Melanoma vs Nevus: Microscopic Clues for Malignancy Explained in 5 Minutes

Excerpt from "Dermatopathology Pearls for Head & Neck / Oral & Maxillofacial Pathologists" (full video: kikoxp.com/posts/6020). Presented at the American Academy of Oral & Maxillofacial Pathology (AAOMP) 2021 Annual Meeting (Virtual), May 2021.
A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).
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This video is geared towards medical students, pathology or dermatology residents, or practicing pathologists or dermatologists. Of course, this video is for educational purposes only and is not formal medical advice or consultation.
Presented by Jerad M. Gardner, MD. Please subscribe to my channel to be notified of new pathology teaching videos.
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[@JMGardnerMD]

A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).

[@anamikaadhikary3585]

Thank you sir. Your videos are extremely helpful 🙏

[@evelyne7071]

Beautiful detail.

[@miladisamira6535]

Thank you so much

[@RaulRodriguez-sh6vb]

Very helpful

[@user-yh5dn8lf4w]

Excellent thank you sir

[@bharanim8031]

Thank you sir😊🙏

[@jonaben5714]

Can we say that "bug shading" in a dysplasic naevus is the first sign of changing?

[@nerom_de]

Now when i see this video I'm thinking: Could the pathologist wrongly identify a displastic nevus as melanoma or vice-versa. As a patient - how can I be sure ? Should a second opinion be asked for? I thought the differences were much easier to tell , but it seems they're rather fluid. Does the clinical appearance of the lesion help the pathologist as well or does it not matter when you're looking at this microscopic level? I'm concerned that a dermatologist who might have had some histology course might not be able to differentiate clearly enough compared to a "full-time histologist/pathologist".

[@speaklifegardenhomesteadpe8783]

Great questions that I wish he answered!!

[@seantrevathan3041]

​@@speaklifegardenhomesteadpe8783 Dysplastic nevus vs melanoma can be tricky but is usually mostly bssed off of histology. And even then, dysplastic nevus is graded as mild, moderate and severe. There is a lot of inter-observer variability between the two entities.

[@12ind1]

When in a biopsy, total epidermis is absent due to unzipping artifact, is it considered as an ulcerated Melanoma? If so, breslow's thickness would be measured from the base of the ulcer? Please clarify.

[@JMGardnerMD]

It’s a bit complicated. If epidermis is missing just due to unzipping artifact, then I would not call it ulcerated. If totally absent epidermis and I think it’s artifactual I would probably say for ulceration “cannot assess” with a comment that the epidermis is missing and it appears to be artifactual but because of this I can’t determine if true ulcer or not. If it’s truly ulcerated (fibrin and neutrophils on surface favor ulcer, clean surface favors artifact but sometimes hard to be certain) and the epidermisis absent due to that then I would call it ulcerated. In both cases I would measure the breslow from the area where the epidermis used to be (ie ulcer base or unzipped area) down to deepest point of invasion. My general rule is I try to give the required prognostic parameters for melanoma by the AJCC book. But Sometimes cases don’t fit neatly or follow the rules. In those cases I just give the information as best I can and say uncertain or cannot assess for any feature that I’m not able to give an accurate result for. And then I add a comment explaining why I was not able to give that data point. Hope that helps a little bit.

[@zahiakatia9734]

❤❤❤❤❤❤❤

[@pkumar6009]

So fast speach tone makes less retention.

[@evelyne7071]

Beautiful examples of really ugly malignant melanomas

[@lastanatomy9]

))))

[@eamonbreathnach4613]

Too much technical language

[@nadiahv]

Thank you so much