A nongrading histologic approach to Clark (dysplastic) nevi: A potential to decrease the excision rate

The management of dysplastic naevi: a survey of Australian dermatologists

“…Limited sectioning (bread loafing) influences diagnostic accuracy . Partially biopsied lesions may not be accurately representative of the whole lesion histopathologically . There is a possibility that a residual lesion, not always clinically visible, will transform into a melanoma or is already a melanoma, as demonstrated by studies where, on complete excision, the diagnosis was upgraded to that of melanoma .…”

“…Partially biopsied lesions may not be accurately representative of the whole lesion histopathologically . There is a possibility that a residual lesion, not always clinically visible, will transform into a melanoma or is already a melanoma, as demonstrated by studies where, on complete excision, the diagnosis was upgraded to that of melanoma . Finally, there is the possible impact of a field change associated with melanoma, whereby atypical cells may be found extending beyond the clinically apparent lesion …”

“…These rates vary from 0–2%. Some authors have suggested that 2% is an acceptable incidence of under‐diagnosis …”

Complexities of perceived and actual performance in pathology interpretation: A comparison of cutaneous melanocytic skin and breast interpretations

“…Another possible explanation is the presence of multiple philosophical differences among dermatopathologists, likely based on where they received fellowship training. For example, not all dermatopathologists believe in the grading of dysplasia while others aggressively dismiss the idea of dysplasia altogether . These differences have resulted in a highly complex system of classification for melanocytic lesions with the development of local variations in terminology and criteria that make agreement across different centers more difficult to achieve, perhaps, than in breast cancer where there is more standardization.…”

Variation among pathologists' treatment suggestions for melanocytic lesions: A survey of pathologists

“…7–11 Some pathologists have also proposed to abandon the grading system of dysplastic nevi entirely, given the ambiguity of the connotations associated with “mild” or “moderate” dysplastic nevi. 12 Lesions with the same diagnosis, such as Spitz nevi, can vary in pathologic characteristics and pathologists may make recommendations to better guide treatment for these lesions.…”