Giuseppe Argenziano, Giulia Briatico, Eugenia Veronica Di Brizzi, Camila Scharf, Gabriella Brancaccio, Elvira Moscarella, Maria Maddalena Nicoletti, Pasquale Verolino, Aimilios Lallas, Harald Kittler
ABSTRACT
Introduction: The recent WHO classification of melanocytic tumors introduces a refined molecular and histopathological framework suggesting distinct pathways and precursor lesions for all melanoma subtypes. While conceptually appealing, its clinical applicability is increasingly questioned.
Objectives: This review critically examines the transformation theory from benign nevi to melanoma, highlighting inconsistencies between the proposed models and real-life practice.
Methods: Through illustrative cases and key epidemiological evidence, we evaluated the validity of current models proposing intermediate lesions in melanoma development.
Results: We argue that most melanomas arise de novo and that the so-called intermediate lesions, such as dysplastic nevi and atypical Spitz tumors, may mimic melanoma but are not true biological precursors.
Conclusions: We propose a simplified, clinically oriented reclassification of melanocytic lesions based on morphologic ambiguity and actual behavior, aiming to guide therapeutic decisions and reduce di-agnostic overinterpretation.
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