A. Neil Crowson, M.D.
University of Oklahoma and
Regional Medical Laboratories
Tulsa, OK

The 2005 Long Course aims to update pathologists on important advances in the field of epidermal neoplasms and neoplastic mimics that have occurred over the past several decades; the emphasis will be on difficult areas that are prone to misinterpretation. The skin was last a topic of the Long Course in 1986, and that course was limited to a discussion of melanocytic proliferations. Keratinocytic neoplasms have not been addressed in a Long Course since 1967.

The morning session begins with a brief historical overview of the pathology of the skin, noting the major expansion in our understanding and classification of these tumors in the past decades. Consideration is then given to a discussion of potential precursor lesions, followed by benign and atypical appearing melanocytic nevi. These discussions will both emphasize diagnostic criteria and features enabling accurate distinction from cutaneous melanoma. Attention will then be directed to a review of the diagnostic features of melanoma, the most deadly of all cutaneous neoplasms. This session will highlight the heterogeneous appearances of these tumors. The next session will emphasize unusual subtypes of melanoma that are frequently missed in clinical practice, again concentrating on diagnostic criteria and biologic behavior of these neoplasms. The morning session will conclude with a discussion of the role of sentinel node biopsy in the treatment of cutaneous melanoma, and the role of the pathologist in appropriately processing and interpreting these tissue specimens. This presentation will also address updated information regarding the pathologic microstaging of melanomas.

The afternoon session begins with a discussion of cutaneous squamous cell carcinomas, concentrating on the diagnostic criteria for precursor lesions, followed by a discussion of common squamous cell carcinomas and more aggressive histologic subtypes. This presentation will include a brief discussion of molecular aberrations, presumed pathogenetic mechanisms, and prognostic indicators. It will be followed by a presentation of malignant appendageal neoplasms. While uncommon, these tumors are frequently misinterpreted and may be associated with high metastatic potential. This talk will be followed by a review of basal cell carcinomas, concentrating on the underlying molecular biology leading to their formation, morphologic differences and the correlation of these differences with differences in biologic behavior. The penultimate presentation will address medicolegal aspects of cutaneous neoplasia, one of the most frequently contested areas for the practicing pathologist. A final summation session will cast an eye on the future of the pathologist in diagnosing and prognosticating cutaneous neoplasms.

AGENDA

Morning: Melanocytic Neoplasia

Introduction: Historical Perspective - Bruce R. Smoller, M.D., University of Arkansas School for Medical Sciences, Little Rock, AR

Precursors to melanoma and their mimics: nevi of peculiar anatomic sites - David Elder, M.B., Ch.B., F.R.C.P.A., University of Pennsylvania Health System, Philadelphia, PA

The atypical Spitz nevus; low and high - risk Spitz tumors and Spitzoid melanomas - Raymond Barnhill, M.D., University of Miami School of Medicine, Miami, FL

The essential diagnostic criteria for melanoma - Bruce R. Smoller, M.D., University of Arkansas School for Medical Sciences, Little Rock, AR

Unusual melanoma variants : nevoid, animal type, and desmoplastic melanoma - Cynthia M. Magro, M.D., Ohio State University College of Medicine, Columbus, OH

Prognostic microstaging of melanoma: the essentials of the pathology report and the sentinel lymph node - A. Neil Crowson, M.D., University of Oklahoma and Regional Medical Laboratories, Tulsa, OK

Afternoon: Epidermal and Adnexal Neoplasia

Squamous cell carcinoma: the spectrum from precursors to aggressive variants - Bruce R. Smoller, M.D., University of Arkansas School for Medical Sciences, Little Rock, AR

Malignant adnexal neoplasms - Martin C. Mihm, Jr., Massachussets General Hospital, Harvard University, Boston, MA

Basal cell carcinoma: biology, morphology and clinical implications - A. Neil Crowson, M.D. University of Oklahoma and Regional Medical Laboratories, Tulsa, OK

Medicolegal aspects of neoplastic dermatopathology: risk management based on real case scenarios - Steven R. Tahan, M.D., Beth Israel Deaconness Medical Center, Harvard University, Boston, MA

Concluding remarks - A. Neil Crowson, M.D. University of Oklahoma and Regional Medical Laboratories, Tulsa, OK