Melanocytic lesions pathology

Author: A/Prof Patrick Emanuel, Dermatopathologist, Auckland, New Zealand; Harriet Cheng BHB, MBChB, Dermatology Department, Waikato Hospital, Hamilton, New Zealand, 2013.

Unfortunately, the histological diagnosis of melanocytic lesions is often challenging, as some diagnoses are not categorical but rather on a continuum between benign and malignant entities. Also, there may be considerable variation in reporting style between pathologists.

This may be confusing for the clinician, but in ambiguous cases open communication with your pathologist by email or telephone is invaluable. As always, supplying the pathologist with adequate clinical details including a detailed description of the lesion is essential for accurate diagnosis. Ideally, send clinical images with your specimens, but diagrams showing areas of concern are also useful. Many pathologists now welcome dermatoscopic images.

Practical pathologic approach to primary melanocytic lesions

The inexperienced pathologist should:

Special stains for melanocytes

Special stains can be used to confirm melanocytic origin in lesions with spindle or epithelioid morphology.

Immunohistochemical stains for melanocytes:

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