Correlation between histologic assessment and fluorescence in situ hybridization using MelanoSITE in evaluation of histologically ambiguous melanocytic lesions.

CONTEXT: The 4-probe, multicolor, fluorescence in situ hybridization (FISH) panel targeting chromosomes 6 and 11 has shown promising sensitivity and specificity in distinguishing between benign nevi and malignant melanoma. Only a few studies have assessed the potential utility of FISH in classification of histologically ambiguous melanocytic lesions. In the United States, this assay is exclusively licensed to NeoGenomics Laboratories (Irvine, California), which provides the technical component and has developed an innovative service (MelanoSITE) allowing pathologists to interpret FISH results using a dedicated Web portal. Thus far, use of MelanoSITE as a diagnostic adjunct in the diagnosis of melanocytic lesions has not, to our knowledge, been reported in the literature. OBJECTIVE: To analyze 1.5 years of experience with the MelanoSITE melanoma FISH assay in the evaluation of histologically ambiguous lesions in the context of second opinion and routine dermatopathology practice. DESIGN: A prospective histologic/FISH correlation study of 140 cases. RESULTS: Twenty-seven percent of abnormal FISH results were false-positive results because of tetraploidy. After correcting for known false-positive results, all lesions considered atypical nevi showed normal FISH signals. Abnormal FISH signals were reported in 30% of lesions considered histologically borderline and in 48% of lesions in which a diagnosis of melanoma was favored. CONCLUSIONS: Four-probe, multicolor FISH results for melanoma correlate with the microscopic assessments of histologically ambiguous lesions. Pathologists using MelanoSITE must be aware of the high rate of false-positive results from tetraploidy.

A comprehensive analysis of a web-based dermatopathology second opinion consultation practice.

CONTEXT: Sharing cases and seeking second opinion consultations is an important part of everyday pathology practice. Internet-based communications and upcoming digital slide technologies have the potential to decrease barriers and open access to the best expertise. We recently developed a dedicated Web-based process for communication with outside practices seeking second opinion consultations. The software allowed us to collect data about the current needs and use of a second opinion consultation practice, a topic that has not been addressed in research studies thus far. OBJECTIVE: To analyze the needs for and performance of a Web-based second opinion consultation practice in dermatopathology. DESIGN: We performed a retrospective analysis on paper and digital records. RESULTS: The average turn-around time from the time of biopsy to the time the report was issued was 7-days. Eighty-two percent of cases were reported the same day they were received. Biopsies of melanocytic lesions, inflammatory dermatoses, and squamous lesions comprised 82% of consultations. Among the remaining cases, soft tissue tumors, adnexal neoplasms, alopecia, and nonmelanoma nonsquamous lesions were the most common diagnoses. In 69% of cases, the outside report contained information about the diagnosis favored by the submitting pathologists. In 5%, there was a significant change in the diagnosis. CONCLUSIONS: Web-based communication facilitates rapid turn-around time and reduces costs and barriers to second opinion consultation.