The following communication summarizes the proceedings of a one-day International Workshop focusing on the histology of benign melanocytic nevi. Areas of controversy identified in 6 focus sessions were the nomenclature and relationships among common nevi including nevi with halo reactions, traumatized nevi, \"dysplastic\" nevi, and nevi from particular anatomic sites; developmental biology and frequency of malignant transformation associated with congenital nevi; the characterization and biologic nature of atypical spitzoid neoplasms; the basic definition of particular melanocytic cellular phenotypes, and the nomenclature and biologic nature of many candidate blue nevi, combined nevi, and other controversial lesions such as deep penetrating nevus and pigmented epithelioid melanocytoma. Concentrated data collection and follow-up, molecular characterization, and future consensus Workshops may facilitate the resolution of some of these problems. The Group recommended the description of ambiguous or \"borderline\" lesions as tumors with indeterminate or uncertain biologic/malignant potential. The participants also advised that such lesions at a minimum should be managed by complete excision with clear surgical margins.

Subungual melanoma (SUM) is an uncommon variant of melanoma that is often difficult to diagnose, both clinically and pathologically. In an attempt to provide pathologic clues to diagnosis, especially in early lesions or small biopsies, and to provide practical advice to pathologists in reporting, the clinicopathologic features of 124 cases of SUM were reviewed, the largest series reported to date. The features of 28 cases of subungual melanoma in situ (MIS), comprising 4 cases of MIS and 24 cases where areas of MIS were present adjacent to dermal-invasive SUMs, were compared with those of a similar number of acral nevi to identify useful distinguishing features. The median age of the patients was 59 years and the most common site was the great toe (24%). Nine percent of cases were AJCC stage 0, 14% were stage I, 41% were stage II, 32% were stage III, and 4% were stage IV at initial diagnosis. The commonest histogenetic subtype was acral lentiginous (66%), followed by nodular (25%) and desmoplastic (7%). The majority of tumors were locally advanced at presentation with 79% being Clark level IV or V. The median Breslow thickness was 3.2 mm. The median mitotic rate was 3 per mm and 33% of cases demonstrated primary tumor ulceration. Seven of 29 patients (24%) who underwent a sentinel lymph node biopsy had nodal disease. Multivariate Cox-regression analysis showed higher disease stage to be the only significant predictor of shortened survival. In comparison to acral nevi, MIS more frequently showed lack of circumscription, a prominent lentiginous growth pattern, predominance of single cells over nests, moderate-to-severe cytologic atypia, a dense and haphazard pagetoid intraepidermal spread of melanocytes, and the presence of junctional/subjunctional lymphocytes (\"tumor infiltrating lymphocytes\"). Tumor infiltrating lymphocytes have not been highlighted previously as a feature of subungual MIS and represent a useful diagnostic clue. Guidelines for the reporting of SUMs are also presented. Knowledge and recognition of the pathologic features of SUMs and the important features that distinguish them from nevi should reduce the frequency of misdiagnosis.

Melanoma of the skin is an increasingly common tumour, which often has a slow early growth rate during which curable lesions may be detected and removed. Physicians therefore have the potential to reduce mortality and this guideline is intended to promote early diagnosis of melanoma. The majority of melanomas occur in white-skinned people. The most common risk factors are pale sun-sensitive skin and the presence of increased numbers of melanocytic naevi (moles). Melanoma is more common in women than men; the mean age of onset is 50 years; and a fifth of cases occur in young adults. In the UK population the most common sites are on the lower leg in women, and on the back in men. The predictors of melanoma are progressive change in the shape, size and colour of moles. This guideline provides a series of photographs of moles, melanomas and other skin lesions, which may resemble melanomas.

BACKGROUND: Reflectance confocal microscopy (RCM) has been used for over 10 years for in vivo skin imaging. However, to date no standard RCM terminology has been published.
OBJECTIVE: To establish a glossary of terms for RCM evaluation of melanocytic lesions.
METHODS: Prominent RCM researchers were presented with RCM images of melanocytic lesions. Reviewers evaluated RCM images for image quality, lesion architecture, and cellular details. Reviewers could utilize published descriptors or contribute unpublished terminology to describe lesion attributes. An online meeting was conducted to reach consensus that integrates and defines existing and new RCM descriptive terms.
RESULTS: We present a glossary with descriptors of image quality, normal skin morphology, lesion architecture, and cellular details for RCM evaluation of melanocytic lesions.
CONCLUSIONS: Usefulness of the glossary in RCM diagnosis of melanocytic lesions needs to be assessed.
CONCLUSIONS: Standardization of terminology is important toward implementation of RCM in the clinical setting.

OBJECTIVE: 1. The Guideline for the Management of Melanoma has been developed in an attempt to improve management through the process of locating the best available evidence on which to base decisions. It is expected to help to improve the quality of care. 2. Melanoma remains a common cancer in South Africa. Despite the achievement of earlier diagnosis, it would appear from current statistics that at least 850 people continue to die of melanoma each year. Many of these deaths occur at a younger age than for other solid tumours, so the number of years of life lost due to melanoma exceeds that of many other cancers. It is seen as imperative to maximise effective management of melanoma. 3. Prevention of melanoma has not yet been achieved, and there are no conclusive data to show that current promotion of sun avoidance has substantially altered its incidence. 4. Early detection is an important factor in melanoma management, with diagnosis based mainly on changes in colour, diameter, elevation and border (irregularity of outline) of a skin lesion, asymmetry of a lesion, or a lesion different from other naevi. People at high risk of melanoma should be offered a surveillance programme.
CONCLUSIONS: 1. All clinicians should be trained in the recognition of early melanoma. 2. If there is doubt about a lesion, the patient should be referred for specialist opinion (if readily available) or a biopsy should be undertaken. Biopsy of a pigmented lesion should be done only on the basis of suspicion of melanoma. Excision with a 2 mm margin is adequate. 3. Prophylactic excision of benign naevi is not recommended. In general, elective lymph node dissection is not indicated. 4. People with high-risk primary melanoma, lymph node involvement and melanoma in unusual sites (e.g. mucosal and disseminated melanoma) should be managed with support from a melanoma centre.
RESULTS: Melanoma management involves many medical specialties. Guidelines should therefore be developed through a multidisciplinary consensus. The Melanoma Advisory Board consists of a forum of dermatologists, oncologists, plastic surgeons and pathologists.

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