Abstract
There is no doubt that dermatopathology is the most important method to decide if amelanocytic lesion is benign or malignant; however, like most morphologic examinations, dermatopathology is subjective. Arecent study demonstrated that the pathologic diagnosis of melanocytic skin lesions has ahigh variability. Reports with false-positive or false-negative diagnoses are relatively common. The pathologic examination of melanocytic lesions also has observer-independent limitations and one has to accept that some melanocytic lesions cannot be classified as benign or malignant with confidence by dermatopathology alone. If aconfident diagnosis is not possible adermatoscopic-pathologic correlation may be helpful. This, however, is only possible if dermatoscopic images are available and if the dermatopathologist knows how to interpret dermatoscopic structures. Adermatoscopic-pathologic correlation is not useful in all difficult melanocytic lesions but it should be considered in difficult flat pigmented lesions. In these cases dermatoscopy may provide even more important additional information than molecular findings.
Highlights
Kann man anhand der histopathologischen Kriterien keine sichere Diagnose stellen oder steht die histopathologische Diagnose im Widerspruch mit der klinischen oder dermatoskopischen Diagnose, so kann es hilfreich sein, beide Untersuchungen zu integrieren
There is no doubt that dermatopathology is the most important method to decide if a melanocytic lesion is benign or malignant; like most morphologic examinations, dermatopathology is subjective
The pathologic examination of melanocytic lesions has observerindependent limitations and one has to accept that some melanocytic lesions cannot be classified as benign or malignant with confidence by dermatopathology alone
Summary
Ein möglicher Ausweg aus diesem Dilemma ist eine Strategie, die man als diagnostischen Pragmatismus bezeichnen könnte. Dass die Diagnose selbst gar nicht mehr in den Vordergrund gestellt wird, sondern die Konsequenzen. Der Befunder stellt keine Diagnose mehr, sondern gibt dem Kliniker Handlungsanweisungen, die in 5 Klassen unterteilt werden [7]. A Ein Nävus, wie er mit dem freien Auge erscheint. Am rechten Bild kann man retikuläre Linien erkennen, die mit dem freien Auge unsichtbar sind. D Retikuläre vom Typ solare Lentigo und Nävus =Hyperpigmentierung der Reteleisten. E Braun strukturlos vom Typ seborrhoische Keratose = Hyperpigmentierung der Epidermis. G Braune Schollen =Nester pigmentierter Melanozyten in der Epidermis oder (seltener) in den dermalen Papillenspitzen. H Braune Punkte =kleine Melanineinschlüsse in der Epidermis. K Blau strukturlos =Melanin in der retikulären Dermis (in Melanozyten oder Melanophagen).
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