Cutaneous melanocytomas: a conceptual cluster of atypical and indolent melanocytic neoplasms

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In recent years, clinical dermoscopy has yielded improvement in the early disclosure of various atypical melanocytic neoplasms (AMN). Beyond this approach, histopathology of AMN remains mandatory in the establishment of their precise diagnosis and proper management. Of note, panels of expert pathologists in AMN diagnosis report only moderate agreement in a variety of puzzling cases. The risk for divergence in opinion and microscopic misdiagnosis is probably increased when histopathologic criteria are not fine-tuned and when the number of AMN entities is increasing. In addition, some of the AMN have been differently designated in the literature including atypical Spitz tumor, metastasizing Spitz tumor, borderline and intermediate melanocytic tumor, malignant Spitz nevus and pigmented epithelioid melanocytoma or animal-type melanoma. Some acronyms have been further proposed such as MELTUMP (after ‘melanocytic tumor of uncertain malignant potential’) and STUMP (after ‘Spitzoid melanocytic tumor of uncertain malignant potential’). In this review, such AMN at the exclusion of cutaneous malignant melanoma variants are grouped under the tentative broad heading ‘cutaneous melanocytoma’. These lesions typically follow an indolent course, although they exhibit atypical and sometimes worrisome patterns or cytologic aspects. Rare cases of cutaneous melanocytomas progress to locoregional clusters of lesions (agminate lesions), and even to regional lymph nodes. At times, the distinction between a cutaneous melanocytoma and malignant melanoma remains problematic and even proves to be merely impossible. However, multipronged immunohistochemistry helps to assess the malignancy risk.

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