Diagnostic Change From Atypical Intraepidermal Melanocytic Proliferation to Melanoma After Conventional Excision-A Single Academic Institution Cross-Sectional Study.
BACKGROUND
Atypical intraepidermal melanocytic proliferation (AIMP) is a histopathologic diagnosis with uncertain malignant potential and presents a surgical management dilemma for clinicians.


OBJECTIVE
To identify the associated clinical and histopathologic factors and the frequency of diagnostic change to melanoma after conventional excision of AIMP.


METHODS
Retrospective cross-sectional study of 306 AIMPs treated by conventional excision.


RESULTS
Diagnostic change to melanoma occurred in 4.2% (13/306) of AIMP lesions after histopathologic review of the excision specimen; melanomas were in situ in 85% (11/13) and invasive in 15% (2/13) of cases. Factors associated with diagnostic change to melanoma included anatomic location on the head and neck (Odds ratio [OR] 8.49, 95% confidence interval [CI] 2.17, 33.19; p = .001) and acral areas (OR 9.24, 95% CI 2.18, 39.24; p = .001), lesion extension to the base of the biopsy specimen (OR 13.07, 95% CI 2.98, 57.31; p = .001), biopsy using the punch technique (OR 6.06, 95% CI 1.95, 18.86; p = .013), and melanoma in the initial biopsy's histopathologic differential diagnosis (OR 13.29, 95% CI 1.71, 103.57; p = .001).


CONCLUSIONS
Preoperative counseling and surgical planning for AIMP should be individualized to account for potential diagnostic change to melanoma, especially when specific risk factors are present.
*Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; †Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Junqian
J
Zhang
Christopher J
CJ
Miller
Joseph F
JF
Sobanko
Thuzar M
TM
Shin
Jeremy R
JR
Etzkorn
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008544:Melanocytes / Q000473:pathology; D008545:Melanoma / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*