastuji‐Garin, Sylvie; Spatz, Alan; Bailly, Christiane; Cribier, B.; Andrac-Meyer, Lucile; Vergier, Béatrice; Fraïtag, Sylvie; Vérola, O; Wolkenstein, Pierre

doi:10.1001/archderm.138.5.625

Cited by 81 publications

(46 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…24 Of greater concern is the estimate from one group that, among children, more than 40% of cases diagnosed as Spitz nevus are actually a malignancy that has been misdiagnosed. 25 Few studies have been published characterizing the differential expression of any marker between Spitz nevi and spitzoid melanomas with only CD99, a transmembrane protein associated with the epithelial-mesenchymal transformation, showing moderate discriminant activity between the two lesions. 26 Two immunohistochemical studies of HMB45 staining in Spitz nevi have been published, one reporting on 15 cases, the other on 30.…”

Section: Discussionmentioning

confidence: 99%

Nuclear to non-nuclear Pmel17/gp100 expression (HMB45 staining) as a discriminator between benign and malignant melanocytic lesions

et al. 2008

View full text Add to dashboard Cite

HMB45 is a mouse monoclonal antibody raised against Pmel17/gp100, a melanoma-specific marker, which is routinely used in the diagnosis of primary cutaneous malignant melanoma. The standard expression pattern for a positive HMB45 staining result on immunohistochemistry is based upon the results of chromogenic-based methods. We re-evaluated the patterns of HMB45 staining across the 480-core 'SPORE melanoma progression array' containing lesions representing the spectrum of melanocytic lesions ranging from thin nevus to visceral metastasis using the fluorescence-based staining technique and automated quantitative analysis (AQUA) of the obtained digital images. The methods validated the expected cytoplasmic HMB45 staining pattern in 70/108 malignant lesions and in the epithelial components of nevus specimens. However, the fluorescence-based approach revealed a nuclear gp100 localization present in the dermal component of all nevi that was not seen before. This nuclear localization could not be observed on routine chromogenic stains, because the standard hematoxylin nuclear counterstain overwhelms the weak nuclear HMB45 stain. The thin (0.450 ± 0.253) and thick (0.513 ± 0.227) nevi had strongly positive mean ln(nuclear/non-nuclear AQUA score ratios), which are significantly higher than those from the group of malignant lesions (Po0.0001). This finding was reproduced on a smaller but independent progression array composed of nevi and melanomas from the Yale Pathology archives (Po0.01). The odds ratio associated with a sample being a nevus was 2.24 (95% CI: 1.87-2.69, Po0.0001) for each 0.1 unit increase of the ln(nuclear/non-nuclear AQUA score ratio) to yield an ROC curve with 0.93 units of area and a simultaneously maximized sensitivity of 0.92 and specificity of 0.80 for distinguishing benign nevi from malignant melanomas. On the basis of this preliminary study, we propose that the ratio of nuclear to non-nuclear HMB45 staining may be useful for diagnostic challenges in melanocytic lesions.

show abstract

Section: Discussionmentioning

confidence: 99%

Nuclear to non-nuclear Pmel17/gp100 expression (HMB45 staining) as a discriminator between benign and malignant melanocytic lesions

et al. 2008

View full text Add to dashboard Cite

show abstract

“…22 In our hands and in the experience of others, predicting a malignant phenotype in melanocytic proliferations in childhood is particularly challenging. 23 The fourth consideration is that melanoma, as it is a disease of young as well as old patients, has the potential to cause great loss of life with attendant social and economic disruption for the family members of the deceased, as it results in more lost years of life per case fatality than any other neoplastic disorder, except perhaps leukemia. 1,24 Underdiagnosis With respect to the underdiagnosis of melanoma, several factors can increase the risk of such events.…”

Section: The Nature Of Error In Dermatopathological Practicementioning

confidence: 99%

Medicolegal aspects of neoplastic dermatology

Crowson

2006

Modern Pathology

View full text Add to dashboard Cite

Medical malpractice litigation is rising at an explosive rate in the US and, to a lesser extent, in Canada. The impact of medical malpractice litigation on health care costs and the cost of insurance is dramatic. Certain specialist categories are becoming uninsurable in some parts of the US, while in others, clinicians are retiring early, restricting or changing practice or changing states of residence in consequence of medical malpractice claims and of the cost and availability of insurance. This, in turn, has had the real effect of denying care to patients in some communities in the US. Some 13% of all medical malpractice claims relate to one area of neoplastic dermatopathology, specifically, melanocytic neoplasia. Certain steps can be taken by pathology laboratories to reduce, but never completely eliminate, the risk of medical malpractice claims. In this review, attention is paid to the source of medical malpractice claims and an abbreviated approach to specific strategies for risk management is presented.

show abstract

“…Not surprisingly, a recent study of interrater reliability of the diagnosis of malignant melanoma in childhood was poor, even when the slides were evaluated by pairs of experts. 29 Other groups have reported better diagnostic concordance with respect to melanocytic lesions. 30,31 The interobserver concordance reported in the present study is maximized because only 2 diagnostic "bins" were used: positive or negative for LM and/or LMM.…”

Section: Commentmentioning

confidence: 97%