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The Histopathology of Melanocytic Nevi and Malignant Melanoma

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Melanoma in Clinical Practice

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Abstract

Melanocytic tumors are a common specimen in surgical pathology. Change within a pre-existing lesion and/or irregularity of a lesion cause clinical concern resulting in surgical removal. A large number of different types of nevus are now recognized, many of which can have features that mimic a malignant tumor and prompt a misdiagnosis. Furthermore, some less common variants of melanocytic tumor challenge the simplistic benign–malignant dichotomy, having an intermediate biological behavior. Similarly, malignant melanoma is not a uniform genus and numerous morphological subtypes pose specific diagnostic challenges and are associated with differing clinical outcomes. Considerable research into the molecular abnormalities of melanocytic tumors has given rise to an emergent genetic classification, imperfectly grafted onto our traditional morphological understanding, as this rapidly developing field constantly unmasks the over simplification of the latter. Nevertheless, current diagnosis and prognostication remain very much a morphological exercise and successful patient management requires a thorough knowledge of the various types of nevus and melanoma, diagnostic challenges associated with each, and the histological parameters that guide prognosis. These are discussed within this chapter, under benign, intermediate, and malignant headings, and pitfalls and challenges encountered in providing the pathological staging data outlined. Finally, immunohistochemistry has a rather modest role in the assessment of melanocytic tumor biology, but some well-defined applications and documented potential traps are considered.

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Authors and Affiliations

  1. St John’s Institute of Dermatology, Guy’s Hospital, King’s College London, London, UK

    Zena Willsmore

  2. LDPath Limited, London, UK

    Alistair Robson

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  1. Zena Willsmore
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  1. Department of Dermatology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA

    Rhoda M. Alani

  2. Department of Dermatology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA

    Debjani Sahni

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Willsmore, Z., Robson, A. (2021). The Histopathology of Melanocytic Nevi and Malignant Melanoma. In: Alani, R.M., Sahni, D. (eds) Melanoma in Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-82639-0_4

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