Pathology of Melanocytic Nevi and Melanoma

656 Pages·2014·83.066 MB·English

by  Raymond L. Barnhill, Michael W. Piepkorn, Klaus J. Busam (eds.)

Pathology of
Melanocytic Nevi
aanndd MMeellaannoommaa
Raymond L. Barnhill
Editor in Chief
Michael Piepkorn
Klaus J. Busam
Editors
Third Edition
123
Pathology of Melanocytic
Nevi and Melanoma

Raymond L. Barnhill
Editor-in-Chief
Michael W. Piepkorn (cid:129) Klaus J. Busam
Co-Editors
Pathology
of Melanocytic Nevi
and Melanoma
Editors
Raymond L. Barnhill Klaus J. Busam
Department of Pathology Department of Pathology
and Laboratory Medicine Weill Medical College of Cornell
David Geffen School of Medicine at the University and Memorial
University of California, Los Angeles Sloan-Kettering Cancer Center
and Jonsson Comprehensive Cancer New York , NY
Center USA
Los Angeles , CA
USA
Michael W. Piepkorn
Division of Dermatology
Department of Medicine
School of Medicine
University of Washington
Seattle , WA
USA
ISBN 978-3-642-38384-7 ISBN 978-3-642-38385-4 (eBook)
DOI 10.1007/978-3-642-38385-4
Springer Heidelberg New York Dordrecht London
Library of Congress Control Number: 2013956432
© Springer-Verlag Berlin Heidelberg 2014
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To Claire
To my family
In gratitude to Vinita, Jonathan, and Sophia

Foreword I
M elanoma is currently viewed by many as an important public health issue.
The development of melanoma is an illustration of the interplay between the
deleterious effects of the environment, individual life styles, and genetics in
the onset of disease. Fortunately, patients now benefi t from the most advanced
combinations of immunotherapy and chemotherapy. Yet, there is still consid-
erable controversy and uncertainty surrounding the classifi cation and patho-
biology of melanoma, particularly with respect to the mechanisms of tumor
cell dissemination and the development of metastases. In addition, despite the
signifi cant progress achieved to date, reliable biomarkers for the identifi ca-
tion of individuals at risk for early disease and for the classifi cation of lesions
have yet to be discovered and validated. The identifi cation of the specifi c
melanocytic lesions most apt to disseminate and the ability to predict the
routes of tumor cell dissemination are a major focus of current research.
Thus, accurate histopathological evaluation of melanocytic lesions and mela-
nomas is clearly critical to translational medicine and its goals of linking the
latest advances in science to the improved care of patients.
A dditionally, we have now, practically speaking, entered into the era of
personalized medicine. This fi eld of medicine, as appealing and interesting as
it may be, has remained over the past years an elusive promise. There is now
solid evidence that shows that host response pattern-derived diagnostic tests
help predict the effi cacy of given therapies and the expected tolerance to
treatment. Biomarkers, at the heart of clinical management, are going through
a shift, from unique to multiple markers used in combination. A variety of
technologies has become available for their identifi cation, yet the integration
of multi-parameter results still remains a major challenge. Although much
work has been done to identify biomarkers of clinical utility in melanoma,
such studies have been hampered by the failure of individual biomarkers to
provide signifi cant prognostic information.
It is increasingly clear that science and technology may be fated to the
mere reporting of discoveries without relevance, unless they begin to rely on
precise and carefully updated pathological and clinical correlations. Indeed,
correlating scientifi c results with the exact phenotype of patients is the key
driver for the success of modern and personalized medicine. As an interesting
example, the histopathologic fi nding of angiotropism of melanoma cells has
been emphasized for more than a decade by Raymond Barnhill as a marker
for extravascular migration of melanoma cells and potentially for metastasis.
In any case, currently the single best indicator of prognosis for patients with
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viii Foreword I
invasive melanoma is the tumor stage at fi rst clinical presentation, i.e., the
clinical and histological criteria that form the basis for the current staging
system in melanoma.
Raymond Barnhill is a recognized world expert pathologist (and derma-
tologist) for melanoma, and he is also a pioneer researcher in melanoma
metastasis research. This triple expertise provides him with the perfect skills
for writing a comprehensive textbook on the pathology of melanoma.
In this context, this third edition of Raymond Barnhill’s Pathology of
Melanocytic Nevi and Melanoma provides, in a single textbook, a most com-
prehensive, modern and up-to-date view of this subject. Extremely well writ-
ten, it compiles notable contributions by leading experts in histopathology,
dermatology, and pathogenesis. As a reference work, it supplies pathologists,
clinicians, and basic scientists with the information they require to carry out
their studies and establish meaningful correlations. Finally, students will rely
on it as a valuable educational tool for use as a comprehensive summary of
this major fi eld of medicine.
Paris, France Christian Bréchot
Directeur Général de l’Institut Pasteur
Foreword II
Over the past 50 years, our understanding of melanocytic pathology has
expanded dramatically, but its subtleties and complexities remain. The fi eld is
now being rendered even more complex by new discoveries in molecular
pathology.
A s a surgical trainee in the early 1970s, I spent a 6 month term in the
Pathology Department of the Royal Prince Alfred Hospital in Sydney. My
mentor was Professor Vincent McGovern, who was by then already acknowl-
edged internationally as a leader in the fi eld of melanocytic pathology. Back
then I did not realise what an infl uence this experience was to have on my
subsequent career as a surgical oncologist, and eventually as the Director of
Melanoma Institute Australia (formerly the Sydney Melanoma Unit), one of
the largest dedicated melanoma treatment and research centres in the world.
Thanks to that experience with Professor McGovern I have always been very
conscious of the critically important role of pathologists in planning the ratio-
nal management of patients with malignant disease.
Raymond Barnhill, a contemporary international leader in the fi eld of
melanocytic pathology, together with Michael W. Piepkorn and Klaus Busam,
has produced a third edition of what is now a classic monograph on the
pathology of melanocytic naevi and melanoma. Its stated goal is to provide a
comprehensive, practical description of melanocytic lesions of the skin, in
order to facilitate the provision by physicians of the best possible care for
their patients. Drawing on their vast experience, Dr. Barnhill and his two col-
leagues, with input from other internationally prominent pathologists, pro-
vide a detailed, orderly and easily understood outline of the pathology of
benign and malignant melanocytic skin lesions, relating their pathologic fea-
tures to their clinical appearances and behaviour.
This monograph will be of enormous value to dermatopathologists, gen-
eral pathologists, clinical dermatologists, surgeons, and others who treat skin
malignancies. Diffi cult diagnostic problems are not shirked, but are lucidly
and rationally discussed in a way that provides practical guidance for the
pathological interpretation of atypical or borderline melanocytic lesions.
This book will also be a considerable resource for the better understanding
of the biology and pathological features of benign and malignant melanocytic
skin lesions, and to the provision of better treatment options for patients.
Sydney, Australia John Thompson, MD
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