MELANOMA AND MELANOMA IN-SITU - BUILD A BETTER DIAGNOSIS THROUGH ARCHITECTURE

Conventional microscopy has remained the gold standard for melanoma di agnosis for several de cades, and a diagnosis of melanoma is optimally based on a summation of microscopic features (criteria) that are eval uated as objectively as possible by an experienced histopathologist. M ost pathologists and dermatopathologists assess multiple criteria befo re arriving at a diagnosis of melanoma, but the diagnosis remains some what subjective as different interpreters employ similar criteria but assemble them in very different ways. Due to the subjective aspects of the microscopic diagnosis of melanoma, considerable interobserver var iability exists, even among expert diagnosticians, This article includ es a brief analysis of the reproducibility of a diagnosis of melanoma with a comparison of architectural and cytological criteria. There is evidence to suggest that architectural attributes hold greater reprodu cibility over cytological features in the diagnosis of melanocytic neo plasms. If architectural criteria outperform cytological criteria in t erms of reproducibility, then architectural features should probably b e given preference over cytopathological aberrations in daily diagnosi s, The author forwards four steps that can be used in the evaluation o f any melanocytic neoplasm as well as an approach to melanoma diagnosi s in which architectural features are emphasized. Copyright (C) 1997 b y W.B. Saunders Company.