Abstract
The traditional “dichotomic” (benign vs. malignant) approach to the diagnosis of melanocytic skin neoplasms is increasingly becoming less popular. Definitional features for a “gray zone” (in between the benign “white zone” and the malignant “black zone”) are as follows: (1) an “intermediate morphology,” ascribed to either deceptively bland melanomas or morphologically “atypical” but benign nevi; (2) an “intermediate biology,” referred to melanocytic tumors (“melanocytomas”) showing a high rate of regional node involvement but a very low rate of distant metastases. The histopathological report of these tumors should always reflect the diagnostic uncertainty with a “provisional diagnosis” based on the following categories: (1) atypical (junctional/compound/dermal) melanocytic nevus, for a neoplasm that is felt to be most likely benign; (2) severely atypical (junctional/thin compound/thick compound/dermal based) melanocytic proliferation for a neoplasm that is possibly/probably malignant. Recommendations about the management should be set up through a multidisciplinary team meeting.
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