Pitfalls in the diagnosis of pigmented lesions

Richard Scolyer, BMedSci, MBBS, MD, FRCPA, FRCPath, FAHMS, Melanoma Institute Australia, Wollstonecraft, Australia, discusses pitfalls in diagnosing melanocytic tumors and how to avoid them. The fourth edition of the WHO classification of skin tumors identified several new tumor entities. Dr Scolyer highlights two uncommon benign tumors at risk of being over-diagnosed as melanoma termed BAP1 inactivated nevus and deep penetrating nevus. BAP1-inactivated nevus generally occurs as a combined nevus in which there are small benign common nevus cells associated with larger epithelioid melanocytes which have arisen from the nevus cells. These tumors are difficult to recognize as the second component represents a step in neoplastic progression towards melanoma and they can also be a marker of hereditary cancer predisposition syndrome associated with a germline BAP1 mutation. The deep penetrating nevus occurs following a second genetic hit within a benign nevus cell and activation of the beta-catenin pathway and are unlikely to progress onto melanoma. This interview took place at the 18th World Congress on Cancers of the Skin (WCCS 2022) in Buenos Aires, Argentina.
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