Journal Scan / Research · December 13, 2022 Incidence and Outcomes of Melanocytic Tumors With Ambiguous Histopathological Features Journal of the American Academy of Dermatology
- Written by
Fortunately, the histologic diagnosis of melanoma is straightforward in most cases. Nevertheless, as all dermatologists and dermatopathologists know, there are some that demonstrate "conflicting" histologic criteria such that the diagnosis is uncertain. To characterize this uncertainty, a number of "students" of melanocytic neoplasia have proposed terms such as "MELTUMP" — melanocytic tumor of uncertain malignant potential (the most common one used) — SAMPUS, THIMUMP, and several others. All of them have in common the "uncertain" element. The problem with "wastebasket" diagnostic terms, however, is the vast subjectivity that they encompass. What is one person's "uncertain" diagnosis is another's "obvious" diagnosis depending on many variables such as the confidence and experience of the interpreter. Furthermore, what qualifies as a MELTUMP is not consistent, as the basket contains a wide variety of atypical "dysplastic" nevi, recurrent nevi, BAP1 deleted nevi, atypical Spitz tumors, possible nevoid melanoma, among many others. Is it rational to give a conglomerate of things purportedly unknown a specific name?
In the aforementioned study, all "uncertain" lesions were evaluated by dermatopathologists and all were excised. We can take comfort in that very few of the many lesions evaluated in this study metastasized, although we can only speculate what would have happened had they been left to their own devices. This suggests that the majority were truly benign and not biologically uncertain at all, only "uncertain" in the eye of the beholder.
Of interest was the fleeting use of the term "SAMPAS." It seems to have been a mid–twenty-first century linguistic fad not too dissimilar to other linguistic terms that enjoyed their 15 minutes of fame such as "twenty-three skidoo."
The authors made one statement that I heartily agreed with: new genetic and other techniques are now available and will become increasingly more utilized to lessen diagnostic uncertainty. In the not-too-distant future, I predict it will be time to "dump" MELTUMP and its aliases, once and for all.
- Written by
Fortunately, the histologic diagnosis of melanoma is straightforward in most cases. Nevertheless, as all dermatologists and dermatopathologists know, there are some that demonstrate "conflicting" histologic criteria such that the diagnosis is uncertain. To characterize this uncertainty, a number of "students" of melanocytic neoplasia have proposed terms such as "MELTUMP" — melanocytic tumor of uncertain malignant potential (the most common one used) — SAMPUS, THIMUMP, and several others. All of them have in common the "uncertain" element. The problem with "wastebasket" diagnostic terms, however, is the vast subjectivity that they encompass. What is one person's "uncertain" diagnosis is another's "obvious" diagnosis depending on many variables such as the confidence and experience of the interpreter. Furthermore, what qualifies as a MELTUMP is not consistent, as the basket contains a wide variety of atypical "dysplastic" nevi, recurrent nevi, BAP1 deleted nevi, atypical Spitz tumors, possible nevoid melanoma, among many others. Is it rational to give a conglomerate of things purportedly unknown a specific name?
In the aforementioned study, all "uncertain" lesions were evaluated by dermatopathologists and all were excised. We can take comfort in that very few of the many lesions evaluated in this study metastasized, although we can only speculate what would have happened had they been left to their own devices. This suggests that the majority were truly benign and not biologically uncertain at all, only "uncertain" in the eye of the beholder.
Of interest was the fleeting use of the term "SAMPAS." It seems to have been a mid–twenty-first century linguistic fad not too dissimilar to other linguistic terms that enjoyed their 15 minutes of fame such as "twenty-three skidoo."
The authors made one statement that I heartily agreed with: new genetic and other techniques are now available and will become increasingly more utilized to lessen diagnostic uncertainty. In the not-too-distant future, I predict it will be time to "dump" MELTUMP and its aliases, once and for all.
TAKE-HOME MESSAGE
- The clinical management of melanocytic lesions with ambiguous histology is difficult. To help determine the prognostic significance of melanocytic tumor of uncertain malignant potential (MELTUMP) and superficial atypical melanocytic proliferation of uncertain significance (SAMPUS), cases in the Dutch Nationwide Pathology Databank were reviewed in this retrospective cohort study. With a minimum follow-up of 3 years, 0.7% of all cases showed evidence of local recurrence, local progression to melanoma, or metastatic behavior. These cases were more likely to be on the head and neck. All cases of metastasis were MELTUMP.
- Melanocytic lesions classified as MELTUMP had low malignancy potential and those classified as SAMPUS had no malignancy potential; however, the use of these terms should be avoided when possible. Consultation is recommended for ambiguous melanocytic lesions.
Ambiguous melanocytic lesions: A retrospective cohort study of incidence and outcome of melanocytic tumor of uncertain malignant potential and superficial atypical melanocytic proliferation of uncertain significance in the Netherlands
J Am Acad Dermatol 2022 Nov 18;[EPub Ahead of Print], J Vermariën-Wang, T Doeleman, R van Doorn, AL Mooyaart, WAM Blokx, AMR SchraderSkin Care Physicians of Costa Rica
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posted by dermatica at
December 16, 2022
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