Diagnostic pitfalls have been widely documented on atypical naevi, a group of pigmented lesions that occupy a grey portion between benign and malignant variants. As malignant melanoma is associated with a high mortality rate it is vital we have a reliable diagnostic testing method for these challenging lesions. A pilot study was proposed using dual immunohistochemistry staining with a new depth measurement, the Lancaster depth, to develop a validating tool to measure difficult atypical lesions against. The Lancaster depth was recorded for 68 pigmented lesions; 34 benign and 34 malignant, where measurement was taken from the granular layer to the deepest HMB-45/Ki67 dual stained melanocyte. This measurement was compared against the established Breslow depth measurement where the distance between the two was of interest. The mean malignant Lancaster depth at 1.51mm was higher than that of the benign at 0.12mm. There was a statistically significant difference of 1.40mm, P = <.001. There was a statistically significant difference between the mean Lancaster and Breslow depths in both malignant and benign lesions. In the malignant group this was 0.28mm, P = <.001 compared to the benign which was 1.07mm, P = <.001. A narrow distance ratio between the two depths indicated a malignant diagnosis. A wider distance ratio was indicative of a benign diagnosis. As a diagnostic validator the Lancaster depth shows promises but has limitations as a standalone model. Working in conjunction with the Breslow depth we potentially have a useful adjunct to accurately diagnose difficult atypical lesions.
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