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Journal of the American Academy of Dermatology
Volume 71, n° 6
pages 1204-1211 (décembre 2014)
Doi : 10.1016/j.jaad.2014.07.056
accepted : 29 July 2014

Variability in mitotic figures in serial sections of thin melanomas

Stevan R. Knezevich, MD, PhD a, b, , Raymond L. Barnhill, MD e, David E. Elder, MB, ChB, FRCPA f, Michael W. Piepkorn, MD c, g, Lisa M. Reisch, PhD d, Gaia Pocobelli, PhD d, Patricia A. Carney, PhD h, Joann G. Elmore, MD, MPH d
a Veterans Affairs Medical Center, Seattle, Washington 
b Department of Pathology, University of Washington School of Medicine, Seattle, Washington 
c Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington 
d Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington 
e Department of Pathology, University of California at Los Angeles, Los Angeles, California 
f Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania 
g Dermatopathology Northwest, Bellevue, Washington 
h Departments of Family Medicine and Public Health and Preventive Medicine, Oregon Health and Sciences University, Portland, Oregon 

Reprint requests: Stevan R. Knezevich, MD, PhD, Department of Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108.

T1 melanoma staging is significantly affected by tissue sampling approaches, which have not been well characterized.


We sought to characterize presence of mitotic figures across a minimum of 5 sequential sections of T1 melanomas.


A cohort of T1 melanomas with either 5 (single section per slide) or 10 (2 sections per slide) sequential sections (5-μm thickness) per case were prepared and examined for mitotic figures.


In all, 44 of 82 T1 melanomas (54%) were classified as T1b. The number of sections with a mitotic figure present ranged from only 1 of 5 sections (n = 5 of 44 cases, 11.4%) to all 5 (n = 20 of 44 cases, 45.5%). A sequential approach versus a nonsequential approach did not appear to matter.


Cases were taken from a single pathology practice in the Pacific Northwest, which may not generalize to other populations in the United States.


The variation in the presence of mitotic figures within sequential sections supports reviewing 3 to 5 sections to fulfill American Joint Committee on Cancer recommendations. The prognostic significance of a T1b melanoma with a rare mitotic figure on a single section versus a T1b melanoma with mitotic figures on multiple sections deserves more attention to see if further subclassification is possible or even necessary.

The full text of this article is available in PDF format.

Key words : accuracy, American Joint Committee on Cancer TNM staging, mitosis, mitotic rate, reproducibility, T1b, variability

 The National Cancer Institute (R01 CA151306 and K05 CA104699) supported this work.
 Conflicts of interest: None declared.

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