ESP, EORTC, and EURACAN Expert Opinion: practical recommendations for the pathological diagnosis and clinical management of intermediate melanocytic tumors and rare related melanoma variants

Virchows Arch. 2021 Jul;479(1):3-11. doi: 10.1007/s00428-020-03005-1. Epub 2021 Jan 12.


The recent WHO classification of skin tumors has underscored the importance of acknowledging intermediate grade melanocytic proliferations. A multistep acquisition of oncogenic events drives the progressive transformation of nevi into melanomas. The various pathways described are modulated by the initial oncogenic drivers that define the common, blue, and Spitz nevi groups. Intermediate lesions are most often the result of a clonal evolution within such nevi. Based on this established classification, we have suggested for each pathway a practical diagnostic approach, benefiting from the recently developed molecular tools, both in the setting of general pathology labs and expert centers. Moreover, recommendations regarding the re-excision and clinical follow-up are given to support decision-making in multidisciplinary tumor boards.

Keywords: BAP-1 inactivated nevus; Deep penetrating nevus; Intermediate melanocytic tumors; MELTUMP; Melanocytoma; Melanoma variants; Pigmented epithelioid melanocytoma; Spitz tumors.

MeSH terms

  • Adult
  • Biomarkers, Tumor / genetics*
  • Cell Proliferation*
  • Clinical Decision-Making
  • Decision Support Techniques*
  • Female
  • Genetic Predisposition to Disease
  • Humans
  • Infant
  • Male
  • Melanocytes / pathology*
  • Melanoma / genetics*
  • Melanoma / pathology
  • Melanoma / surgery
  • Middle Aged
  • Molecular Diagnostic Techniques*
  • Neoplasm Grading
  • Nevus, Pigmented / genetics*
  • Nevus, Pigmented / pathology
  • Nevus, Pigmented / surgery
  • Phenotype
  • Predictive Value of Tests
  • Skin Neoplasms / genetics*
  • Skin Neoplasms / pathology
  • Skin Neoplasms / surgery


  • Biomarkers, Tumor