Nevus/Melanocytoma/Melanoma An Emerging Paradigm for Classification of Melanocytic Neoplasms?

Context.-Until recently, the prevailing paradigm in classification and clinical management of melanocytic proliferations mandated dichotomous classification of all melanocytic lesions as either entirely benign (nevus) or entirely malignant (melanoma). However, some diagnostically challenging lesions cannot be unequivocally classified as nevus or melanoma by histologic evaluation of the primary tumor. Such lesions have been referred to as borderline or melanocytic tumors of uncertain malignant potential. Objective.-To review and update the problem of diagnostically difficult melanocytic proliferations and recent concepts regarding borderline melanocytic tumors. Data Sources.-Published literature and personal experience of the authors. Conclusions.-Preliminary evidence indicates that it may be appropriate to expand the classification scheme of melanocytic neoplasms to include a third diagnostic category of melanocytic lesions of intermediate malignant potential that are capable of metastasis to regional lymph nodes but have limited potential for distant spread. We propose the term melanocytoma for this group of lesions. We believe that a nevus/melanocytoma/melanoma paradigm may provide a useful intellectual framework to understand, research, and clinically manage borderline melanocytic tumors. (Arch Pathol Lab Med. 2011;135:300-306)