Background: The clinical value of an expert pathological review in patients with an atypical melanocytic lesion diagnosis remains unclear. Herein, we evaluate its impact in a prospective clinical study.
Methods: Patients with newly diagnosed or suspected atypical melanocytic proliferations and challenging skin tumours were reviewed prospectively by a specialised dermatopathologist through the nationwide 'Second Opinion Platform' of the Italian Melanoma Intergroup (IMI) network. The primary aim was the rate of major discrepancies that impacted patient management. Major discrepancies in diagnosis between referral and specialised review were blindly re-analysed by a panel of European Organisation for Research and Treatment (EORTC) Melanoma pathologists.
Results: The samples submitted to central review included 254 lesions from 230 patients. The most frequent referral diagnoses were atypical melanocytic nevi of different subtypes (74/254, 29.2%), invasive melanomas (61/254, 24.0%), atypical melanocytic proliferations (37/254, 14.6%), AST (21/254, 8.3%) and in situ melanomas (17/254, 6.7%). There was disagreement between referral diagnosis and expert review in 90/254 cases (35.4%). Most importantly, 60/90 (66.7%) were major discordances with a change to the patient's clinical management. Among the 90 discordant cases, the most frequent new diagnosis occurred in World Health Organisation (WHO) Pathway I, followed by WHO Pathway IV (64/90 and 12/90, respectively). In total, 51/60 cases with major discrepancies were blindly re-evaluated by EORTC Melanoma pathologists with a final interobserver agreement in 90% of cases.
Conclusion: The study highlights that a second opinion for atypical melanocytic lesions affects clinical management in a minor, but still significant, proportion of cases. A central expert review supports pathologists and clinicians to limit the risk of both over- and under-treatment.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.ejca.2023.05.009 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Atypical Presentation of Spindle Cell Lipoma in a Young Male with a History of Malignant Melanoma.
Dermatopathology (Basel)
November 2024
Department of Dermatology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
Spindle cell lipoma (SCL) is a benign adipocytic tumor usually found in the subcutis of the posterior neck, upper back, and shoulder, predominantly in middle-aged males. This case report describes an atypical presentation of SCL in a 26-year-old male with a history of malignant melanoma. The patient presented with an erythematous plaque with central hyperpigmentation on the right upper arm, an uncommon location and presentation for SCL.
View Article and Find Full Text PDFFatal Spitz Melanoma With MAD1L1::BRAF Fusion: A Case Report and Literature Review.
J Cutan Pathol
December 2024
Drug Discovery and Development Division, Shizuoka Cancer Center Research Institute, Sunto, Japan.
Spitz melanoma is extremely rare, and only a few cases of distant metastases have been reported. Herein, we describe a case of Spitz melanoma with multiple distant metastases. A 37-year-old woman presented with a 5.
View Article and Find Full Text PDFPatient and Tumor Factors on Overall Survival in Spindle Cell Melanoma.
Cureus
November 2024
Oncology, Creighton University School of Medicine, Omaha, USA.
Introduction: Spindle cell melanoma (SCM) is a rare melanoma subtype characterized histologically by atypical, spindled, malignant melanocytes. SCM often presents in older patients and lacks typical cytologic markers, complicating diagnosis and frequently leading to advanced disease upon presentation. While some studies have documented SCM incidence, none have thoroughly examined the demographic, socioeconomic, and treatment factors influencing survival outcomes.
View Article and Find Full Text PDFPatients' Ability to Take Dermoscopic Follow-Up Images of Atypical Melanocytic Lesions With Smartphones: A Pilot Study.
Dermatol Pract Concept
October 2024
Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Introduction: Short-term teledermoscopic monitoring helps to distinguish early melanomas from nevi. As the incidence of melanoma is increasing, there are several benefits of patients' taking their own dermoscopic images, but only a few previous studies have investigated the feasibility of this approach.
Objectives: To examine patients' ability to take evaluable dermoscopic images of atypical melanocytic lesions in need of short-term monitoring.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!