Ex Vivo Dermoscopy of Cutaneous Biopsies for Melanocytic Neoplasms

Abstract

Clinical dermoscopy has provided new insights into the diagnosis and classification of melanocytic neoplasms. There are only limited data on its applications in dermatopathology. In our laboratory, we routinely photograph all skin biopsies with ex vivo dermoscopy (EVD). We retrospectively reviewed 517 cutaneous biopsies with corresponding EVD images to determine whether EVD provides useful ancillary information in the histopathologic diagnosis of melanocytic neoplasms. Four hundred eighty-three cases (93.4%) yielded usable images. The lesions could be categorized according to a published dermoscopic classification system of melanocytic proliferations. Reticular pigmentation correlated with dysplastic nevi, globular pigmentation with congenital nevi, homogenous blue pigmentation with blue nevi, starburst peripheral globular pigmentation with Spitz nevi, and atypical pigment patterns with melanoma. Eighteen of 25 cases (72%) with ambiguous histopathology were assigned a more definite diagnosis when reviewed contemporaneously with EVD images. The surgical margins in 40 cases (7.7%) were reclassified when EVD images were included in the review. We found EVD to be a useful technique and advocate its use for diagnosis and clinical-pathologic correlation.

Fluorescence in-situ hybridization and dermoscopy in the assessment of controversial melanocytic tumors

“…The discordance mainly concerns dermoscopic criteria, whereas interobserver disagreement in the final diagnosis is less frequent. The diagnostic interobserver variability among dermoscopists is predictive of a diagnostic disagreement among pathologists [3,4], who, in turn, show a relatively high variability in histological judgment [19]. Although the level of discordance in the routine histopathologic interpretation of melanocytic neoplasms can be high (a recent research study has found a discordance rate of up to 26%) [4], histopathology still represents the gold standard for the diagnosis of melanoma and provides the ultimate judgment.…”

“…In fact, in this study, the concordance rate between histopathology and FISH increased as the pathologist evaluated the specimens also guided the FISH analysis. For the abovementioned reasons, it is of utmost importance that the dermatologist expert in dermoscopy and the dermatologic surgeon can support the pathologist in the diagnosis, thanks to the accurate detection of the tumor margins and structures [19].…”