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  • Presentation

Variability in Mitotic Figures in Serial Sections of Thin Melanomas

Description

The presentation discusses the variability of mitotic figures in thin melanoma based on a study utilizing five serial sections. The findings emphasize the importance of examining multiple sections, as looking at just one can lead to underdiagnosis of invasive melanoma. Specifically, the chances of detecting a mitotic figure improve significantly with the number of sections analyzed—from 73% with one section to 98% with four. Moreover, the discussion introduces a new concept related to melanocytic neoplasms with a mitotic rate of zero, suggesting that patients with specific criteria may not fit into the T1 melanoma classification, based on SEER data indicating a zero likelihood of death over seven years. The presentation also touches on the reintroduction of mitotic figures into the AJCC classification system, highlighting studies that show increased mitotic rates correlate with poorer survival and higher probabilities of lymph node positivity and recurrence. The speaker encourages further exploration of these topics through the works of Elmore and Elder.

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Conclusions

  • It is recommended to examine at least three to five serial sections to improve the detection of mitotic figures in thin melanomas.
  • Relying on only one section may lead to underdiagnosis of invasive melanoma in patients.
  • Sensitivity for detecting mitotic figures increases with the number of sections examined, ranging from 73% with one section to up to 98% with four sections.
  • Mitotic figures are not consistently present across all sections of a mitotically active melanoma, indicating variability.
  • The study introduces criteria for identifying melanocytic neoplasms of low malignant potential (MNLMP), which may influence diagnosis and categorization of patients.
  • The prognosis and likelihood of lymph node positivity and recurrence in melanoma patients can be predicted by examining mitotic rates.
  • Reintroduction of mitotic figures into the AJCC staging system is suggested based on recent studies linking mitotic figures to decreased survival rates.
  • Knezevich SR, Barnhill RL, Elder DE, Piepkorn MW, Reisch LM, Pocobelli G, Carney PA, Elmore JG. Variability in mitotic figures in serial sections of thin melanomas. J Am Acad Dermatol. 2014 Dec;71(6):1204-11. doi:10.1016/j.jaad.2014.07.056.
  • Elder DE, Eguchi MM, Barnhill RL, Kerr KF, Knezevich SR, Piepkorn MW, Reisch LM, Elmore JG. Diagnostic error, uncertainty, and overdiagnosis in melanoma. Pathology. 2023 Mar;55(2):206-213. doi:10.1016/j.pathol.2022.12.345.
  • Saw RPM, Cleaver JE, Kim KB, Leong SP, Thompson JF, Scolyer RA. Reappraisal of the Prognostic Significance of Mitotic Rate Supports Its Reincorporation into the Melanoma Staging System. Cancer. 2020 Nov 1;126(21):4717-4725. doi:10.1002/cncr.33088.
  • Ly CL, Blaha O, Wei W, Galan A, Kluger H, Ariyan S, Olino K. Predictive accuracy of elevated mitotic rate on lymph node positivity and recurrence in thin melanomas. Front Oncol. 2022;12:1077226. PMCID: PMC9853390. doi:10.3389/fonc.2022.1077226.