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Routine Clinical-Pathologic Correlation of Pigmented Skin Tumors Can Influence Patient Management.

Longo C, Piana S, Lallas A, Moscarella E, Lombardi M, Raucci M, Pellacani G, Argenziano G - PLoS ONE (2015)

Bottom Line: Interestingly, a re-appraisal was requested for 158 out of 2015 (7.7%) excised lesions because clinical-pathologic correlation was missing.Of note, in 0.6% of them (13 out of 2045) the first histologic diagnosis was revised in the light of clinical information that assisted the Pathologist to re-evaluate the histopathologic findings that might be bland or inconspicuous per se.In conclusion, our study demonstrated that an integrated approach involving clinicians and pathologists allows improving management of selected patients by shifting from a simply disease-focused management (melanoma versus nevus) to a patient-centered approach.

View Article: PubMed Central - PubMed

Affiliation: Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.

ABSTRACT

Background: Several studies have demonstrated the benefit of integrating clinical with pathologic information, to obtain a confident diagnosis for melanocytic tumors. However, all those studies were conducted retrospectively and no data are currently available about the role of a clinical-pathologic correlation approach on a daily basis in clinical practice.

Aim of the study: In our study, we evaluated the impact of a routine clinical-pathologic correlation approach for difficult skin tumors seen over 3 years in a tertiary referral center.

Results: Interestingly, a re-appraisal was requested for 158 out of 2015 (7.7%) excised lesions because clinical-pathologic correlation was missing. Of note, in 0.6% of them (13 out of 2045) the first histologic diagnosis was revised in the light of clinical information that assisted the Pathologist to re-evaluate the histopathologic findings that might be bland or inconspicuous per se.

Conclusion: In conclusion, our study demonstrated that an integrated approach involving clinicians and pathologists allows improving management of selected patients by shifting from a simply disease-focused management (melanoma versus nevus) to a patient-centered approach.

No MeSH data available.


Related in: MedlinePlus

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.
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pone.0136031.g005: 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.

Mentions: Reasons for diagnosis reappraisal following the consensus meeting were mainly due to the discordant clinical aspect of the lesion. More specifically, in 6 cases despite bland/inconspicuous histopathologic features, the overall clinical picture (i.e. solitary lesion, ugly duckling sign, heavily pigmented lesion in the elderly) strongly supported the diagnosis of melanoma that therefore could not be rendered confidently based solely on the limited set of histopathologic features (Figs 2 and 3). In one case the diagnosis was made on a punch biopsy in which the conspicuous lesion size and all the set of histopathologic features were missing (case 8). The evident growing attitude of the lesion documented by digital monitoring was supporting the histopathologic diagnosis of melanoma in one case that had been histopathologically underestimated (case 13) (Figs 4 and 5). Conversely, the long-standing history of the lesion (case 12) reported by the patient favored the final diagnosis of an asymmetrical nevus with sclerosis rather than a melanoma arising on a nevus. Four cases were initially under-diagnosed by a general surgical pathologist without formal dermatopathology training. A second opinion was requested in 6 out of 13 cases, confirming the reappraisal of the diagnoses as reported by the referral dermatopathologist of our center.


Routine Clinical-Pathologic Correlation of Pigmented Skin Tumors Can Influence Patient Management.

Longo C, Piana S, Lallas A, Moscarella E, Lombardi M, Raucci M, Pellacani G, Argenziano G - PLoS ONE (2015)

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.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556521&req=5

pone.0136031.g005: 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.
Mentions: Reasons for diagnosis reappraisal following the consensus meeting were mainly due to the discordant clinical aspect of the lesion. More specifically, in 6 cases despite bland/inconspicuous histopathologic features, the overall clinical picture (i.e. solitary lesion, ugly duckling sign, heavily pigmented lesion in the elderly) strongly supported the diagnosis of melanoma that therefore could not be rendered confidently based solely on the limited set of histopathologic features (Figs 2 and 3). In one case the diagnosis was made on a punch biopsy in which the conspicuous lesion size and all the set of histopathologic features were missing (case 8). The evident growing attitude of the lesion documented by digital monitoring was supporting the histopathologic diagnosis of melanoma in one case that had been histopathologically underestimated (case 13) (Figs 4 and 5). Conversely, the long-standing history of the lesion (case 12) reported by the patient favored the final diagnosis of an asymmetrical nevus with sclerosis rather than a melanoma arising on a nevus. Four cases were initially under-diagnosed by a general surgical pathologist without formal dermatopathology training. A second opinion was requested in 6 out of 13 cases, confirming the reappraisal of the diagnoses as reported by the referral dermatopathologist of our center.

Bottom Line: Interestingly, a re-appraisal was requested for 158 out of 2015 (7.7%) excised lesions because clinical-pathologic correlation was missing.Of note, in 0.6% of them (13 out of 2045) the first histologic diagnosis was revised in the light of clinical information that assisted the Pathologist to re-evaluate the histopathologic findings that might be bland or inconspicuous per se.In conclusion, our study demonstrated that an integrated approach involving clinicians and pathologists allows improving management of selected patients by shifting from a simply disease-focused management (melanoma versus nevus) to a patient-centered approach.

View Article: PubMed Central - PubMed

Affiliation: Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.

ABSTRACT

Background: Several studies have demonstrated the benefit of integrating clinical with pathologic information, to obtain a confident diagnosis for melanocytic tumors. However, all those studies were conducted retrospectively and no data are currently available about the role of a clinical-pathologic correlation approach on a daily basis in clinical practice.

Aim of the study: In our study, we evaluated the impact of a routine clinical-pathologic correlation approach for difficult skin tumors seen over 3 years in a tertiary referral center.

Results: Interestingly, a re-appraisal was requested for 158 out of 2015 (7.7%) excised lesions because clinical-pathologic correlation was missing. Of note, in 0.6% of them (13 out of 2045) the first histologic diagnosis was revised in the light of clinical information that assisted the Pathologist to re-evaluate the histopathologic findings that might be bland or inconspicuous per se.

Conclusion: In conclusion, our study demonstrated that an integrated approach involving clinicians and pathologists allows improving management of selected patients by shifting from a simply disease-focused management (melanoma versus nevus) to a patient-centered approach.

No MeSH data available.


Related in: MedlinePlus