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Reaching a consensus about diagnosis and management of melanocytic proliferations, is it feasible?


Dr. Mona Abdel-Halim

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The diagnosis of melanocytic lesions can be very difficult. Not all cases fall in the clear ends of the spectrum from a benign straightforward nevus to a frank invasive melanoma. The problem always lie in the lesions falling in between, in the grey zone.

The problem is not only in the diagnosis but in the implications of this diagnosis on the management and prognosis. If we wrote in our report: atypical site nevus, or dysplastic nevus, moderate dysplasia, what is the message transferred to the patient as regards his prognosis? What is the further step needed from the clinician? Is there a consensus among clinicians on what to do next? With the expanding types of melanocytic lesions, is this consensus feasible?

These questions were answered when I came across this interesting work by Piepkorn et al*. Through extensive revisions of melanocytic cases, the authors provided a reporting scheme for melanocytic lesions called: MPATH-Dx, melanocytic pathology assessment tool and hierarchy for diagnosis and management. It categorizes melanocytic lesions according to histological features and degree of atypia into 7 categories. They then linked or mapped these categories with 5 classes of prognosis and management lines. They are proposing this diagnosis-treatment mapping scheme as a method to avoid ambiguity in the diagnosis of melanocytic lesions and its consequences both on patients and on health providers.

I found this work very interesting and I advise you all to read it and would love to read your insight about it. How it can be generalized among dermatopathologists and clinicians? Are there currently any similar mapping schemes?

[b]*The MPATH-Dx reporting schema for melanocytic proliferations and melanoma[/b][b]. Piepkorn et al., JAAD; [/b][b]2014; 70:131-41.[/b]
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