Melanoma and melanoma in-situ diagnosis after excision of atypical intraepidermal melanocytic proliferation: A retrospective cross-sectional analysis

• Published in: Journal of the American Academy of Dermatology Vol. 80; no. 5; pp. 1403 - 1409
• Main Authors: Blank, Nina R., Hibler, Brian P., Tattersall, Ian W., Ensslin, Courtney J., Lee, Erica H., Dusza, Stephen W., Nehal, Kishwer S., Busam, Klaus J., Rossi, Anthony M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2019
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; ambiguous melanocytic lesions; atypical intraepidermal melanocytic proliferation; atypical junctional melanocytic hyperplasia; atypical junctional melanocytic proliferation; atypical melanocytic proliferation; Biopsy; Child; Cross-Sectional Studies; Dermatologic Surgical Procedures; Diagnosis, Differential; excision; Female; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - pathology; Humans; lentiginous junctional melanocytic proliferation; Male; Margins of Excision; melanoma; Melanoma - diagnosis; Melanoma - pathology; melanoma in situ; Middle Aged; Retrospective Studies; Sex Factors; Skin - pathology; Skin Neoplasms - diagnosis; Skin Neoplasms - pathology; Young Adult; atypical melanocytic proliferation; excision; melanoma in situ; OR; atypical intraepidermal melanocytic proliferation; CI; melanoma; atypical junctional melanocytic proliferation; lentiginous junctional melanocytic proliferation; AIMP; MIS; biopsy; ambiguous melanocytic lesions; atypical junctional melanocytic hyperplasia
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2019.01.005

There is little evidence to guide surgical management of biopsies yielding the histologic descriptor atypical intraepidermal melanocytic proliferation (AIMP). Determine frequency of and factors associated with melanoma and melanoma in-situ (MIS) diagnoses after excision of AIMP and evaluate margins used to completely excise AIMP. Retrospective, cross-sectional study of 1127 biopsies reported as AIMP and subsequently excised within one academic institution. Melanoma (in situ, stage 1A) was diagnosed after excision in 8.2% (92/1127) of AIMP samples. Characteristics associated with melanoma/MIS diagnosis included age 60-79 years (odds ratio [OR] 8.1, 95% confidence interval [CI] 2.5-26.2), age ≥80 years (OR 7.2, 95% CI 1.7-31.5), head/neck location (OR 4.9, 95% CI 3.1-7.7), clinical lesion partially biopsied (OR 11.0, 95% CI 6.7-18.1), and lesion extending to deep biopsy margin (OR 15.1, 95% CI 1.7-136.0). Average ± standard deviation surgical margin used to excise AIMP lesions was 4.5 ± 1.8 mm. Single-site, retrospective, observational study; interobserver variability across dermatopathologists. Dermatologists and pathologists can endeavor to avoid ambiguous melanocytic designations whenever possible through excisional biopsy technique, interdisciplinary communication, and ancillary studies. In the event of AIMP biopsy, physicians should consider the term a histologic description rather than a diagnosis, and, during surgical planning, use clinicopathologic correlation while bearing in mind factors that might predict true melanoma/MIS.