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Reporting for Pigmented Lesions and Margin Assessment - Terry L. Barrett, M.D.
REPORTING FOR PIGMENTED LESIONS AND MARGIN ASSESSMENT by Terry L. Barrett, M.D.
At ProPath we use standard reporting systems for nevi with atypia and margin assessment. The following terminologies are used when reporting for pigmented lesions and margin assessment. Please call me or any of the dermatopathologists on our team if you have questions about a case or want to discuss a patient.
Nevus with Architectural Disorder (Dysplastic Nevus)
We use the recommended NIH nomenclature of "nevus with architectural disorder." If there is atypia, it is graded as either mild or severe (we do not use moderate). If there is severe atypia and the lesion has not been excised, a comment on the report will recommend conservative excision. There will also be a comment indicating that this lesion may be part of the Familial Mole Melanoma Syndrome.
Atypical Melanocytic Hyperplasia
Lesions that have intraepidermal spread that falls short of melanoma in-situ are classified as "atypical melanocytic hyperplasia". The atypia is not graded, as it is the pattern that is of concern. The report will include a comment that AMH may represent an evolutionary precursor to melanoma and recommend that the lesion be conservatively excised.
Atypical Compound Nevus
Lesions that have atypia in both the junctional and dermal components, but in the absence of diagnostic melanoma, are classified as "atypical compound nevus". Often, we will perform immunomarkers to determine proliferative activity to exclude nevoid melanoma on these lesions. For lesions designated as atypical compound nevus (ACN), we recommend conservative excision. Please note that we do not use atypical compound nevus and nevus with architectural disorder (dysplastic nevus) synonymously. Dysplastic nevi have atypia only at the junction, not ascending cells (AMH) and not dermal atypia (ACN).
Margin examination may be requested; however, only the Mohs technique allows examination of 100% of the margin. For all other types of biopsies and excisions, margins are sampled only. The greater the sampling, the higher the degree of confidence in the margin assessment. To increase the degree of sampling, larger specimens may be sectioned during grossing and then step sectioned to view multiple cuts on the slide. We report that the “examined margins are negative” or that the lesion extends to the deep or a lateral margin. It should be noted, however, that while a positive margin is positive, a negative margin does not ensure that the lesion has been completely removed.
For example, if you do a shave excision of a BCC, we will say on the report that the examined margins are negative. This means that on the two dimensions which can be examined on a slide, the margins are negative, not necessarily that the lesion has been fully removed.
If a specimen is oriented (tagged), we will use color coded inks. In the event a margin is positive, we will be able to describe which margin is positive. If you mark on the requisition that the specimen is a biopsy, no margin assessment will be made unless requested. If you mark that the specimen is some type of excision, we will assess the margins to the extent possible as indicated above.
Terry L. Barrett, M.D.
Jeffrey G. Detweiler, M.D.
Mary M. Feldman, M.D.
Ryan W. Hick, M.D.
Gregory A. Hosler, M.D., Ph.D.
Imrana Khalid, M.D.
Robert M. Law, M.D.
Marc R. Lewin, M.D.