Pre and post-analytical guidelines for the microscopic diagnosis of melanoma: recommendations from the Brazilian Society of Pathology<sup/>

Xavier-Júnior, José Cândido Caldeira; Coelho, Karina Munhoz de Paula Alves; Macedo, Mariana Petaccia de; Lellis, Rute Facchini; Pinheiro Junior, Nathanael de Freitas; Rocha, Robledo Fonseca

doi:10.1016/j.abd.2025.501139

home Sumário navigate_before Anterior Atual Seguinte navigate_next

Texto (Inglês)

Download PDF (Inglês)

Texto (Inglês)
Download PDF (Inglês)

Whatsapp
BlueSky
Mastodon
Facebook
Mais

home Sumário

Facebook
X
Google+
LinkedIn
Reddit
StambleUpon
CiteULike
Mendeley

Texto (Inglês)

Download PDF (Inglês)

CONTINUING MEDICAL EDUCATION • An. Bras. Dermatol. 100 (4) • 2025 • https://doi.org/10.1016/j.abd.2025.501139 linkcopy

Pre and post-analytical guidelines for the microscopic diagnosis of melanoma: recommendations from the Brazilian Society of Pathology^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The guidelines project of the Brazilian Society of Pathology aims to disseminate recommendations for pathologists, surgeons, and clinicians, based on solid data from the literature and through adaptations of international guidelines to the reality of Brazilian physicians. This article is the result of the efforts of a group of pathologists, members of the Dermatopathology Committee of the Brazilian Society of Pathology, focused on melanocytic diseases, who, through topics, established pertinent recommendations for clinicians and surgeons for the accurate diagnosis of melanocytic lesions suspected of melanoma. This article aims to clarify the best way to perform excision in cases of suspected melanocytic lesions, as well as the pre-analytical care related to the material, how to interpret the anatomopathological report, and the situations in which immunohistochemical and molecular studies can be auxiliary tools for diagnosis and/or therapy.

KEYWORDS
Dermatology; Guideline; Melanoma; Microscopy; Pathology

Authorship

person José Cândido Caldeira Xavier-Júnior ∗

Design · planning of the study · collection of data · or analysis · interpretation of data · drafting · editing of the manuscript or critical review of important intellectual content · effective participation in research orientation · critical review of the literature · approval of the final version of the manuscript

schoolInstituto de Patologia de Araçatuba, Araçatuba, SP, BrazilInstituto de Patologia de AraçatubaBrazilAraçatuba, SP, BrazilInstituto de Patologia de Araçatuba, Araçatuba, SP, BrazilschoolFaculty of Medicine, Centro Universitário Católico Unisalesiano, Araçatuba, SP, BrazilCentro Universitário Católico UnisalesianoBrazilAraçatuba, SP, BrazilFaculty of Medicine, Centro Universitário Católico Unisalesiano, Araçatuba, SP, BrazilschoolPostgraduate Program in Pathology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, BrazilUniversidade Estadual PaulistaBrazilBotucatu, SP, BrazilPostgraduate Program in Pathology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil

0000-0003-0503-419X

person Karina Munhoz de Paula Alves Coelho

Design · planning of the study · collection of data · or analysis · interpretation of data · drafting · editing of the manuscript · critical review of important intellectual content · critical review of the literature · approval of the final version of the manuscript

schoolCEDAP, Centro de Diagnósticos Anátomo-Patológicos, Joinville, SC, BrazilCentro de Diagnósticos Anátomo-PatológicosBrazilJoinville, SC, BrazilCEDAP, Centro de Diagnósticos Anátomo-Patológicos, Joinville, SC, BrazilschoolInstituto Nacional de Ciência e Tecnologia em Biologia do Câncer Infantil e Oncologia Pediátrica - INCT BioOncoPed, BrazilInstituto Nacional de Ciência e Tecnologia em Biologia do Câncer Infantil e Oncologia PediátricaBrazilBrazilInstituto Nacional de Ciência e Tecnologia em Biologia do Câncer Infantil e Oncologia Pediátrica - INCT BioOncoPed, Brazil

0000-0002-4743-8742

person Mariana Petaccia de Macedo

Design · planning of the study · collection of data · drafting · editing of the manuscript · collection · analysis · interpretation of data · critical review of the literature · approval of the final version of the manuscript

0000-0002-0434-7605

person Rute Facchini Lellis

Design · planning of the study · drafting · editing of the manuscript · critical review of important intellectual content · graphic design · approval of the final version of the manuscript

schoolDepartment of Pathology, Rede D’Or/São Luiz Hospital, São Paulo, SP, BrazilRede D’Or/São Luiz HospitalBrazilSão Paulo, SP, BrazilDepartment of Pathology, Rede D’Or/São Luiz Hospital, São Paulo, SP, BrazilschoolSanta Casa de Misericórdia de São Paulo, São Paulo, SP, BrazilSanta Casa de Misericórdia de São PauloBrazilSão Paulo, SP, BrazilSanta Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil

0000-0001-7690-0513

person Nathanael de Freitas Pinheiro Junior

Design · planning of the study · critical review of important intellectual content · approval of the final version of the manuscript

schoolImagepat Anatomia Patológica Ltda, Salvador, BA, BrazilImagepat Anatomia Patológica LtdaBrazilSalvador, BA, BrazilImagepat Anatomia Patológica Ltda, Salvador, BA, Brazil

0000-0003-0691-3006

person Robledo Fonseca Rocha

Design and planning of the study · critial review of importan intellectual content · critical reviw of the literature · approval of the final version of the manuscript

schoolCentro de Ciências da Saúde, Universidade Federal de Roraima, Boa Vista, RR, BrazilUniversidade Federal de RoraimaBrazilBoa Vista, RR, BrazilCentro de Ciências da Saúde, Universidade Federal de Roraima, Boa Vista, RR, BrazilschoolLaboratório de Patologia de Roraima, Boa Vista, RR, BrazilLaboratório de Patologia de RoraimaBrazilBoa Vista, RR, BrazilLaboratório de Patologia de Roraima, Boa Vista, RR, Brazil

0009-0000-0083-8434

Conflicts of interest

None declared.

person∗ Corresponding author.
E-mail:josecandidojr@yahoo.com.br (J.C. Xavier-Júnior).

SCIMAGO INSTITUTIONS RANKINGS

Instituto de Patologia de Araçatuba, Araçatuba, SP, BrazilInstituto de Patologia de AraçatubaBrazilAraçatuba, SP, BrazilInstituto de Patologia de Araçatuba, Araçatuba, SP, Brazil

Faculty of Medicine, Centro Universitário Católico Unisalesiano, Araçatuba, SP, BrazilCentro Universitário Católico UnisalesianoBrazilAraçatuba, SP, BrazilFaculty of Medicine, Centro Universitário Católico Unisalesiano, Araçatuba, SP, Brazil

Postgraduate Program in Pathology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, BrazilUniversidade Estadual PaulistaBrazilBotucatu, SP, BrazilPostgraduate Program in Pathology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil

CEDAP, Centro de Diagnósticos Anátomo-Patológicos, Joinville, SC, BrazilCentro de Diagnósticos Anátomo-PatológicosBrazilJoinville, SC, BrazilCEDAP, Centro de Diagnósticos Anátomo-Patológicos, Joinville, SC, Brazil

Instituto Nacional de Ciência e Tecnologia em Biologia do Câncer Infantil e Oncologia Pediátrica - INCT BioOncoPed, BrazilInstituto Nacional de Ciência e Tecnologia em Biologia do Câncer Infantil e Oncologia PediátricaBrazilBrazilInstituto Nacional de Ciência e Tecnologia em Biologia do Câncer Infantil e Oncologia Pediátrica - INCT BioOncoPed, Brazil

Department of Pathology, Rede D’Or/São Luiz Hospital, São Paulo, SP, BrazilRede D’Or/São Luiz HospitalBrazilSão Paulo, SP, BrazilDepartment of Pathology, Rede D’Or/São Luiz Hospital, São Paulo, SP, Brazil

Santa Casa de Misericórdia de São Paulo, São Paulo, SP, BrazilSanta Casa de Misericórdia de São PauloBrazilSão Paulo, SP, BrazilSanta Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil

Imagepat Anatomia Patológica Ltda, Salvador, BA, BrazilImagepat Anatomia Patológica LtdaBrazilSalvador, BA, BrazilImagepat Anatomia Patológica Ltda, Salvador, BA, Brazil

Centro de Ciências da Saúde, Universidade Federal de Roraima, Boa Vista, RR, BrazilUniversidade Federal de RoraimaBrazilBoa Vista, RR, BrazilCentro de Ciências da Saúde, Universidade Federal de Roraima, Boa Vista, RR, Brazil

Laboratório de Patologia de Roraima, Boa Vista, RR, BrazilLaboratório de Patologia de RoraimaBrazilBoa Vista, RR, BrazilLaboratório de Patologia de Roraima, Boa Vista, RR, Brazil

Figures | Tables

Figures (8)
Tables (1)

Thumbnail

Figure 1 The correct way to store the specimen is using a volume of 10% buffered formalin greater than 10-20 times the volume of the specimen (bottom right image). It is not acceptable to send the material without formalin, in a volume that does not cover the specimen in its entirety or in a volume slightly greater than the volume of the specimen.

Thumbnail

Figure 2 Color variation in melanocytic lesions reflects the location of the melanin pigment in the skin. The schematic drawing shows the correspondence of the colors/tones of melanoma in the dermoscopic examination according to the melanin deposit: black in the stratum corneum, brown in the basal layer of the epidermis, and bluish/gray in the dermis.

Thumbnail

Figure 3 Traumatized nevi are a good example of the need for clinical-pathological correlation. See the panoramic image of a nevus on the thigh of a 44-year-old female patient. The remaining nevus can be seen on the left, the central fibrosis and the dermal inflammatory infiltrate with melanophages on the right (A) Hematoxylin & eosin ×40. In detail, the remaining intradermal nevus and the fibrosis parallel to the direction of the epidermis, Hematoxylin & eosin ×200 (B). In detail, the inflammatory infiltrate with melanophages, Hematoxylin & eosin ×200 (C). Presence of atypical proliferated junctional melanocytes, a common finding in traumatized melanocytic lesions, Hematoxylin & eosin ×400.

Thumbnail

Figure 4 Another example of the importance of anatomical-clinical correlation: intradermal melanocytic nevus removed for aesthetic purposes from a 14-year-old female patient. Panoramic view of the intradermal nevus (A), Hematoxylin & eosin ×40. Melanocytes arranged in nests with maturation to depth (B) Hematoxylin & eosin ×100 and no signs of atypia (C) Hematoxylin & eosin ×200. The presence of atypical deep mitosis in the center of the image, which does not change the diagnosis, Hematoxylin & eosin ×1000.

Thumbnail

Figure 5 Macroscopic image of acral melanoma with a small discontinuous lesion (A) and a large tumor component (B). The identification of satellites/microsatellites/cutaneous metastases influences staging and can occur through detailed macroscopic examination.

Thumbnail

Figure 6 Example of a structured report. It is important to note that some cases do not require notes and services have the autonomy to adapt the structure by inverting the order or merging, for example, microscopy with diagnosis.

Thumbnail

Figure 7 The histological section (Hematoxylin & eosin ×40) shows the primary melanoma in vertical growth (A) and microsatellite (B) in the dermis. The microsatellite is characterized by discontinuous tumor proliferation, adjacent to the main tumor, permeated by normal tissue, without findings of inflammatory infiltrate or fibrosis that could suggest tumor regression.

Thumbnail

Figure 8 The histological section (Hematoxylin & eosin ×40) shows melanoma (A) associated with intradermal melanocytic nevus (B). The melanoma is characterized by nests of atypical melanocytic cells without signs of maturation and exhibiting moderate nuclear pleomorphism (A). Below (B) small melanocytic cells can be observed, scattered throughout the dermis, exhibiting scarce cytoplasm and no cytological atypia.

Thumbnail

Table 1 Summary of recommendations.

imageFigure 1 The correct way to store the specimen is using a volume of 10% buffered formalin greater than 10-20 times the volume of the specimen (bottom right image). It is not acceptable to send the material without formalin, in a volume that does not cover the specimen in its entirety or in a volume slightly greater than the volume of the specimen. open_in_new

imageFigure 2 Color variation in melanocytic lesions reflects the location of the melanin pigment in the skin. The schematic drawing shows the correspondence of the colors/tones of melanoma in the dermoscopic examination according to the melanin deposit: black in the stratum corneum, brown in the basal layer of the epidermis, and bluish/gray in the dermis. open_in_new

imageFigure 3 Traumatized nevi are a good example of the need for clinical-pathological correlation. See the panoramic image of a nevus on the thigh of a 44-year-old female patient. The remaining nevus can be seen on the left, the central fibrosis and the dermal inflammatory infiltrate with melanophages on the right (A) Hematoxylin & eosin ×40. In detail, the remaining intradermal nevus and the fibrosis parallel to the direction of the epidermis, Hematoxylin & eosin ×200 (B). In detail, the inflammatory infiltrate with melanophages, Hematoxylin & eosin ×200 (C). Presence of atypical proliferated junctional melanocytes, a common finding in traumatized melanocytic lesions, Hematoxylin & eosin ×400. open_in_new

imageFigure 4 Another example of the importance of anatomical-clinical correlation: intradermal melanocytic nevus removed for aesthetic purposes from a 14-year-old female patient. Panoramic view of the intradermal nevus (A), Hematoxylin & eosin ×40. Melanocytes arranged in nests with maturation to depth (B) Hematoxylin & eosin ×100 and no signs of atypia (C) Hematoxylin & eosin ×200. The presence of atypical deep mitosis in the center of the image, which does not change the diagnosis, Hematoxylin & eosin ×1000. open_in_new

imageFigure 5 Macroscopic image of acral melanoma with a small discontinuous lesion (A) and a large tumor component (B). The identification of satellites/microsatellites/cutaneous metastases influences staging and can occur through detailed macroscopic examination. open_in_new

imageFigure 6 Example of a structured report. It is important to note that some cases do not require notes and services have the autonomy to adapt the structure by inverting the order or merging, for example, microscopy with diagnosis. open_in_new

imageFigure 7 The histological section (Hematoxylin & eosin ×40) shows the primary melanoma in vertical growth (A) and microsatellite (B) in the dermis. The microsatellite is characterized by discontinuous tumor proliferation, adjacent to the main tumor, permeated by normal tissue, without findings of inflammatory infiltrate or fibrosis that could suggest tumor regression. open_in_new

imageFigure 8 The histological section (Hematoxylin & eosin ×40) shows melanoma (A) associated with intradermal melanocytic nevus (B). The melanoma is characterized by nests of atypical melanocytic cells without signs of maturation and exhibiting moderate nuclear pleomorphism (A). Below (B) small melanocytic cells can be observed, scattered throughout the dermis, exhibiting scarce cytoplasm and no cytological atypia. open_in_new

table_chartTable 1 Summary of recommendations.

Recommendation 1	In the case of suspected melanoma, excisional biopsy with exigous margins (1-3 mm) should be the preferred approach.
Recommendation 2	After removal, the biopsy/surgical specimen should be immediately submerged in an appropriate container containing buffered formalin (10% buffered formaldehyde) in a volume approximately 10 to 20 times the sample size.
Recommendation 3	Clinical information, especially patient age and sex, as well as lesion location and size, are essential data for the accurate microscopic diagnosis of melanocytic lesions.
Recommendation 4	Whenever possible, include all the material sent in case of lesions suspected of melanoma. Clinicians and surgeons are advised to verify whether this recommendation was followed by carefully reading the macroscopy section of the anatomopathological report.
Recommendation 5	Immunohistochemical studies are not essential for the microscopic diagnosis of melanoma, being reserved for selected cases, indicated by the pathologist in the report, often through comments and notes.
Recommendation 6	Perioperative examination is contraindicated for both diagnosis and margin evaluation of melanocytic lesions.
Recommendation 7	Perioperative examination is contraindicated for sentinel lymph node evaluation in cases of cutaneous melanoma.
Recommendation 8	Molecular testing to detect mutations in the BRAF gene is recommended in the scenario of patients with high-risk stage 2, 3 and 4 melanoma, using a sample with adequate neoplastic representation and a molecular technique duly validated by the laboratory.

How to cite

linkcopy

vertical_align_top show_chart

more_horiz close
- image
- translate
- link
- article
- vertical_align_top
- file_download
- show_chart
- image
- translate
- link
- article

location_on

Sociedade Brasileira de Dermatologia Av. Rio Branco, 39 18. and., 20090-003 Rio de Janeiro RJ, Tel./Fax: +55 21 2253-6747 - Rio de Janeiro - RJ - Brazil
E-mail: revista@sbd.org.br

rss_feed Acompanhe os números deste periódico no seu leitor de RSS