Rethinking Melanocytic Tumors: A Critical Appraisal of the WHO Classification and the Myth of Nevus-to-Melanoma Progression

Giuseppe Argenziano; Giulia Briatico; Eugenia Veronica Di Brizzi; Camila Scharf; Gabriella Brancaccio; Elvira Moscarella; Maria Maddalena Nicoletti; Pasquale Verolino; Aimilios Lallas; Harald Kittler

doi:10.5826/dpc.1504a6994

Rethinking Melanocytic Tumors: A Critical Appraisal of the WHO Classification and the Myth of Nevus-to-Melanoma Progression

Authors

Giuseppe Argenziano Dermatology Unit, University of Campania, Naples Italy
Giulia Briatico Università degli Studi L. Vanvitelli
Eugenia Veronica Di Brizzi Dermatology Unit, University of Campania, Naples Italy
Camila Scharf Dermatology Unit, University of Campania, Naples Italy
Gabriella Brancaccio Dermatology Unit, University of Campania, Naples Italy
Elvira Moscarella Dermatology Unit, University of Campania, Naples Italy
Maria Maddalena Nicoletti Dermatology Unit, University of Campania, Naples Italy
Pasquale Verolino Dermatology Unit, University of Campania, Naples Italy
Aimilios Lallas Second Dermatology Department, Aristotle University of Thessaloniki, Greece
Harald Kittler Department of Dermatology, Medical University of Vienna, Vienna

Keywords:

melanocytic tumors, dysplastic nevus, WHO classification, nevus-to-melanoma progression, dermoscopy, diagnostic gray zone

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 diagnostic overinterpretation.

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