Fig 1.
Workflow for the management of atypical melanocytic lesions in our tertiary referral center.
When the histopathologic report is rendered, the clinician reviews the case in light of the clinical-dermoscopic pictures. Cases for which a good clinico-pathologic correlation is missing are jointly reviewed by clinicians and pathologists combining all relevant clinical and histopathologic data including clinical-dermoscopic images. A consensus diagnosis is finally reached and the patient treated accordingly.
Table 1.
List of cases missing a clinical-pathologic correlation: demographic description and reasons for diagnosis re-appraisal.
Fig 2.
A. Solitary hyperpigmented flat lesion on the shoulder of a 52 years old lady. B. dermoscopy reveals an irregularly shaped lesion with atypical network.
Fig 3.
A. On histology, there is a diffuse, lentiginous proliferation made up by pigmented, monomorphous melanocytes. B and C. The cells are cytologically bland and mainly located in the lower epidermis.
Pagetoid spread is not a feature.
Fig 4.
A. Large flat lesion on the arm of a 32 years old man. B. at the time of surgical excision, dermoscopy reveals the presence of asymmetry of color and structure, with pigment network and regressive features suggestive for melanoma. C and D. Digital dermoscopic follow up of the lesion reveals the asymmetric growth of the tumor (circle) over time.
Fig 5.
A. Histopathology shows an irregular melanocytic lesion, associated with a slightly thickened epidermis. B and C. Junctional melanocytes are rather pleomorphic while the dermal component is bland and monomorphous.
Fibrosis and inflammation are evident in the superficial dermis.