title: Histopathological diagnostics of malignant melanoma in accordance with the recent AJCC classification 2009: Review of the literature and recommendations for general practice.
abstract: BACKGROUND
  TNM classifications are the basis for diagnostic and therapeutic procedures in oncology. Histopathological reports have to enable a proper indexing of tumor specific findings into recent classifications.
  
  
  METHODS
  A systematic review of the literature was performed to identify reports dealing with the assessment of mitotic rate and the processing and evaluation of sentinel node biopsies in malignant melanoma. On the basis of this review an expert panel of dermatopathologists and general pathologists discussed and agreed recommendations for general practice.
  
  
  RESULTS
  Following recommendations were agreed with a broad consensus (93-100 % agreement): The determination of the mitotic rate in primary melanoma is performed on HE slides. The evaluation of an area of 1 mm(2) is sufficient. Only dermal mitoses are considered. The counted number of mitoses is provided as an integer value. The mitotic rate shall be determined in primary melanomas of ≤1.00 mm vertical tumor thickness according to the hot-spot method and provided as an integer value in relation to an area of 1 mm(2) . The determination of the mitotic rate in the case of thicker primary melanomas is desirable. In general, for the evaluation of each sentinel lymph node, 4 slides should be prepared. For diagnostic purposes, immunohistochemistry (preferably with antibodies against S100ß, Melan A and HMB-45) should be performed in addition to HE staining. The pathology report should provide information about micro-metastases and their longest extension (one-tenth of a millimeter).
  
  
  CONCLUSIONS
  These recommendations are suitable for standardizing the histopathological diagnosis of malignant melanoma and for providing a common basis for clinical decisions and scientific research.
authors.affiliation: Department of Dermatology, Tübingen University Hospital, Germany. claus.garbe@med.uni-tuebingen.de
authors.forename: Claus
authors.initials: C
authors.lastname: Garbe
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Eigentler
authors.forename: Jürgen
authors.initials: J
authors.lastname: Bauer
authors.forename: Norbert
authors.initials: N
authors.lastname: Blödorn-Schlicht
authors.forename: Falko
authors.initials: F
authors.lastname: Fend
authors.forename: Markus
authors.initials: M
authors.lastname: Hantschke
authors.forename: Peter
authors.initials: P
authors.lastname: Kurschat
authors.forename: Heinz
authors.initials: H
authors.lastname: Kutzner
authors.forename: Dieter
authors.initials: D
authors.lastname: Metze
authors.forename: Harald
authors.initials: H
authors.lastname: Pressler
authors.forename: Michael
authors.initials: M
authors.lastname: Reusch
authors.forename: Martin
authors.initials: M
authors.lastname: Röcken
authors.forename: Rudolf
authors.initials: R
authors.lastname: Stadler
authors.forename: Michael
authors.initials: M
authors.lastname: Tronnier
authors.forename: Amir
authors.initials: A
authors.lastname: Yazdi
authors.forename: Gisela
authors.initials: G
authors.lastname: Metzler
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D005858:Germany; D006801:Humans; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000145:classification / Q000473:pathology*; D008940:Mitotic Index; D009361:Neoplasm Invasiveness; D061206:Neoplasm Micrometastasis; D009367:Neoplasm Staging / Q000639:trends; D021701:Sentinel Lymph Node Biopsy; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000145:classification / Q000473:pathology*; D014481:United States
chemical_list: D014408:Biomarkers, Tumor