Melanoma in situ with epidermal effacement: a compelling adjunctive finding.

Since many studies have shown the discordant diagnoses of melanocytic lesions among pathologists despite the existence of an established histologic criteria, we sought to refine the histologic criteria by finding an additional reliable and reproducible objective histopathologic feature to aid in the diagnosis of melanoma in situ. We performed a retrospective analysis of 100 cases histologically diagnosed as melanoma in situ and compared them to a study control group consisting of junctional benign melanocytic nevi. The epidermis of all the melanocytic lesions was examined for epidermal effacement. Examination of the epidermis in the study group revealed an absence of epidermal effacement in only 7 (10%) cases, whereas 93 (93%) cases showed an absence of rete ridges in some foci, making this an overwhelming majority finding in the cases examined. These results serve as a compelling adjunctive finding that can be used to increase the histologic diagnostic accuracy of melanoma in situ.

Histologic patterns of melanocytic nevi: a proposal for a new classification.

A new classification of melanocytic nevi is presented that may incorporate 1 of 3 anatomic patterns, 1 of 12 architectural patterns, and 1of 3 cellular patterns in the diagnosis. In this scheme, the patterns are easy to understand, logical, and the end result is an unambiguous descriptive diagnosis. A pattern diagnosis for melanocytic nevi allows for an understandable and reproducible interpretation by the physician. The nosology of a pattern diagnosis is familiar to physicians. It is common to have a variety of histopathologic patterns for a clinical condition alone or in combination and to be portrayed in the clinical diagnosis. There are countless examples in the literature, such as squamous cell carcinoma (superficial, spindle cell, atypical fibroxanthomatous, pseudovascular types) and basal cell carcinoma (superficial, nodular, pigmented, cystic, morpheaform, fibroepithelial types) to mention but a few. Our classification emphasizes the benignancy of the melanocytic nevus and makes it feasible for the physician to picture it. A pattern diagnosis thus results in a bona fide service to the patient resulting in less confusion, misinterpretation, or fear of malignancy, as well as unnecessary surgery.

Issues affecting specialty career paths in dermatology.

As the field of medicine changes, physicians deal with ever-increasing challenges and pressures. An overview of broad career paths within the specialty of dermatology is presented and important issues affecting these subspecialty tracks are discussed. These issues include increasing regulatory controls, the medical liability crisis, competitive forces, corporate and global outsourcing threats, managed care, and reimbursement.