Major Diagnostic Challenges for Pigmented Lesions, with Ashfaq Marghoob, MD

At the Maui Derm NP+PA Fall 2024 conference, 3 experts in the dermatology field and in the diagnosis of pigmented lesions covered their approaches to a wide variety of clinical scenarios related to such lesions, from congenital nevi to metastatic melanoma.

In an interview with the HCPLive team, Ashfaq Marghoob, MD, 1 of the experts in this talk and director of Memorial Sloan Kettering’s regional skin cancer clinic, spoke about the most important diagnostic challenges.

“I spoke on an entity known as the dysplastic nevus, or the atypical mole,” Marghoob said. “It's also known as the large acquired nevus. There still is a lot of controversy that revolves around this entity, and we basically spoke about the morphology of these lesions. The one unifying feature of them is that they tend to be large, larger than 5 millimeters in greatest diameter, and they may have irregular borders and different shades of brown. And sometimes they can mimic the morphology that one sees in melanoma.”

Marghoob noted this as a clinical conundrum in medicine, given that the lesion is benign but can strongly resemble clinical melanoma. He then touched on how clinicians may respond.

“There are different tools, such as dermoscopy, that can assist us in further differentiating between nevus and melanoma,” Marghoob explained. “But what is probably more important is biology and the ability to track these lesions over time to see whether they change, the premise being that a benign lesion is not going to change, whereas a malignant lesion will.”

The morphological overlap with nevus and melanoma is 1 of the major challenges to diagnosis Marghoob noted. He also highlighted the set of tools used to assess lesions—such as confocal microscopy, optical coherence tomography, and others—are geared toward a narrow group of lesions.

“Usually what happens is that your clinical morphology and dermoscopic morphology just don't provide enough assurance between benign and malignant,” Marghoob said. “Enter these new technologies which promise, at least, to improve upon that. But time will tell whether that will actually prove to be true.”

For additional information from Marghoob, view the full interview above. Additional information on subjects like these can be found by viewing our latest conference coverage.

The quotes used in this interview summary were edited for the purposes of clarity.

Marghoob is supported in part through the Memorial Sloan Kettering Cancer Center institutional National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30CA008748.