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. Author manuscript; available in PMC: 2022 Feb 8.
Published in final edited form as: J Am Acad Dermatol. 2019 Dec 17;82(6):1435–1444. doi: 10.1016/j.jaad.2019.12.020

Figure 2: Two Examples of Melanoma In Situ Glass Slide Biopsies evoking High and Low Variability in Treatment Suggestions by the Study Participants.

Figure 2:

Both cases were diagnosed as melanoma in situ by consensus panel and 17 out of 18 pathologists. For Case A, 29% of participating pathologists suggested a lower treatment (<0.5cm) and 18% suggested a higher treatment (≥ 1cm margin) than NCCN guidelines, showing relatively large variability in treatment suggestions. Case A is relatively small (~4mm) and does not have an obviously atypical melanocytic proliferation at low magnification. Higher magnification allows the identification of a poorly circumscribed intraepidermal melanocytic proliferation. In contrast, Case B had a smaller proportion of pathologists (12%) rendering a treatment suggestion lower than NCCN guidelines, and no pathologists suggested a higher treatment than NCCN guidelines. Case B is a larger lesion (~8mm) that more readily is identifiable as an atypical lentiginous and nested proliferation with pagetoid scatter.