Biological Sciences Division
Published January 11, 2023 | Version v1
Journal article Open

Revision of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis Classification Schema for Melanocytic Lesions: A Consensus Statement

Creators

  • 1. University of Paris
  • 2. Hospital of the University of Pennsylvania
  • 3. University of Washington
  • 4. Pathology Associates
  • 5. University of California, Los Angeles
  • 6. University of California, San Francisco
  • 7. University Medical Center Utrecht
  • 8. Yale University
  • 9. Memorial Sloan Kettering Cancer Center
  • 10. South Warwickshire NHS Trust
  • 11. Royal Surrey NHS Foundation Trust
  • 12. Harvard University
  • 13. Centre Léon Bérard
  • 14. Northwestern University
  • 15. Sahlgrenska University Hospital
  • 16. Cleveland Clinic
  • 17. Universidade Federal de São Paulo
  • 18. The University of Texas MD Anderson Cancer Center
  • 19. University of Michigan
  • 20. University of Florence
  • 21. Moffitt Cancer Center
  • 22. Emory University
  • 23. University of Chicago

Description

Importance: A standardized pathology classification system for melanocytic lesions is needed to aid both pathologists and clinicians in cataloging currently existing diverse terminologies and in the diagnosis and treatment of patients. The Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) has been developed for this purpose.

Objective: To revise the MPATH-Dx version 1.0 classification tool, using feedback from dermatopathologists participating in the National Institutes of Health-funded Reducing Errors in Melanocytic Interpretations (REMI) Study and from members of the International Melanoma Pathology Study Group (IMPSG).

Evidence Review: Practicing dermatopathologists recruited from 40 US states participated in the 2-year REMI study and provided feedback on the MPATH-Dx version 1.0 tool. Independently, member dermatopathologists participating in an IMPSG workshop dedicated to the MPATH-Dx schema provided additional input for refining the MPATH-Dx tool. A reference panel of 3 dermatopathologists, the original authors of the MPATH-Dx version 1.0 tool, integrated all feedback into an updated and refined MPATH-Dx version 2.0.

Findings: The new MPATH-Dx version 2.0 schema simplifies the original 5-class hierarchy into 4 classes to improve diagnostic concordance and to provide more explicit guidance in the treatment of patients. This new version also has clearly defined histopathological criteria for classification of classes I and II lesions; has specific provisions for the most frequently encountered low-cumulative sun damage pathway of melanoma progression, as well as other, less common World Health Organization pathways to melanoma; provides guidance for classifying intermediate class II tumors vs melanoma; and recognizes a subset of pT1a melanomas with very low risk and possible eventual reclassification as neoplasms lacking criteria for melanoma.

Conclusions and Relevance: The implementation of the newly revised MPATH-Dx version 2.0 schema into clinical practice is anticipated to provide a robust tool and adjunct for standardized diagnostic reporting of melanocytic lesions and management of patients to the benefit of both health care practitioners and patients.

Notes

Due to the large number of authors, only the first 20 and the University of Chicago authors are included on the above author list. Please download the article for the complete list of authors.

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Additional details

Identifiers

DOI
10.1001/jamanetworkopen.2022.50613
Other
oai:uchicago.tind.io:11246

Funding

National Cancer Institute
R01 CA201376
National Cancer Institute
R35CA220481
Melanoma Research Alliance
622600
Office of the Assistant Secretary of Defense for Health Affairs
Melanoma Research Program

UChicago Information

Division(s)
Biological Sciences Division
Department(s)
Medicine