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Advances in Anatomic Pathology:
doi: 10.1097/PAP.0b013e318268ef7d
Letters to the Editor

“Indeterminate Biological Malignant Potential” Cannot be Used Like a Synonym of “Uncertain Malignant Potential”

Pusiol, Teresa MD*; Piscioli, Francesco MD

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*Section of Cytopathology

Institute of Anatomic Pathology Rovereto Hospital, Italy

The authors have no funding or conflicts of interest to disclose.

To the Editor:

In the definition of MELTUMP, Barnhill et al1 include “melanocytic neoplasms with indeterminate biological potential” or “melanocytic tumor of uncertain malignant potential.” The biological potential of tumor may be established only with the use of molecular studies. Chromosomal instability has long been recognized as a hallmark of cancer.2 Fluorescence in situ hybridization (FISH) is used to look at chromosomal copy number aberrations.3 Gerami and Zembowicz4 believe that melanoma FISH is unlikely to entirely solve the problem associated with “controversial melanocytic proliferation.” The diagnosis of “melanocytic neoplasms with indeterminate biological potential” may be made after molecular study. While making this diagnosis, the result of FISH should be specified. On the basis of hematoxylin-eosin and immunohistochemistry, the pathologist only formulates a morphologic diagnosis and cannot express an opinion about the biological outcome of the lesion. The diagnosis of “melanocytic tumor of uncertain malignant potential” may be made only when the pathologist is unable to establish the benign or malignant nature of the lesion based on hematoxylin-eosin and/or immunohistochemistry. At the time of making the diagnosis of “melanocytic tumor of uncertain malignant potential,” the pathologist should specify the “atypical” histologic features that do not permit to establish with certainty the benign or malignant nature of the lesion. In conclusion, we believe that “melanocytic neoplasms with indeterminate biological potential” is not synonymous of “melanocytic tumor of uncertain malignant potential.” The definitions of these lesions must be distinct. We believe that “melanocytic tumor of uncertain malignant potential” is not a necessary category in the classification of melanocytic lesions. Barnhill et al1 defined the histologic features of atypical or ambiguous melanocytic tumors: atypical or ambiguous variants of Spitz tumors, blue nevus with atypical features, atypical blue nevi possibly low-grade malignant melanocytic tumors. These tumors reveal overlapping features of both benign nevus lesions and corresponding melanomas. Consequently, the conclusive diagnosis cannot be made and clinical outcome of disease cannot be established.

Teresa Pusiol, MD*

*Section of Cytopathology

Francesco Piscioli, MD†

†Institute of Anatomic Pathology, Rovereto Hospital, Italy

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REFERENCES

1. Barnhill RL, Cerroni L, Cook M, et al. State of the art, nomenclature, and points of consensus and controversy concerning benign melanocytic lesions: outcome of an international workshop. Adv Anat Pathol. 2010;17:73–90

2. Sandberg AA, Chen Z. Cytogenetics and molecular genetics of human cancer. Am J Med Genet. 2002;115:111–112

3. Dongsong N, Zhou JY. FISH is more sensitive than Southern analysis at identifying increased levels of cyclin D1 gene amplified in breast cancer cell lines. Mol Biol Rep. 2010;37:3473–3480

4. Gerami P, Zembowicz A. Update on fluorescence in situ hybridization in melanoma: state of the art. Arch Pathol Lab Med. 2011;135:830–837

© 2012 Lippincott Williams & Wilkins, Inc.

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