scholarly journals Variability in the Histopathological Diagnosis of Nonmelanocytic Lesions Excised to Exclude Melanoma

2021 ◽  
pp. e2021094
Author(s):  
Ian Katz ◽  
Tony Azzi ◽  
Alister Lilleyman ◽  
Blake O'Brien ◽  
Brian Schapiro ◽  
...  
Keyword(s):  
Classification Scheme ◽  
Large Cell ◽  
Histopathological Diagnosis ◽  
Benign Lesions ◽  
Seborrheic Keratosis ◽  
Melanocytic Lesions ◽  
Marked Variability ◽  
Solar Lentigo ◽  
Cancer Clinic ◽  
Gold Standards

Introduction. The differential diagnosis of lesions excised to exclude melanoma include a variety of benign and malignant melanocytic and non-melanocytic lesions. Objectives. We examined the variability between pathologists in diagnosing non-melanocytic lesions. Methods.  As part of a larger study prospectively examining the diagnosis of lesions excised to exclude melanoma in 198 patients at a primary care skin cancer clinic in Newcastle, Australia, we compared diagnosis made by 5 experienced dermatopathologists, of 44 non-melanocytic lesions in 44 patients aged 22-90. Results. Forty-four lesions (out of 217 in total) were non-melanocytic. Among the 5 pathologists who examined each case there was marked variability in the terminology used to diagnose each case. The most common variability was found between seborrheic keratosis, large cell acanthoma, solar lentigo, and lichenoid keratosis. The diagnosis made by the majority of the pathologists was deemed to be the reference diagnosis.  Versus majority diagnosis, 4% of benign lesions were considered malignant, and 7% of malignant diagnoses were considered as benign. Conclusions. The different terminology adopted and lack of consensus in the diagnosis of these non-melanocytic lesions in this setting suggests that training AI systems using gold standards may be problematic.  We propose a new management classification scheme called MOLEM (Management of Lesions Excised to exclude Melanoma) which expands the previously described MPATH-dx to include non-melanocytic lesions.

scholarly journals Factors associated with use of immunohistochemical markers in the histopathological diagnosis of cutaneous melanocytic lesions

2020 ◽  
Vol 47 (10) ◽  
pp. 896-902
Author(s):  
Caitlin J. May ◽  
Michael W. Piepkorn ◽  
Stevan R. Knezevich ◽  
David E. Elder ◽  
Raymond L. Barnhill ◽  
...  
Keyword(s):  
Histopathological Diagnosis ◽  
Factors Associated ◽  
Immunohistochemical Markers ◽  
Melanocytic Lesions

Melanin Bleaching with Warm Hydrogen Peroxide and Integrated Immunohistochemical Analysis: An Automated Platform 

2017 ◽  
Author(s):  
Chia-Hsing Liu ◽  
Chih-Hung Lin ◽  
Min-Jan Tsai ◽  
Yu-Hsuan Chen ◽  
Sheau-Fang Yang ◽  
...  
Keyword(s):  
Hydrogen Peroxide ◽  
Immunohistochemical Staining ◽  
Histopathological Examination ◽  
Immunohistochemical Analysis ◽  
Melanin Pigment ◽  
Histopathological Diagnosis ◽  
Tissue Samples ◽  
Melanocytic Lesions ◽  
Automated Platform ◽  
Melanoma Tissue

Diagnosing melanocytic lesions is among the most challenging problems in the practice of pathology. The difficulty of physically masking melanin pigment and the similarity of its color to commonly used chromogens often complicate examination of the cytomorphology and immunohistochemical staining results for tumor cells. Melanin bleach can be very helpful for histopathological diagnosis of heavily pigmented melanocytic lesions. Although various depigmentation methods have been reported, no standardized methods have been developed. This study developed a fully automated platform that incorporates hydrogen peroxide-based melanin depigmentation in an automated immunohistochemical analysis. The utility of the method was tested in one cell block of malignant melanoma cells in pleural effusion, ten ocular melanoma tissue samples, and ten cutaneous melanoma tissue samples. Our results demonstrated that the proposed method, which can be performed in only 3 hours, effectively preserves cell cytomorphology and immunoreactivity. The method is particularly effective for removing melanin pigment to facilitate histopathological examination of cytomorphology and for obtaining an unmasked tissue section for immunohistochemical analysis.

In Vivo Microscopic Approaches for Facial Melanocytic Lesions after Quality-Switched Ruby Laser Therapy: Time-Sequential Imaging of Melanin and Melanocytes of Solar Lentigo in Asian Skin

2010 ◽  
Vol 36 (7) ◽  
pp. 1138-1147 ◽  
Author(s):  
TOYONOBU YAMASHITA ◽  
KEI NEGISHI ◽  
TAKESHI HARIYA ◽  
MOTOHIRO YANAI ◽  
TOMIO IIKURA ◽  
...  
Keyword(s):  
Laser Therapy ◽  
Ruby Laser ◽  
Melanocytic Lesions ◽  
Solar Lentigo

Diagnostic Accuracy of Mammography and Contrast-Enhanced MR Imaging in 238 Histologically Verified Breast Lesions

1997 ◽  
Vol 38 (4) ◽  
pp. 489-496 ◽  
Author(s):  
B. Boné ◽  
Z. Péntek ◽  
L. Perbeck ◽  
B. Veress
Keyword(s):  
Mr Imaging ◽  
Breast Surgery ◽  
Histopathological Examination ◽  
High Sensitivity ◽  
Histopathological Diagnosis ◽  
Breast Lesions ◽  
Benign Lesions ◽  
Post Contrast ◽  
X Ray ◽  
Contrast Enhanced

Purpose: To determine the sensitivity and specificity of X-ray mammography and of MR imaging in 238 consecutively operated breasts, and to correlate the findings to histopathological diagnosis. Material and Methods: Over 15 months, 220 patients scheduled for breast surgery were examined consecutively, before surgery, by means of both mammography and MR imaging. of the 220 patients, 18 underwent bilateral breast surgery. The entire breast was examined by means of T1-weighted transversal images using a 3D fast low-angle shot (FLASH) sequence. One pre— and 2 post-contrast scans were performed. Each breast was examined by means of mammography and 3 views were applied as routine. All palpable and mammographically suspect lesions were examined on additional images as microfocus magnification or spot compression. The two methods were evaluated independently of each other. Results: In total, 145 malignant and 93 benign lesions were found at histopathological examination. The sensitivity of mammography was 89% and MR imaging 92%. The specificity was 72% in both methods. When the results of the 2 methods were combined, a sensitivity of 99% and a specificity of 55% was achieved. Conclusion: Mammography and MR imaging seemed to complement each other to produce a high sensitivity. Unfortunately it is impossible at present to supplement mammography with MR imaging in each patient as a routine owing to the current technical and financial limitations.

Expert review remains important in the histopathological diagnosis of cutaneous melanocytic lesions

2007 ◽  
Vol 52 (2) ◽  
pp. 139-146 ◽  
Author(s):  
M C R F Van Dijk ◽  
K K H Aben ◽  
F Van Hees ◽  
A Klaasen ◽  
W A M Blokx ◽  
...  
Keyword(s):  
Histopathological Diagnosis ◽  
Expert Review ◽  
Melanocytic Lesions

Lymphoma of the Skin

Hematology ◽  
2002 ◽  
Vol 2002 (1) ◽  
pp. 263-282 ◽  
Author(s):  
Joseph M. Connors ◽  
Eric D. Hsi ◽  
Francine M. Foss
Keyword(s):  
T Cell ◽  
Classification Scheme ◽  
Cell Lymphoma ◽  
Large Cell ◽  
World Health ◽  
T Cell Lymphomas ◽  
Cutaneous Lymphomas ◽  
Health Organization ◽  
Hodgkin's Lymphomas ◽  
Lymphoma Classification

Abstract This chapter describes the various ways in which the non-Hodgkin’s lymphomas can involve the skin, how these diseases should be assessed, standard treatments available in 2002, and new directions in research. The goal of the session is to succinctly review recent developments in lymphoma classification and treatment as they apply to the unique aspects of lymphoma when manifest in the skin. In Section I, Dr. Eric Hsi reviews the special characteristics of the lymphomas seen when they proliferate in the skin and the application of the new World Health Organization classification system to the cutaneous lymphomas, emphasizing the unique challenges of recognizing and correctly classifying these diseases. He summarizes the evidence in favor of including the skin lymphomas in the overall lymphoma classification scheme and concludes with a practical description of the specific skin lymphoma entities. In Section II, Dr. Joseph Connors describes the current optimal treatment of the B-cell lymphomas when they present in or metastasize to the skin. Building on the classification scheme described by Dr. Hsi, Dr. Connors outlines a treatment approach based on current understanding of pathophysiology of these diseases and application of each of the effective modalities available for cutaneous lymphoma including radiation, chemotherapy, and immunotherapy. In Section III, Dr. Francine Foss concludes the session with a discussion of the different T-cell lymphomas that start in or spread to the skin concentrating on mycosis fungoides, cutaneous anaplastic large cell lymphoma and peripheral T-cell lymphoma. She includes comments on the newer anti-T-cell chemo- and immuno-therapeutics focusing on agents and techniques specific for cutaneous T-cell lymphomas.

Are All Seborrheic Keratoses Benign? Review of the Typical Lesion and Its Variants

2008 ◽  
Vol 12 (5) ◽  
pp. 203-210 ◽  
Author(s):  
Kristin Noiles ◽  
Ronald Vender
Keyword(s):  
Large Cell ◽  
Contributing Factors ◽  
Seborrheic Keratosis ◽  
Aged Patients ◽  
Internal Malignancy ◽  
Ovid Medline ◽  
Clinical Variants ◽  
Underlying Mechanisms ◽  
Typical Lesion ◽  
Seborrheic Keratoses

Background: Seborrheic keratosis (SK) is one of the more common benign epidermal neoplasms seen in adult and middle-aged patients. Objective: As little is written in the literature about the variants of SK, this article aims to categorize and discuss the different subtypes and their important associations. Methods: An in-depth literature search using OVID Medline and PubMed was conducted to classify the various subtypes of SK. Clinical variants were photographed and used to help document the subtypes. The pathology is described for each. Results: Six subtypes of SK were identified: dermatosis papulosa nigra, stucco keratosis, inverted follicular keratosis, large cell acanthoma, lichenoid keratosis, and flat seborrheic keratosis. Although the etiology and pathogenesis of SKs are still largely debatable, several underlying mechanisms and contributing factors have been identified. All subtypes represent benign lesions, and treatment is usually done for cosmetic reasons. Several of the subtypes may act as cutaneous markers for internal malignancy and should be monitored closely for any atypical changes. Conclusion: Although all subtypes of SK are benign, their association with other malignant lesions and ability to serve as cutaneous markers of internal malignancy emphasize the importance of correctly identifying all variants.

scholarly journals Dermoscopic Features of Facial Pigmented Skin Lesions

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Yana Goncharova ◽  
Enas A. S. Attia ◽  
Khawla Souid ◽  
Inna V. Vasilenko
Keyword(s):  
Retrospective Analysis ◽  
Actinic Keratosis ◽  
Skin Lesions ◽  
Vascular Pattern ◽  
Lentigo Maligna ◽  
Diagnostic Challenge ◽  
Seborrheic Keratosis ◽  
Solar Lentigo ◽  
Pigmented Skin Lesions ◽  
Pigmented Actinic Keratosis

Four types of facial pigmented skin lesions (FPSLs) constitute diagnostic challenge to dermatologists; early seborrheic keratosis (SK), pigmented actinic keratosis (AK), lentigo maligna (LM), and solar lentigo (SL). A retrospective analysis of dermoscopic images of histopathologically diagnosed clinically-challenging 64 flat FPSLs was conducted to establish the dermoscopic findings corresponding to each of SK, pigmented AK, LM, and SL. Four main dermoscopic features were evaluated: sharp demarcation, pigment pattern, follicular/epidermal pattern, and vascular pattern. In SK, the most specific dermoscopic features are follicular/epidermal pattern (cerebriform pattern; 100% of lesions, milia-like cysts; 50%, and comedo-like openings; 37.50%), and sharp demarcation (54.17%). AK and LM showed a composite characteristic pattern named “strawberry pattern” in 41.18% and 25% of lesions respectively, characterized by a background erythema and red pseudo-network, associated with prominent follicular openings surrounded by a white halo. However, in LM “strawberry pattern” is widely covered by psewdonetwork (87.5%), homogenous structureless pigmentation (75%) and other vascular patterns. In SL, structureless homogenous pigmentation was recognized in all lesions (100%). From the above mentioned data, we developed an algorithm to guide in dermoscopic features of FPSLs.

scholarly journals Utility of p63 and AMACR in Differentiating Benign and Malignant Prostatic Lesions

2021 ◽  
Vol 8 (2) ◽  
pp. A39-44
Author(s):  
Ashily Koshy ◽  
Rupali Bavikar
Keyword(s):  
Treatment Options ◽  
Common Finding ◽  
P Value ◽  
Histopathological Diagnosis ◽  
Complete Positivity ◽  
Benign Lesions ◽  
Cytoplasmic Staining ◽  
Common Cancer ◽  
Hematoxylin And Eosin ◽  
Difficult Cases

Background: Prostate cancer is the sixth most common cancer in the world. Since treatment options and prognosis of prostatic adenocarcinomas and benign lesions differ significantly, so, the current study using p63and AMACR was carried out with aim to evaluate the utility of immunohistochemistry in resolving ambiguous lesions of prostate. Methods: The study was conducted on 130 prostatic specimens which included prostate biopsy, TURP and prostatectomy specimens. Routine hematoxylin and eosin staining and immunohistochemical staining using AMACR, p63 monoclonal antibody marker were performed. Results: Total of 130 cases of prostate samples were studied out of which benign lesions were seen in 102 cases (78.5%) and malignant carcinoma in 28 cases (21.5%). This study showed p63 had a sensitivity of 92.86% and specificity of 100% whereas AMACR has a sensitivity of 96.4% and specificity of 95%. BPH with prostatitis was a common finding in majority of benign lesions. All cases of LGPIN 15 cases (11.5%) were histologically associated with BPH, showing complete positivity in 12 cases (80%) and partial positivity in 3 cases (20%) with p63 immunostaining. HGPIN (1.5%) were associated with prostatic adenocarcinoma showing focal positivity whereas adenocarcinoma showed complete negativity of p63 expression (100%) and positive cytoplasmic staining with AMACR. Comparative study done between DRE, PSA, final histopathological diagnosis, expression of p63 and AMACR immunostaining gives highly significant p value of 0.001(<0.05). Conclusion: p63 and AMACR are reliable markers which can be used in morphologically difficult cases.

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