American Society of Dermatopathology

View all recommendations from this society

October 17, 2018

Do not perform diagnostic cytogenetic analysis on a lesion from an adult patient when the histopathology is definitive for a melanoma.

Histologic examination is currently the gold standard in the diagnosis of melanocytic lesions. Cytogenetic analysis can serve as an adjunct test when a definitive diagnosis cannot be rendered on histologic grounds, but should not be used when a diagnosis can be made unequivocally by histologic examination.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Society of Dermatopathology (ASDP) is committed to improving the quality of lives by continually advancing the theory and practice of dermatopathology. In 2015, under the vision of the then Society President, Dr. Dirk Elston, the Appropriate Use Criteria (AUC) Task Force was created to help guide dermatopathologists and inform their clinical colleagues in their use of ancillary studies performed in dermatopathology in specific clinical scenarios with overarching goal of producing high quality care, lowering costs and ensuring efficient use of laboratory resources. The Task Force identified ancillary studies performed in dermatopathology encompassing four broad areas in which AUC could be developed. These include: lymphoproliferative, melanocytic, soft tissue, and other, which includes entities that do not fit into one of the aforementioned groups. Using the methodology developed by RAND/ UCLA, which combines best scientific evidence with expert opinion to develop patient-centered guidelines (appropriateness ratings), the Task Force explored 12 ancillary studies used in dermatopathology and 211 clinical scenarios that are commonly encountered in dermatopathology. The Task Force was transitioned to a standing Committee in 2017, and along with working on dissemination of the developed AUC, the committee identified areas, which have a potential for misuse and are supported by evidence, which could be converted into recommendations for the Choosing Wisely Campaign. The recommended list was reviewed and approved by the ASDP Ethics Committee and Board of Directors.

Sources

Emanuel PO, Andea AA, Vidal CI, et al. Evidence behind the use of molecular tests in melanocytic lesions and practice patterns of these tests by dermatopathologists. J Cutan Pathol. 2018 Jul 24. [Epub ahead of print]

Lang UE, Yeh I, McCalmont TH. Molecular Melanoma Diagnosis Update: Gene Fusion, Genomic Hybridization, and Massively Parallel Short-Read Sequencing. Clin Lab Med. 2017 Sep;37(3):473-484.

Vidal CI, Armbrect EA, Andea AA, et al. Appropriate Use Criteria in Dermatopathology: Initial Recommendations from the American Society of Dermatopathology. J Cutan Pathol. 2018 Aug;45(8):563-580 (full version) and J Am Acad Dermatol. 2018 Apr 21. [Epub ahead of print] (abbreviated version) [co-published].