Main histopathological difficulties in diagnosing atypical melanocytic proliferations using MPATH-Dx V2…

Cohort studyPathology· Apr 2026

Main histopathological difficulties in diagnosing atypical melanocytic proliferations using MPATH-Dx V2: impact on patient management based on 6006 files referred for second opinions.

Fanny Beltzung, Rémi Vergara, Marie-Laure Jullie … Béatrice Vergier

DermatopathologyCohort studyDiagnosisQ1IF 1.9

Invasive thick melanomas mimicking a naevus made up half of class IV melanoma second opinions

Main histopathological difficulties in diagnosing atypical melanocytic proliferations using MPATH-Dx V2: impact on patient management based on 6006 files referred for second opinions.

Fanny Beltzung … Béatrice Vergier

Pathology · Apr 2026 · Q1 in Pathology

Background

Diagnosing atypical melanocytic proliferations (atypical melanocytic proliferations) is histologically challenging, and hence, these cases are referred to expert dermatopathologists for second opinions.

Methods

Our study retrospectively analysed 6006 atypical melanocytic proliferations referred for second opinions over 13 years (the largest series to date), classifying them into the four Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis version 2.0 (MPATH-Dx-V2.0) classes.

n = 6006 AMPs

50%

Results

50%

half of aggressive class IV melanomas looked deceptively benign, like a naevus

n = 6006 AMPs

More results

MPATH-Dx-V2.0 does not supplant existing nomenclature/classifications but is a complementary tool (based on the probabilistic tumour-progression risk) enabling clinicians to better prioritise problems and assess their impact on patient management.

More results

We propose a step-by-step integrative methodology using the 5th World Health Organization and MPATH-Dx classifications.

MPATH-Dx classes I and II (76.4%), which carry favourable prognoses, presented the most frequent diagnostic problems.

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Conclusion

We propose a step-by-step integrative methodology to interpret atypical melanocytic proliferations, aiming to optimise patient management by enhancing non-pathologists' understanding of diagnostic terminology.

Main histopathological difficulties in diagnosing atypical melanocytic proliferations using MPATH-Dx V2: impact on patient management based on 6006 files referred for second opinions.

Main histopathological difficulties in diagnosing atypical melanocytic proliferations using MPATH-Dx V2: impact on patient management based on 6006 files referred for second opinions.

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