Classification and Criteria for Benign Melanocytic Neoplasms

Benign melanocytic neoplasms constitute a heterogenous spectrum of lesions that are classified according to a number of clinical, histological, and other attributes (Tables 1 and 2). As with any classification there is controversy as to the basis for defining and including the various entities in such a classification. The scheme outlined in Table 3 will be utilized in this chapter. Major considerations for classification include age of onset of the lesion, size, anatomic site, other gross morphologic features, location of melanocytes in the skin, the spatial relationships of melano-cytes, cytological features of melanocytes, stromal attributes, and finally abnormal features such as atypical architecture, cytological atypia, and proliferation rate.

In the routine evaluation of melanocytic lesions one is continually faced with the decision as to whether a lesion is benign or malignant. In approaching this problem one has to apply a number of criteria for this interpretation (Table 4) since no single criterion is sufficient. At present there is no universal consensus as to which criteria should be included in this exercise, or the relative importance or relative weight of each criterion. It is certain that this latter exercise should take into consideration clinical information, organizational, cytological, and cell proliferation-related properties of the individual lesion. It must be emphasized that there are exceptions to each criterion, and the failure to consider this may result in both over- and underdiagnosis of melanoma.

An important aspect of the interpretation of melano-cytic lesions is recognizing the subjectivity of such evaluation and the imperfect state of knowledge at present. It cannot be overemphasized that despite having criteria for

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